By Kate Davies CBE
We welcome this publication detailing findings from the consultation and review of prison mental health carried out by Centre for Mental health over the summer of 2020. The timing of this work coincided with the COVID-19 pandemic and restriction of movement across the country. We are grateful that Centre for Mental Health was able to adapt its engagement process allowing partners and stakeholders to take part. The timing enabled the inclusion of COVID-19 as a factor on the health and wellbeing of people in prison and allowed us to gain some early insight into the impact that wave one was having in our prisons.
It is reassuring to read that much of mental health provision in our prisons is working well. However, there are gaps that still need much attention, which we are progressing work on. This includes improving reception and secondary health screenings to ensure that everyone receives a secondary health screen within seven days of arriving in prison. This is essential in identifying all long-term health needs, including mental health.
The COVID-19 pandemic highlighted many inequalities particularly within communities experiencing racial inequality
We are also getting smarter in how we use data and technology; the use of telemedicine over the past 12 months has seen many benefits and it is important that we build upon this. We are exploring how telemedicine can be used to improve engagement and continuity of care with substance misuse and mental health services for prison leavers. Data and technology need to work for us to improve our services and for our patients to have confidence that the information they share is being used to ensure that care is delivered effectively and seamlessly. This will start with the commission of a mental health needs assessment already referred to in this paper that will provide a baseline of current need, provision and unmet mental health need within our prisons. Work has commenced to improve how strategic reporting can be used both nationally and regionally to monitor performance of prison mental health services including delays in mental health transfers, number of people receiving interventions and those people with serious mental illness that have received an annual health check.
The COVID-19 pandemic highlighted many inequalities particularly within communities experiencing racial inequality. This report highlights the need for more information about the health needs and experiences of this population in prison. We need to better understand their needs and tailor services to meet them with cultural sensitivity whilst not limiting our approach through the lens of race and ethnicity only, but to recognise the importance of intersectionality and its role in preventing further marginalisation.
Mental health promotion and ill health prevention is as important as treatment and intervention
The 2011 Cross Governmental strategy No health without mental health has long been superseded, but the message remains the same and we will not be satisfied until we are assured that people in prison receive mental health care that is equitable with both physical health and with community care, and that we have eradicated all unwanted variability between prisons across England. Ensuring consistency of NHS mental health services in all prisons to meet increased needs is essential to achieving this. Mental health promotion and ill health prevention is as important as treatment and interventions, and we are working alongside our partners in HMPPS and Public Health England to share best practice from each organisation, trial new ways of joint working and to provide advice or recommendations to solve emerging issues to promote mental wellbeing. Central to this is our ongoing work with those who have lived experience, along with enhancing clinical, trauma informed and therapeutic services and peer support.
2021 sees the publication of this paper alongside other complementary publications which provides a real opportunity to focus on the mental health and wellbeing of those in our prisons and immigration removal centres. The publication of the Transfer and Remission of prisoners under the Mental Health Act 1983 good practice guidance by NHS England and NHS Improvement details the new time frames outlined in the White Paper ‘Reforming the Mental Health Act’, published in January. It includes other welcome, yet stretching recommendations for Part III of the Act such as the use of prison as a ‘place of safety’. These documents, together with the NHS Long-Term Plan and the development of place based care, will provide the direction of movement for ongoing improvements in the mental health and wellbeing of our prison populations.
Kate Davies CBE is Director of Health and Justice, Armed Forces and Sexual Assault Services Commissioning at NHS England and NHS Improvement