Prison mental health services supporting one prisoner in seven, finds new report

3 April 2023

One prisoner in seven is getting support from mental health services, rising to more than one in four among women in custody, according to a survey report published today by Centre for Mental Health.

The report, Prison mental health services in England, 2023, is based on a survey of three-quarters of prisons in England, commissioned by NHS England. It finds that more than 7,700 people in the prisons surveyed were receiving support from a mental health service while in custody.

The most common mental health needs were depression and anxiety, but many prisoners had multiple and complex needs for support. Almost 40% of people using prison mental health services also had substance use problems. More than half had histories of self-harm and 40% had attempted suicide.

The report finds that a quarter of people waiting for a transfer to hospital spent more than 28 days waiting for an assessment or a bed under the Mental Health Act.

Most prisons do not employ someone with mental health expertise to carry out screening at reception. This means many people’s needs may be missed when they arrive in prison.

Prison mental health services vary widely between regions in England in terms of their resourcing and workforce. Children in custody tend to get more intensive mental health support than adults. Young people moving to the adult estate therefore face a potential ‘cliff-edge’ in the support available to them.

More than a quarter of prisoners receiving mental health support were due to be released within a year. It is vital that they get effective support ‘through the gates’, including from NHS England’s new RECONNECT services.

Prison mental health services in England, 2023 says that more mental health trained staff should be involved in screening processes. Prison mental health services should also be more consistently staffed, with a range of professionals with expertise across different disciplines.

The report recommends that the Government goes ahead with its plan to amend the Mental Health Act so that no one waits more than 28 days for a transfer to hospital. For this to happen, the process for transfers to take place must be reformed to prevent multiple assessments and refusals of beds to people needing urgent care.

The report also calls for more ‘through the gates’ mental health support when people leave prison. This should include support with housing, employment and benefits.

Report author Dr Graham Durcan said: “The vast majority of prisoners have at least one mental heath difficulty, and many have multiple and complex needs. Prison mental health services have come a long way since the NHS took responsibility for them two decades ago. They are working with more than 7,000 people at a time and providing a range of services for people who face significant risks and vulnerabilities.

“It is vital that every prison has access to high quality mental health support, with multi-disciplinary teams to meet people’s needs fully. This must be backed up by speedy transfers to hospital when someone needs urgent care, and by effective mental health support in the community when prisoners are released.”

Kate Davies, Health and Justice Director at NHS England, said: “We welcome this report and remain committed to reducing the health inequalities faced by patients in health and justice settings. An important driver for this is ensuring that we have mental health services that provide holistic care and support to meet the needs of some of the most vulnerable patients in society. As part of this, we are refreshing the mental health service specification for health and justice settings, which is being rolled out across England, along with the RECONNECT service, which is on target to achieve 100% coverage of English prisons. Together with our justice partners, we are also collaborating on our response to the impact and implementation of the Mental Health Act changes to support the safe and timely transfer of patients to the appropriate services.”

Download the report

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