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Waiting for too long: the urgent need for health and justice reform

19 February 2024
By Andy Bell
Andy Bell

The first few weeks of 2024 has seen the publication of numerous reports about the wellbeing of prisoners in England and Wales. They present a picture of a system that is struggling to cope, putting the wellbeing of both prisoners and staff members at considerable risk.

From inspectorate reports about individual prisons, such as at HMP Bedford, to thematic reviews across the country, there is compelling evidence of the risks to both mental and physical health that people are facing. In January, for instance, the Independent Monitoring Board published evidence about the use of segregation units in prison for people experiencing acute mental health needs, in many cases while waiting for weeks and months for an urgent hospital bed. Then in February, HM Inspectorate of Prisons and the Care Quality Commission raised further concerns about these protracted waits and their effects on people’s health and safety. Data published by the Ministry of Justice last year also show rising rates of self-harm, suicide deaths and assaults on staff members in prisons in England and Wales. In the year to September 2023, there were 93 deaths described as ‘self-inflicted’ (out of a total of 311 deaths in prisons), 67,773 incidents of self-harm involving 12,292 people, and more than 25,000 assaults on members of staff.

We have known for many years that the mental health of the prison population is poor, with up to nine out of ten prisoners experiencing at least one mental health difficulty, and a majority having two or more, often combined with other complex needs. Recent research by Centre for Mental Health found that one prisoner in seven in England is on the caseload of a prison mental health team. The ability of those services to provide everyone who needs it with the care they require, in an environment and system that make this difficult at the best of times, is limited by high levels of need, poor screening practices, wide variations in the skill-mix of teams, and the frequent ‘churn’ of prisoners moving into and out of establishments.

There are no simple or quick solutions to this crisis. But there are steps that the Government could take now, and that all political parties can commit to take after the next election. The first of these would be to reduce the number of people with mental health difficulties who get sent to prison, either on remand or a short sentence. Liaison and Diversion teams are an essential part of our health and justice system, and with the necessary resources and alternatives to imprisonment (such as community sentencing options including access to mental health treatment), they could stop many people from being imprisoned in the first place, and would likely also reduce levels of reoffending. Resolving the legacy of Imprisonment for Public Protection, finally, would also help to reduce the protracted or repeated imprisonment of people who have long since served their time.

The second step would be to reform the Mental Health Act, including provisions recommended in the Independent Review to repeal the 1976 Bail Act (under which people can still be imprisoned for their own safety) and institute a 28-day waiting time for a hospital transfer. While 28 days is still a long time to wait for a bed, too many people are currently held in poor conditions while extremely unwell for much longer than that, often being subjected to multiple assessments and refusals of a bed before finally getting admitted. A more seamless system with a maximum wait enshrined in law would greatly help to reduce the distress these waits are causing.

And third, the Government and prison service must ensure that prisons are made safer, for both prisoners and staff, by creating trauma-informed environments and regimes. Rates of mental ill health are so high among the prison population that the best way to make prisons safer for those who need to be there is to address the environmental and procedural risks they face. Access to multi-disciplinary mental health services offering a range of psychological interventions, linked to support ‘through the gates’ with health, housing, money and work, is essential for those who need it.

Too often, the mental health of prisoners is on the margins of policy debate, obscured by both the physical walls in front of them and the extra barriers of wilful ignorance for the welfare of people who have offended. There is, nonetheless, an urgent need for reform, without which people will continue to be at heightened risk both during and after their time inside.

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