Lidington's Smokescreen

On the day David Lidington is due to give a speech on prison policies at the think tank Reform, maybe he could address matters such as mental health, rather than the carefully-constructed moral panic smokescreen his media team have been busy producing over the weekend from a story 12 months old? This from the i online newspaper last week:- 

As a prison psychiatrist, I know suicide rates on the inside don’t need to be this high

“In this country, we do not give a death sentence, but for everyone who has taken their life in prison that is exactly what they got”.

These were the words of the grieving father of Dean Saunders, a young man suffering from severe mental health problems who took his own life in prison. The care was not there for Dean when he needed it most, and tragically he is by no means alone. Suicides in prisons have reached their highest peak since records began in 1978. According to Inquest, this year 61 people have taken their own lives in prisons, and that is not including the 47 awaiting classification.

As a doctor tasked with preventing such crises, it’s clear to me that Dean Saunders should not have died. However, I can see exactly how it happened. 

The system is at breaking point 

I have been a forensic psychiatrist for over 25 years, and in that time I have never known the system so utterly unable to care for those in custody with mental health problems as that in our prisons today.

Up to three quarters of doctors specialising in mental health in prisons don’t think it is possible for them to provide adequate care. If only 25 per cent of oncologists thought they could provide adequate cancer care, there would be a public outcry. Yet the double stigma attached to those in contact with the criminal justice system with mental health problems provokes no such anger. There are now fewer staff looking after more prisoners. The number of frontline operational staff employed in the public prison estate has fallen by over a quarter (26 per cent) in the last seven years—6,428 fewer staff looking after over 300 more people. 

Specialists unable to see their patients 

It can hardly be a surprise that this is now having a serious impact on safety in our prisons. I have colleagues who haven’t been able to see their patients because there were not enough officers to supervise. When we find ourselves in this situation how can we possibly provide the care to prevent mental health problems from escalating to crisis point? The road to suicide is rarely simple, nor is preventing it, but there are practical changes that would help reduce the toll. 

A prison in the Midlands is trying to have a target of 45 minutes of face to face time between a prisoner and their key worker. If implemented widely, this would enable prison officers to alert mental health staff to need immediately. We are calling on NHS England to ensure all mental health teams in prisons join the Royal College of Psychiatrists’ Quality Network as a cost-effective way of assuring quality and improving standards through a process of peer-review. The Public Accounts Committee brought out their report of their Mental Health in Prisons inquiry today. It had some great recommendations for how to improve care within prisons, such as improving mental health screening on reception. However, we are calling for a radical shift in the narrative. 

Should all these people be in prison? 

As the UK has one of the highest rates of imprisonment in Europe, we also have to ask the question, is prison the right place for so many people? Surely it is far better for those who pose very little risk to anyone in the wider community when under community supervision to stay there? The alternative of sending another person to prison where it is far more likely that mental health conditions will develop and worsen and they will be stuck in a cycle of re-offending just makes no sense. Scarce funding could be far better used on stronger community services, to reduce reoffending and improve wellbeing, rather than on continuing to incarcerate such a high number of people. 

Mental Health Treatment Requirements (MHTRs) can be used as an alternative to sending some people with mental health problems to prison. They are a three-way agreement between an offender with a mental health condition, mental health services and probation services to treat and support the offender in the community rather than send them to prison. Despite the potential that MHTRs could reduce prison populations while helping people get treatment in the community they are very rarely used. Figures released by the MOJ this year, however, shows that the use of MHTRs have fallen to its lowest point across the decade. Mental health care in prisons is inadequate and getting worse. I urge the government to take urgent action to address this great injustice. 

Dr Huw Stone is the Co-Chair of the CCQI Quality Network for Prison Mental Health Services at the Royal College of Psychiatrists. He has been a forensic psychiatrist for more than 25 years.

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This  from the Independent:-

Record high levels of prisoner self-harm a 'damning indictment' of failures in mental health provision in jails

Record high levels of self-harm in prisons are a “damning indictment” of the current state of the mental health provision in jails across England and Wales, MPs have warned. A report by the Public Accounts Committee (PAC) reveals that long-standing understaffing and increased prevalence of drugs in jails have led to “deep-rooted failures” in the management of prisoners’ mental health.

While the Ministry of Justice (MoJ), HM Prison and Probation Service and NHS England have a duty of care to prisoners, the report finds that they do not know where they are starting from, how well they are doing or whether their current plans will be enough to succeed. Self-harm in prisons in England and Wales reached a record high in October, with figures showing there had been more than 41,000 incidents in a year amid a surge in violence.

It comes after an analysis by The Independent of recent Osted reports found that children in custody were facing a “significant shortfall” in mental health provision, with some given no access to psychology services and having to wait more than half a year for treatment. People in prison are considerably more likely to suffer from mental health problems than those in the community, and helping them meet these needs is an essential step to reducing reoffending and ensuring that those who are released from prison can rebuild their lives in the community.

Yet the Committee found that Government’s efforts to improve the mental health of those in prison so far have been poorly co-ordinated, and information is still not shared across the organisations involved – not even between community and prison GP services. Prisoners miss an average of 15 per cent of medical appointments, largely because of a lack of staff to escort them, with the loss of prison staff already outstripping recruitment in some prisons, states the report.

Inmates with acute mental health problems should wait no more than 14 days to be admitted to a secure hospital – but the majority wait far longer than this. In 2016-17, two-thirds of prisoners who needed treatment waited longer than 14 days to be transferred – with some waiting more than a year.

The PAC also raised concerns over the fact that there is no reliable or up to date data on the prevalence of mental health issues in prison due to failure to establish effective screening procedures, with the most commonly used estimate – that 90 per cent of prisoners have mental health issues – now 20 years old.

The increased availability of drugs in prisons has also contributed to the increase in mental health issues of prisoners, with drug seizures in prisons having risen from 2,500 in 2015 to just over 10,500 in 2016. The number of seizures of spice has soared from 408 in 2015 to nearly 3,500 in 2016, figures show.

The MPs found that NHS England’s oversight of its contracts to provide mental health services had been weak failing to monitor the quality of mental health care delivered by private providers or the outcomes these services achieve. NHS England was unable to tell the PAC how many cases there had been where a provider’s failure to provide adequate mental health services had contributed to an individual taking their own life. A recent National Audit Office report highlighted two examples where NHS England had continued to pay for services that the contractor had not delivered and had not acted to recoup any costs.

Meg Hilier, chair of the Public Accounts Committee, said there were “deep-rooted failures” in the management of prisoners’ mental health, reflected in what she said was an “appalling” toll of self-inflicted deaths and self-harm. “Failing to attend to the mental health needs of inmates can also have devastating effects beyond the prison gates. The evidence is stark but there is no realistic prospect of these serious issues being properly addressed unless Government rethinks its approach,” the Labour MP said.

Urging that this must start with a meaningful assessment of the scale of the problem, she added:

“Without adequate data it is simply not possible to determine whether Government action is making a difference – yet, incredibly, the most commonly used estimate of prisoners’ mental health problems is 20 years old. This is clearly not good enough and implementing more robust health screening processes must be a priority. There are long-standing issues with understaffing in prisons and, as the Government seeks to address these shortfalls, we will expect it to demonstrate swift progress with plans to provide enhanced mental health training."

Deborah Coles, director of charity INQUEST, which supports families of people killed in state-related deaths, said: 

“This report highlights the shameful record of self-inflicted deaths and self-harm in prison and the shocking admission by Government that it has no reliable data on how many people in prison have mental ill health. Tackling mental health in prisons means a dramatic reduction in the prison population, investment in alternatives and a more therapeutic response to those for whom prisons is the last resort.”

Responding to the report, an MoJ spokesperson said: 

“Every death in custody is a tragedy and we are redoubling our efforts to support vulnerable offenders, especially during their first 24 hours in custody. All prisoners are subject to health screening when entering prison and their mental health is monitored closely while they serve their sentence. In April this year we introduced new suicide and self-harm reduction training – over 11,000 staff have embarked on the new training. We continue to support the prisoner listener scheme, as well as providing extra funding for the Samaritans. We will continue to work closely with NHS England to improve services in a number of areas, including the process for prisoners who require transfer to secure hospitals.”