Monday, 18 December 2017

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.


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.”


  1. In the 1990's I worked in a magistrates' courts team which included an embedded, seconded mental health professional. They endeavoured to see every new remand prisoner, every sentenced person & every referral for reports - but certainly prioritised anyone with a known link to mental health services or a presentation giving cause for concern. They had a good working relationship with the Police doctors and a hotline to a consultant psychiatrist if required.

    In 2010 the MoJ produced a report about specialst mental health courts. The Summary was as follows:

    "Ministry of Justice Research Series 18/10
    Process evaluation of the Mental Health Court pilot

    The aim of this study was to assess how the Mental Health Court pilot was implemented at Brighton and Stratford magistrates’ courts. This was in order to draw out areas of best practice and areas for improvement and inform future decisions on the pilot. Interviews with staff, stakeholders and offenders investigated perceptions of how well processes were embedded and gave insight into what worked well. Analysis of data from the courts in the first year of the pilot (January 2009 to January 2010) enabled assessment of the workloads at the courts, and provided some demographic information on offenders. The study found that the key elements of the model were delivered at both sites, but in different ways. The pilot yielded innovative multi-agency collaborations. A wider implementation of Mental Health Courts would require significant changes in the current patterns of multi-agency information sharing and data collection, and early consultation at senior management level."

    As the psychiatrist above makes clear, there is NO excuse.


  3. The former prison's inspector made it clear that cutting resources was increasing risks to safety. Apart for the fact that many with mental health issues should be diverted from custody, it all boils down to funding. If the government had the same political will that found £1bn for the DUP, there would be no mental health crisis in the prisons.

  4. I struggle to see how Mental Health Treatments will cost more that the £40K plus it costs to keep someone in prison for a year.

  5. I'm pretty old and knackered now, and have seen many governments come and go, but I can honestly say that this Tory Government today is the worst I've ever seen. And by some at that.
    Their ideological driven policies are having a brutal effect on all but those rich enough not to care.
    The justice Secretary whilst signing off on cuts to legal aid has employed a 'second' speech writer at £70,000pa. Cuts to prisons and probation go hand in hand with lucrative contracts to private companies.
    The NHS is being sold off at an alarming rate. This week Serco acquired a contract to worth over a hundred million to deliver health care, but they didn't get it from the NHS, they bought it from Carillion?!?!?
    David Gauke the work an pensions minister defended a 140% rise in rough sleeping. A 60% rise in homelessness, and a big rise in child poverty by extolling the wonderful values of universal credit, and the governments record on reducing unemployment on the Andrew Marr show this weekend.
    Everything's a smokescreen, they spout out all kinds of patronising crap to the population and don't really care if it's believed anymore.
    Lidington today will talk about drugs, drones and mobile phones, not about cuts, squalor, mental health and violence. Nor will he talk about what those in prison now can expect upon release. No accommodation, no benefits, and no real support.
    I'm sick of this government I really am, and they need to go ASAP.
    There's a very harrowing article in today's Guardian and not related to criminal justice if you have a few minutes it's worth reading, but it is upsetting.
    Sorry for ranting.


  6. I'd like Lidlington to use his statement today to say a few words about how phones, drones and drugs, are responsible for a 64 year old alcoholic sex offender (with previous) and required to sign the sex offenders register, being released from prison homeless to live in a public park?

    1. That will be an NPS case then. Just shows how appalling the housing situation is. This man should have been placed in supported housing or approved premises and monitored very closely but the crisis we have in probation coupled with a housing crisis and MOJ doing nothing to assist us means a risky and also vulnerable man is sleeping rough in a park where he could pose a risk to public
      He will be out again soon and what then? Back out on the street is quite likely. The MOJ need to invest in accommodation that can be used to place our service users. The housing crisis is one of the most significant issues we are struggling now as an entire nation and offenders are at the bottom of the pile in terms of priority. As getafix points out this goverment are presiding over the biggest fuck up we have witnessed since we were last at war. I am not joking! Unless something is done we are going to witness deprivation that hasn't been seen for over 50 years.people unable to afford a home, fuel or food. What the hell is going on? We have to get rid of this government.

  7. As well as holding Amazon etc responsible for tiny phone absilability, in his speech to Reform thinktank today Lidington also blames prison governors' "overcautious approach" for the massive reduction in ROTLs, conveniently forgetting it was Grayling wot dun it. In 2016 Russel Webster wrote:

    "The briefing argues that recent changes to the ROTL policy have had a significantly negative impact on the ability of voluntary and private organisations to provide work experience opportunities for people on temporary release — which constitutes an obstacle to effective rehabilitation by reducing employment and resettlement opportunities for people being released from prison."

    These 21st century Tories are truly made from shit, piss & wind held together by expensively tailored fabrics.

  8. Aye, I'm assured that venal, mendacious brown starfish spouting shyte are plentiful in Westminster.

    1. Lidingtons comments about ROTL and more people being allowed to go to work from prisons and greater use of tagging is a precursor for extending tagging to more prisoners reaching the end of their sentence in an attempt to reduce the prison population.

  9. Third sector unhappy at not getting a bigger piece of the TR pie.

  10. There's a leaked report on HMIP on Liverpool prison just been published.
    As reports go, it's amazing that criminal prosecutions haven't been brought as a consequence.
    There's no recent reports that's good, but this one really is damning, and says the MoJ should be ashamed by it. It just couldn't be worse.


    1. Grayling should be prosecuted for this, and there should be an urgent question asked in parliament tomorrow.

    2. I certainly hope so 20.06. No Governor is going to be able to turn this around but I reckon this is the tip of the iceberg. I have heard similar reports about other prisons including Bristol with regard to filth, cockroaches, drugs and violence. The whole system is failing whilst Government use brexit as a handy smokescreen. Not long before the national press post staff at doors of prison to interview inmates as they exit. I can see another documentary.


  11. Is it a single contractor who is responsible for maintenance,and gets paid for the upkeep. Or is it the Governors responsibility? Just wondered.

    1. Carillon have the contract for prison maintenance, but will only recognise the MoJ as its employer. Hence, the governor has to ask the MoJ for work to be carried out, who in turn have to get the contractor to do the work.
      I doubt if getting A wings showers fixed is a high priority for David Lidlington or Sam Gymah to sign off on.

    2. Put the likes of Lidlington and Gove in HMP Liverpool for a few weeks. Taste of their own medicine. They would be at home with the cockroaches.

  12. I was having a thought about outing myself. I then thought what if thousands of us did the same, stopped being scared, you know like, 'I'm Spartacus!' several thousand times over. However, 5000 headteachers petitioned the government recently and seemingly to little effect. We have some our most senior representatives no longer couching their language, they are saying this isn't working, this is a disgrace. But all met with a baffling, infuriating soundbite reply. I am sure at some point someone of distinguish will actually throw a wobbly, express numerous expletives, get personal, suggest moral failings. You know, I'm sure your Mother loves you but ... this is a fucking disgrace.

  13. Slightly off topic...

    I have seen a couple of comments regarding the upcoming move for Harrow CRC to Denmark House - which is in the borough of Barnet. A distance of 6.2 miles from the current office.

    The impact this can / will have on Service Users is worrying, to say the least.

    Service Users will now face anything from a 45min - 1.5 hour journey to attend appointments, depending on where they reside in Harrow. Giving ongoing coverage of lack of face to face meetings, this can only be viewed as negative in terms of engagement.

    Just think about the service users who have mental health issues (paranoia, PTSD, anti-social disorder etc) and how they will fare on a 3 bus trek to attend an appointment. Along with those with drug / alcohol dependencies who struggle at times to attend appointments, on time, locally. Service Users of NFA in Harrow. Those who have no funds to purchase food let alone an increase in travel expenditure.

    The impact this will have on a practitioners ability to support, engage and advocate for service users.

    Gone will be the ability to support cases in real crisis to local housing services. No longer is the civic centre a three minute walk.

    Gone will be the ability to support cases to local agencies such as WDP to ensure scripting.

    Gone will be the ability to support those in MH crisis to Bentley House for urgent assessment or support.

    Gone will be the ability to link in quickly with the Job Centre when Service users are being failed and need someone to advocate on their behalf.

    Now, we will have to instruct them from Barnet, back to Harrow, to engage with such services.

    There is a lot of focus on how poor CRC teams operate. How poorly they enrage with service users. Probation Officers (which is what we are...not Offender Mangers!) want to have a positive impact with those we work with. The few restrictions now in our way highlighted above, it’s just demoralising.

    This year alone, I am aware of service users managed by Harrow who have received quality 1-1 support to help achieve change. Being out of borough will, I guarantee, reduce such positive change.

    It’s all well and good being told we can provide travel fares for service users - though not to promote this (we are though, loudly). This isn’t the issue. It’s being removed from local services, partnership agencies which contribute to change. It’s scandalous.

    Desperate to being only two weeks away from this move - local agencies are yet to be informed by management. No discussions have been held about how such a move will be managed going forward. Look Ahead - a very important housing service for OM’s and Service Users - have stated they will not attend Denmark House and are likely to withdraw there service.

    Still, no office space has been secured for staff moving to Denmark House.

    Of concern, as seen by Dorset Close recent move to Askew Road - will there even be adequate interview rooms to hold appointments covering Barnet & Harrow cases? There isn’t at Askew Road to meet demand.

    No changes in letter heads, OM contact number. It’s all very silent from management given such a big change approaching.

    Such a move - all to save a few quid - is neglectful to the service users and the public. It’s being managed appallingly by senior management. It’s a shameful and shambolic decision.

    BIONIC. Nonsense.

    1. 45 mins to 1,5 hour travelling time?
      I think that's ambitious, Grayling is transport secretary don't forget!

    2. As much as I deplore the reduction in local service delivery, it just sounds like you're catching up with the rest of us. Bristol, for example, has a single central office covering a huge geography with crap and costly buses.
      At least London has comprehensive public transport.

  14. Lidington's speech today

    1. But never forget Reform would promote a policy of selling your nearest & dearest to the highest bidder, even if it meant they'd be turned into dogmeat. Their idea of quality is, erm, questionable:

      "Reform was delighted to welcome the Rt Hon Elizabeth Truss MP, Chief Secretary to the Treasury, to lead this roundtable which explored ‘A culture of public service efficiency through digital innovation’."

    2. And previously they hosted pocket-snooker champion Damian Green slavvering on about the magical Universal Credit:

      "It’s a pleasure to speak to you today at Reform’s conference on welfare, especially as Reform has produced so much innovative thinking on welfare over the years. I have now been doing this job for four months, so I thought it was timely to set out my thinking and sense of direction."