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HM Chief Inspector of Prisons for Scotland: out of Sight

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HM Chief Inspector of Prisons for Scotland: out of Sight HM CHIEF INSPECTOR OF PRISONS FOR SCOTLAND HM CHIEF INSPECTOR OF PRISONS FOR SCOTLAND Out of Sight Severe and Enduring Mental Health Out of Sight Problems in Scotland’s Prisons Severe and Enduring Mental Health Problems in Scotland’s Prisons © Crown copyright 2008 This document is also available on the Scottish Government website: www.scotland.gov.uk RR Donnelley B57534 12/08 Further copies are available from Blackwell’s Bookshop 53 South Bridge Edinburgh EH1 1YS Telephone orders and enquiries 0131 622 8283 or 0131 622 8258 Fax orders 0131 557 8149 Email orders [email protected] www.scotland.gov.uk HM CHIEF INSPECTOR OF PRISONS FOR SCOTLAND Out of Sight Severe and Enduring Mental Health Problems in Scotland’s Prisons The Scottish Government, Edinburgh 2008 To the Scottish Ministers I am pleased to forward a report on a thematic inspection of Severe and Enduring Mental Health Problems in Scotland’s Prisons. ANDREW R C McLELLAN HM Chief Inspector of Prisons for Scotland August 2008 © Crown copyright 2008 ISBN: 978-0-7559-5871-9 The Scottish Government Victoria Quay Edinburgh EH6 6QQ Produced for the Scottish Government by RR Donnelley B57534 12/08 Published by the Scottish Government, December, 2008 Further copies are available from Blackwell’s Bookshop 53 South Bridge Edinburgh EH1 1YS The text pages of this document are printed on recycled paper and are 100% recyclable HM CHIEF INSPECTOR OF PRISONS FOR SCOTLAND | OUT OF SIGHT: SEVERE AND ENDURING MENTAL HEALTH PROBLEMS IN SCOTLAND’S PRISONS CONTENTS 1. FOREWORD 1 2. TERMS OF REFERENCE 2 2.1 Scope of the Inspection 2 2.10 Basis of the Inspection 3 3. OVERVIEW OF SEVERE AND ENDURING MENTAL HEALTH PROBLEMS IN PRISONS IN SCOTLAND 4 3.1 The Policy Context 4 3.31 The Nature of Mental Health Problems 9 3.36 The Prevalence of Mental Health Problems 10 3.74 The Impact of Mental Health Problems 16 3.81 Conclusions 18 4. PROVISION FOR PRISONERS WITH SEVERE AND ENDURING MENTAL HEALTH PROBLEMS IN PRISON 20 4.2 Identifying Needs 20 4.22 Referral and Assessment 23 4.33 Treatment, Interventions and Other Support 26 4.68 Conclusions 33 5. PROVISION IN LOCAL AND REGIONAL SECURE MENTAL HEALTH FACILITIES AND THE STATE HOSPITAL 36 5.2 The Forensic Mental Health Estate 36 5.17 Referral, Assessment and Transfer of Prisoners 38 5.31 Treatment, Intervention and Other Support in Hospitals 41 5.43 Return to Prison 44 5.48 Conclusions 45 6. RETURN TO THE COMMUNITY 46 6.2 Pre-release 46 6.21 Return to the Community 48 6.39 Conclusions 54 7. RESOURCES AND STRUCTURAL ISSUES 56 7.2 Staffing and Roles 56 7.32 Joint Working 61 7.62 Record Keeping and Information Sharing 65 7.69 Physical Resources 66 7.80 Conclusions 69 iii 8. RECENT IMPROVEMENTS AND THE USE OF PRISON FOR PEOPLE WITH SEVERE AND ENDURING MENTAL HEALTH PROBLEMS 71 8.2 Improvements in Recent Years 71 8.8 The Use of Prison for People with Severe and Enduring Mental Health Problems 72 8.12 Conclusions 73 9. RECOMMENDATIONS 74 ANNEX 1 76 Glossary ANNEX 2 77 Inspection Team iv HM CHIEF INSPECTOR OF PRISONS FOR SCOTLAND | OUT OF SIGHT: SEVERE AND ENDURING MENTAL HEALTH PROBLEMS IN SCOTLAND’S PRISONS 1. FOREWORD I am pleased to publish this thematic inspection report on prisoners with severe and enduring mental health problems in Scotland’s prisons. Mental health problems exist on a spectrum from mild to severe and this inspection focused on the severe end. At least 315 prisoners, (4.5% of the prisoner population excluding HMYOI Polmont), were found to have a severe and enduring mental health problem. The number of prisoners with less severe forms of mental illness is likely to be much higher. The most common problems were schizophrenia and bi-polar affective disorder. Prison is unlikely to lead to an improvement in these conditions, and may exacerbate the problem, particularly when such prisoners are held in inappropriate locations such as segregation units. This report makes clear that prison is not the most appropriate place for many of these individuals to be living. A wide range of conclusions is highlighted in this report. All organisations involved in the care, treatment and management of prisoners with severe and enduring mental health problems should take account of these conclusions and develop their own practice to address them. ANDREW R C McLELLAN HM Chief Inspector of Prisons August 2008 1 2. TERMS OF REFERENCE SCOPE OF THE INSPECTION The Focus of the Inspection 2.1 The focus of the inspection was on “severe and enduring” mental health problems of prisoners in Scotland. This includes prisoners with a formal diagnosis of a severe and enduring mental health problem, and those who have not been diagnosed, but whose behaviour indicates that they experience such problems, or who suffer substantial disability as a result of their problems. 2.2 Examples of diagnosed severe and enduring mental health problems covered by the inspection include schizophrenia; bi-polar affective disorder; Alzheimer’s disease; and personality disorder. 2.3 Examples of the types of behaviour covered by the inspection include substantial confusion or depression; inability to make informed, consistent decisions, or to cope independently; inability to sustain relationships; and behaviour which poses a significant risk of injury to self or others (including self-neglect). 2.4 A basic definition of the issues covered was provided to participants and was well-recognised by many. Aims 2.5 The aims of the inspection were to examine: • The scale of severe and enduring mental health problems in prisons in Scotland. • The processes involved. • The impact on the prison. • Issues on release. • Prison-based and community interventions. • Reasons for use of prison for people with severe mental health problems. 2.6 The three key approaches to inspection are relevant to the current thematic inspection. Safety 2.7 The individual prisoner should be safe from harm by others, safe from self-harm and as far as is possible be managed in such a way that any risk that the individual poses to others is assessed and appropriate interventions put in place to respond to those risks. Decency, Humanity and Respect for Legal Rights 2.8 The individual prisoner should be treated in such a manner as to preserve that individual’s Human Rights, preserve human dignity, respect individuality and support family ties. Treatment of the prisoner should be fair and consistent and the prisoner should not be treated outwith the law and Prison Rules. The prisoner should be held in clean and hygienic conditions which promote self respect. While in prison the individual prisoner should be able to fill his or her time in a purposeful manner. 2 HM CHIEF INSPECTOR OF PRISONS FOR SCOTLAND | OUT OF SIGHT: SEVERE AND ENDURING MENTAL HEALTH PROBLEMS IN SCOTLAND’S PRISONS Opportunities for Self Improvement and Access to Services and Activities 2.9 The individual prisoner should have access to activities, work, education and healthcare. The prisoner should also have the opportunity to participate in cultural and religious activity and be properly prepared for release. The potential to damage a prisoner’s social ties, reduce self confidence and diminish the capacity to exercise responsibility should be reduced. Interventions should be available to ensure imprisonment does not have an adverse effect on a prisoner’s mental health. BASIS OF THE INSPECTION Preparatory Work 2.10 In preparation for this inspection, inspectors met with a number of individuals within SPS, the NHS and the voluntary sector. Following this, a small reference group was convened. This group again comprised individuals from SPS, the NHS and the voluntary sector, and focused on the development of a working definition of “severe and enduring mental health problems”, provided advice on the methodology which might be adopted and commented on the questionnaires in draft. 2.11 At the end of the fieldwork, this group met again, and provided feedback on the emerging issues. Sources of Evidence 2.12 The following sources of evidence were used to inform the inspection: • A review of some key literature on severe and enduring mental health issues with particular reference to prisoners and the criminal justice system. • Examination of policy documents relevant to consideration of severe and enduring mental health problems among prisoners. • A questionnaire survey of all Scottish prisons. • Visits to eight prisons: Aberdeen; Barlinnie; Cornton Vale; Edinburgh; Greenock; Kilmarnock; Polmont and Shotts. In each case, inspectors met with the Multi-Disciplinary Mental Health Team, with a group of staff and with prisoners (either as a group, or individually). Where further clarification was required, individual meetings were held with relevant managers. • Visits to eight low and medium secure mental health units, and to the State Hospital, as well as the submission of a postal response from one other unit. In each visit, inspectors met with a group of staff usually involving psychiatrists, psychologists, mental health nurses, unit managers and administrators. A meeting held at the Rowanbank Clinic in Glasgow was attended by representatives of all units in the Greater Glasgow and Argyll and Clyde Board areas. • A group discussion involving 10 voluntary organisations each with direct experience of working with offenders and ex-offenders. Following this meeting, two additional written submissions were provided, in one case from an organisation which had been unable to attend the group discussion. • A joint meeting with representatives of the Glasgow and Strathclyde North Community Justice Authorities. • Separate meetings with the SPS Director of Health and Care and the Mental Health & Suicide Risk Management Co-ordinator. • A meeting with the SPS trade union side including Royal College of Nursing.
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