Prison Mental Health: Vision and Reality Prison Mental Health: Vision and Reality 1

Prison mental health: vision and reality Prison mental health: vision and reality 1 Contents Introduction 1 Introduction It is now almost a decade since the government introduced the 4 Authors’ biographies principle of ‘equivalence’ into prison health care in England and Wales and set the stage for the NHS to take responsibility for 6 Louis Appleby Offender health: reform is gathering pace achieving it (DH, 2001). 10 Paula May and Calum Meiklejohn Prison mental health: representation and reality The principle of equivalence means that prisoners country following the publication of the National should receive the same quality of care for their Service Framework for Mental Health (DH, 1999). 16 Kimmett Edgar health as they would receive outside prison. It does Recognising mental health: balancing risk and care not mean that health care will be identical to that This publication aims to examine what has been outside but that services will aim to achieve the achieved in prison mental health over recent years 22 Ian Cummins same quality of care as the prisoner receives from a number of different personal perspectives The relationship between mental institution beds, elsewhere. and individual observations of working in England. prison population and crime rate It looks at the specific achievements of inreach The need for better mental health care in prisons teams and of efforts to divert offenders from has been evident for some time. Reports custody. It also looks more broadly at the rapid throughout the last two decades have shown that growth of the prison population during the same prisoners have dramatically higher rates of the period and the treatment of offenders with mental whole range of mental health problems compared health problems outside as well as inside prison. to the general population. Not only is prison itself a risk factor for emotional distress but the prison Louis Appleby sets out the principles that should population is comprised disproportionately of underpin offender mental health policy and practice people from disadvantaged backgrounds with a and examines how far we have travelled in the last history of trauma, loss and low resilience to distress decade towards those ends. He concludes that the (Durcan, 2008). health and criminal justice systems have developed improved responses to mental ill health among With high levels of mental ill health in prison, the offenders, for example through better screening on last decade has witnessed the creation of new reception to prison, drug treatment and suicide inreach teams in every establishment in England. prevention. But, he argues, ‘changing only one part These new teams were designed to be broadly of the offender health care pathway will merely equivalent to the community mental health teams expose other weak points in the system’ and with that operate outside and to incorporate within the development of inreach the shortcomings of them the outreach and crisis resolution functions prison primary care and diversion from custody of the specialist teams that were set up across the have been held in stark relief. Nonetheless, Appleby 2 Prison mental health: vision and reality Prison mental health: vision and reality 3 concludes that we do now have a broad consensus inform how they are managed by the health and mental illness and offending are inextricably improve the way offenders with mental health about what needs to be done to make the whole justice systems. Public understanding of mental ill linked and is not supported by the evidence of problems are supported, inside and outside system work better and a ‘momentum to bring it health is still very mixed and often quite different any clear link between rates of crime and rates prison, not through adding extra investment about’. Such windows of opportunity do not to reality, as a result of which ‘divisive images of of imprisonment. In its place, we need to onto an unreformed system but by looking at appear very often, and grasping it while it exists mental health problems lead to contradictory examine what it is mental health services should how it all works and reinvesting resources will be vital. solutions’. So we are at one and the same time offer people experiencing mental distress. And towards more effective interventions that are developing more compassionate and better this means we need ‘to do things differently’, in everyone’s interests. Paula May and Calum Meiklejohn write from resourced responses to mental ill health while also using the recommendations of the Bradley the perspective of working currently in a prison becoming ‘ever-more coercive’ towards people Report (2009) as a starting point. References mental health services. They describe the journey who are seen as a threat. the mental health service at HMP Bristol has taken All four contributions make it clear that while a Bradley K (2009) The Bradley Report: Lord over the past five years and what challenges lie Edgar argues that some groups are particularly great deal has been achieved to mitigate mental Bradley’s review of people with mental health ahead for prison mental health care. vulnerable to poor treatment within the criminal distress among the prison population over the problems or learning disabilities in the criminal justice system, such as women and people with past decade, fundamental changes are needed justice system, London: DH. The creation of prison inreach, they argue, saw the learning difficulties. Better management of the both to reduce the size of that population and Department of Health (1999) The National NHS ‘parachute in’ mental health provision to a recent convergence between mental health and the proportion of people within it who have Service Framework for Mental Health: Modern new and difficult environment. The service criminal justice, he argues, will be vital to ensure mental health problems. We need to develop standards and service models, London: DH. inevitably had to adapt to the reality of its that the two services do not compound the ‘whole system’ responses that acknowledge that environment, for example by separating disadvantage those groups experience. most prisoners are incarcerated for short periods Department of Health (2001) Changing the assessments and emergencies from planned work at a time: that almost all return to their outlook – a strategy for developing and with the team’s clients to avoid the former Ian Cummins, finally, examines what the communities and need care and support that modernising mental health services in prisons, becoming the team’s sole function. May and exponential growth of the prison population tells continues ‘through the gates’ and addresses the London: DH. Meiklejohn also conclude that one of the biggest us about our society and how an understanding of things that concern them most in life. Durcan G (2008) From the inside: experiences challenges facing inreach teams is not from within why it has happened it essential to any effort to of prison mental health care, London: the prison but in the attitude of mental health address it. He cites the widely held ‘Penrose Prisons will never be free of mental ill health. Centre for Mental Health. services outside to working with offenders. Again, hypothesis’ that the prison population has grown in No matter how well we divert people with it is how the whole system, not just individual parts response to the closure of the long stay ‘asylums’: mental health problems from custody, we still of it, works that determines how effective prison that there is a ‘static proportion of any population need to ensure that prison mental health care mental health services can be in supporting people that will need or be deemed to need some form of works for those who need it and supports them in their treatment and recovery. institutional control’. in their recovery journeys. After a decade of growth in public services, we face a new decade Kimmett Edgar examines the way in which attitudes He argues that there are, however, serious problems of contraction and retrenchment. Yet as the about mental illness and those experiencing distress with this approach. It assumes, for example, that contributions to this volume show, we can 4 Prison mental health: vision and reality Prison mental health: vision and reality 5 Authors’ biographies Louis Appleby Paula May Ian Cummins Louis Appleby has recently been appointed as Paula May qualified from Hereford and Worcester The delivery of health to the criminal justice services Ian Cummins is a senior lecturer in social work in Department of Health National Clinical Director College of Nursing in 1995. She has worked across is developing and nurses working in criminal justice the School of Social Work, Psychology and Public for Health and Criminal Justice and is Professor a wide range of areas including inpatient services, services require a forum to represent them. The RCN Health at the University of Salford. He has of Psychiatry at the University of Manchester. The high secure forensic settings, PTSD (post-traumatic forum is proactive in representing issues raised by worked as a probation officer and approved aim of his new post is to reduce mental illness in stress disorder) units and also with the third sector. members and advocating nursing issues to wider social worker. His research interests are in the prisons and improve collaboration between mental stakeholders involved in policy and practice issues. areas of forensic mental health services with an health services and the criminal justice system. In Paula managed the court assessment and referral emphasis on policing and mental illness. He has his previous role as National Director for Mental service Avon and Wiltshire in Mental Health Kimmett Edgar carried out research with police forces exploring Health in England he played a central role in plans Partnership NHS Trust from 2007 to 2009 whilst it ways to improve the mental health awareness of to reform mental health services, bringing in a was involved in the national pilot around court Dr Kimmett Edgar, Head of Research at the Prison officers.

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