Prison reform and mental health

Lord

Prison, the UK’s most serious form of , is effective at little or nothing to stop them offending again. The damage is incapacitating the person. Of course, a man locked up in his cell is made much worse when women are imprisoned far from their not going to be carrying out a burglary. But paradoxically, prison is homes and families and receive inadequate health care during and also a release from responsibility. are released from after their time in prison. 6 responsibilities for shelter, food or children. Indeed, No One Knows was a programme conducted by the prevents them from meeting their duties to the world outside; that Trust to draw attention, and prompt a response, to people with is, until they are released and return to society. Certainly, if their learning disabilities in prison. It found that 20 to 30 per cent of the mental health problems are not treated, they will emerge more prison population have learning disabilities or difficulties that dependent and less able to cope with the responsibilities of interfere with their ability to cope within the criminal justice citizenship. Then the prison experience – the stresses they have system, while 7 per cent have an IQ of less than 70. 7 No One endured as well as the lack of responsibility – may well render Knows described the challenges faced by these people from the them more of a risk to society than when they entered custody. moment they arrive in prison: poor literacy skills and difficulty expressing themselves complicate daily living and make much of The statistics the prison regime inaccessible. Difficulties in understanding An undesired legacy of the closing of large mental health information and completing prison forms leave people unusually institutions is a lasting increase in the number of people with vulnerable to discipline or exclusion from prison activities that mental health problems who are sent to prison. Seven per cent of might be helpful to them. male prisoners and 14 per cent of female prisoners have a Set against the backdrop of the stresses custody imposes, what can psychotic disorder, compared to a rate of four per 1,000 of the be provided in prison is often inadequate to prevent a deterioration general population of the UK. 1 Between a third and a half of in mental health. People with learning disabilities are more people received into prison are thought to be problem drug users. 2 susceptible to anxiety and depression, and custody can exacerbate Twenty-one per cent of male and 46 per cent of female sentenced their distress. Prison staff do their best to cope with the complex prisoners attempted to take their own life at least once before needs of people in their care, but few are comfortable with having going to prison. 3 These figures highlight the perennial question of to respond to people who are mentally ill or who have learning how we treat and support people with mental health disorders and disabilities. The number of prisoners who have learning disabilities other impairments when they collide with the criminal justice or mental health needs highlights the importance of training for all system. staff to ensure that they respond in a sensitive and supportive manner. WHO guidelines and the reality inside Promoting mental health should be a central part of any prison’s UK health care service. Caring for mental health needs and promoting It is a universal principle that: ‘All prison health services should emotional well-being should be viewed more widely as part of the strive to provide prisoners with health care equivalent to that core duties of all who work in prison. 4 provided in the community’. Health care in the prisons of and improved The Mental Health Declaration for Europe, adopted at the World significantly in the years after responsibility was taken over by the Health Organization’s European Ministerial Conference in 2005, Department of Health. However, the mental health needs of the stated that mental health within criminal justice covers ‘the population place prison mental health teams in an impossible promotion of mental well-being; the tackling of stigma, situation. Many who enter prison do so suffering from problems discrimination and social exclusion; the prevention of mental health with mental health that ought to have been treated in the problems; care for people with mental health problems, providing community. Most have longstanding mental health needs, and comprehensive and effective services and interventions, offering some are acutely and seriously ill. While this group monopolises the service users and carers involvement and choice; and the recovery attention of mental health teams, more common problems, such as and inclusion into society of those who have experienced serious depression or anxiety, are neglected. 5 mental health problems’. There is a strong consensus that prison is not the right place to The Corston Report, which focused on women offenders in treat and care for seriously and acutely mentally ill people. Whether England and Wales, found that short spells in prison, often on they are diverted from prison in court or transferred from a prison , damage women’s mental health and family life yet do to receive mental health care outside, co-operation between the

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‘All prison health services should strive to provide prisoners with health care equivalent to that provided in the community’ (WHO)

health services and social care outside and the criminal justice evidence that diversion from the criminal justice system to sector is vital. The mental health needs of people who come into mental health treatment can lead to improved outcomes both in conflict with the law is too important – as a matter of public health terms of mental health and reduced re-offending. 9 People with – to be left to the prisons to resolve. The integration of national mental health disorders should be cared for in the most health services with the health care of prisoners also helps to appropriate location – not the most convenient one. ensure continuity of treatment after release. In practice, all prison • For non-violent offenders – which includes most women in health services should maintain strong ties to community-based prison – community sentences should be the norm. provision. • Supervision and support should be person-centred and provided Whether prison works depends not only on the length of the in a structured and timely way as the individual enters and sentence, but on what happens in the prison. Security is not just a travels through the criminal justice system. matter of prison officers and high walls. The security of the public depends to a large extent on how far during a sentence those • There is a need for higher levels of co-operation between the concerned with the ’s life can bring about positive change. health services and social care in the community and the criminal The link should be clear for all between a safe and therapeutic justice sector. environment in the prison and the hoped-for resettlement • Alongside treatment, offenders with mental health needs or outcomes after release. In other words, mental and emotional well- learning disabilities should be supported in building up work being is essential to everything rehabilitation stands for. skills and helped to secure suitable accommodation and The way forward employment. The support of their families is often crucial to the process of rehabilitation. In responding to people who have mental health care needs or Much of this is not merely a question of resources: it requires a learning disabilities, the criminal justice system can take a range of transformation of values in the way prisons respond to mental practical measures: illness and learning disabilities. There is an evident point of principle • There should be broader access to diversion and liaison services here. While they are managed by criminal justice agencies, and (if necessary) to secure health treatment. 8 There is empirical offenders remain citizens with full rights to an equivalent standard

Commonwealth Health Partnerships 2013 51 Mental health and human rights

of health and social care, and with other, often unmet, rights to 8 Lord Keith Bradley (2009), The Bradley Report: Lord Bradley’s advice and support with housing, benefits, training, pensions and review of people with mental health problems or learning family ties. The gains that could be achieved if this principle were disabilities in the criminal justice system, London: The Department of Health. translated into practice mean that improving the mental health care of offenders should be a public health priority. 9 David James, (2002), ‘Outcome of Psychiatric Admissions through the Courts,’ RDS Occasional Paper no. 79, London: The Endnotes Home Office.

1 Prison Reform Trust (2012), Bromley Briefings Prison Factfile, November 2012, page 50. The Rt Hon Lord Hurd of Westwell , CH CBE PC, is 2 Prison Reform Trust (2012), Bromley Briefings Prison Factfile, Honorary President of the Prison Reform Trust, a UK November 2012, page 57. charity. He retired as UK in July 1995, 3 The Home Office (2013), Surveying Prisoners Reduction: after a career in government spanning 16 years. After Gender differences in substance misuse and mental health positions as Minister of State in the Foreign Office and issues among prisoners , Table A71, page 17. the Home Office, he served as Secretary of State for 4 Andrew Fraser (2007), ‘Primary health care in prisons’, in World Northern Ireland from 1984–85, from Health Organization, Health in Prisons: A WHO guide to the 1985–89 and Foreign Secretary from 1989–95. Lord Hurd essentials in prison health , page 21. was formerly Deputy Chairman of NatWest Markets, a 5 ‘Mental Health Declaration for Europe: Facing the Challenges, main Board Director of NatWest Group and Deputy Building Solutions’, cited in World Health Organization Europe Chairman of Coutts & Co. He was Chairman of the (2007), Trencín statement on prisons and mental health, page Advisory Committee of Hawkpoint Partners Limited from 4. 1998 until 2001, and until 2010 a Senior Adviser to the company. He is a President of the German-British Forum, 6 Baroness Jean Corston (2007), The Corston Report: A report by Baroness Jean Corston of a review of women with particular and in November 2000 was also appointed Chairman of vulnerabilities in the criminal justice system, London: The the Advisory Council for the Centre for Effective Dispute Home Office. Resolution (CEDR). 7 Prison Reform Trust (2008), No One Knows: Prisoners’ Voices: Experiences of the criminal justice system by prisoners with learning disabilities and difficulties , by Jenny Talbot, London: Prison Reform Trust.

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