Healthcare and Mental Health in Prisons
Natalie Matranga from Parlby Calder Solicitors Prison Law Department offers a view on prison healthcare and concludes that ‘getting the right medical treatment at the right time is not always as straightforward as one might hope’.
The purpose of a prison sentence is to place restrictions upon a person’s day to day behaviour and to take away the right to liberty. Other rights, such as the right to fair and humane treatment - including medical treatment - should not be affected. Whilst in the custody of the Prison Service, each and every inmate is owed a fundamental duty of care. Nevertheless, it can sometimes be a frustrating business trying to secure prompt access to appropriate treatment and care. Common problems include inmates who have been given a particular prescription for some time and the medication is changed because that specific type of medication may be seen as a commodity that can be sold on to other inmates. It is not uncommon for this to happen to an inmate who has a clean disciplinary record and who has never provoked any kind of suspicion for this sort of behaviour. Other complications can occur with foreign nationals who are unable to communicate with healthcare staff and who are not given access to an interpreter for this purpose. Other, more common, problems include last minute cancellations of appointments, delays in waiting for appointments and delays in being referred to a specialist.Another important aspect of prison healthcare is the provision of treatment for psychological and psychiatric disorders. A significant number of inmates in England and Wales suffer from mental health problems; it is estimated that 72 per cent of male and 70 per cent of female sentenced inmates in prisons and detention centres in England and Wales suffer from some kind of diagnosed mental disorder. These conditions range from depression and anxiety to severe personality disorders and psychiatric illnesses. Prisoners suffering from such conditions are amongst the most vulnerable within the system, and without the right care and treatment it is inevitable that the potential consequences could be extremely serious. Of the 154 deaths in custody last year, 62 were suicides, which equates to more than 40 per cent. This alarming statistic illustrates just how crucial it is to ensure that the correct treatment and care is administered to inmates. As is the case with any other type of medical condition, inmates should be able to expect the prison service’s provisions for treatment to be of the same standard as they would expect if they were not in prison.
In January 2007, a National Partnership Agreement was made between the Department of Health and the Home Office. The purpose of this agreement is to strengthen the existing agreements between the Health Service and the Prison Service. Although the Agreement is not a legally binding contract as such, it does provide a useful insight into the way in which local Primary Care Trusts operate in terms of their provision of healthcare services to inmates. One of the main principles set out in the Agreement is that inmates should expect to receive a level of access to healthcare services ‘in keeping with services provided to the local community’. It is still, however, the responsibility of each Governing Governor to ensure that these standards are met, and it is the Governor who is accountable for the implementation of any requirements that are set by the Department of Health and/or the Home Office. PSO 3100, ‘Clinical Governance - Quality in Prison Healthcare’, sets out the requirements for Governing Governors in order to ensure that standards of healthcare provisions are regularly monitored and assessed.
Despite these safeguards, getting the right medical treatment at the right time is not always as straightforward as one might hope. Delays, problems with medication and access to appointments in hospitals and specialist clinics outside prisons are still a reality for many inmates.
If inmates experience problems in getting access to treatment or medication from prison Healthcare Departments, as a first port of call the internal request/complaint procedure should be used. If this does not resolve matters satisfactorily, legal advice should be obtained (which is generally free under the Advice and Assistance Scheme, subject to any savings or assets owned by the inmate). Solicitors are able to obtain inmates’ medical records and can try to resolve healthcare problems by liasing with Governors and Healthcare Managers. Your solicitor can raise your concerns with the relevant Primary Care Trust and make a formal complaint on your behalf. In addition to this action, your solicitor can contact Members of Parliament, Government Ministers or the Healthcare Ombudsman in order to make representations on your behalf.
Most cases can probably be resolved in this way; for example, if healthcare departments have concerns about prescribing a particular type of medication, i.e. one that they suspect, rightly or wrongly, might be misused, it is usually possible to arrange for the medication to be administered under supervised conditions. More serious cases may require Judicial Review proceedings in order to challenge decisions that have been made in respect of the provision of healthcare. In addition to such judicial challenges, it may also be possible in some cases to take a civil action against a prison that fails to perform its duty of care and an inmate has suffered some form of harm as a consequence.
Recent litigation brought by a group of opiate-addicted prisoners has highlighted the fact that decisions in respect of healthcare can be successfully challenged. In this group action (by around 200 prisoners and ex-prisoners), inmates were not given the necessary treatment and care when withdrawing from opiates, which can be a painful and degrading experience for anyone to have to go through. The prisoners stated that, although the Prison Service was aware of their addictions and of the treatment that some had been receiving in the community, their treatment in prison fell far short of the care that they could have expected in the community. In July 2006, the Home Office accepted liability and awarded substantial compensation payments to a number of inmates (a trial had been listed for November 2006). These cases have emphasised the point that inmates should not be expected to suffer in silence - they should expect the same quality of healthcare as those who are not in the custody of the Prison Service.
Unfortunately, it seems that there is still some way to go before it can truly be said that prison healthcare is on a par, and consistently so, with healthcare services in the community. Many inmates have come to expect and to accept the problems with which prison healthcare can sometimes be fraught, but this should never be the case. The National Partnership Agreement sets out a clear commitment to all inmates and emphasises the fact that Governing Governors will be accountable for ensuring that this commitment is honoured. The effectiveness of the Agreement in practice remains to be seen, but it is certainly an encouraging move on the part of the Home Office, and it provides inmates with a clear authority to rely on if and when healthcare problems do occur.
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