Does prison fail inmates with mental illness?
Solicitor David Wells argues that controlling mental illness by punishment is not the answer
Mentally ill inmates now comprise a substantial portion of the prison population and pose administrative and therapeutic challenges to prison administrators and mental health professionals. Depending on what reports you read, anything up to 90% of prisoners are said to have mental health problems of some description. Mental illness can encompass anything from serious personality disorders, issues of self abuse up to drug and alcohol dependency. The prison service in the UK has under its care one of the most vulnerable and mentally unhealthy populations.
There is no national blueprint for delivering mental health care in custody. Despite ongoing concerns about overcrowding, prison has become the default option for many who pose little public risk. Some would argue that the Criminal Justice System has taken over from the public health system as the destination for many with mental health problems.
The aim of the prison service is to offer an equivalence of care to inmates as the NHS. The reality is that this is not achieved. Problems do not just stem from a Judiciary with little understanding of the true impacts of mental illness, and from a society starved of mental health resources in communities. Of course there are many people in prison who it is felt should not be there. Imprisonment is an expensive and ineffectual way of dealing with inmates with mental health concerns and those deemed vulnerable. The fact is that we are seeing too many people sent to prison who ought to be diverted to better alternatives than being imprisoned. Without diversion, even a short spell in prison can seriously damage a person’s health, family ties and prospects of life, while doing nothing to tackle mental health, drug or alcohol problems.
The problems extend well beyond the sentencing philosophy of the Courts and the obvious inability to divert where diversion is the right choice. That is not to say that a prison sentence should not follow for the most dangerous of offenders. It is a balancing act that poses difficult challenges for professionals involved, including the probation service on whom the Courts place so much reliance.
That being said, research does tend to suggest that prisons are failing the mentally-ill with poor facilities and undertrained staff.
Assuming that an offender is sentenced to a term of imprisonment, there are many problems that are encountered. One of the first problems faced for the inmate and the prison system is one of detection. Even in those cases where mental illness/health is identified, there are problems with definition, diagnosis and subsequent treatment. Of those inmates who manage to get assessed properly, they are often left untreated or not treated adequately; leading to problems on release and an increased risk of further offending. Inmates with short sentences often experience lengthy delays in waiting for transfers to hospital for specialist care. Such delays often exceed the length of the sentence and result in no treatment at all.
Inmates with even a mild mental illness encompassing learning difficulties experience problems. They often find that they cannot progress with courses because of literacy and numeracy deficiencies. Health teams in prisons are often isolated from other departments and not enough activity is provided to inmates. Locked in cells for lengthy periods can do nothing other than exacerbate mental illness, including depression.
Studies have consistently shown that the lack of resources within prison have an adverse impact on mental health. Jail-based treatment is often poor, but with some intervention can help. In the USA, research has shown that public health efforts in conjunction with the Criminal Justice System has taken advantage of incarceration in helping mental illness by extensive and continuous jail house treatment and has shown to reduce offending and relapses markedly.
One very identifiable hurdle for those inmates with mental health issues is the fact that they are often seen as a discipline problem rather than someone who requires real help. Repeated outbursts and anti-social behaviour are often the hallmarks of a mental illness. Where instances of this type occur, the reaction of the prison is immediately to invoke some level of discipline and to place the inmate in segregation rather than be seen by a mental health team, discuss the causes of the behaviour and provide treatment where it is needed. Controlling mental illness by punishment is not the answer.
Now that we have a new Government who have announced significant public spending cuts and reviews, will the most vulnerable, just because they are serving a prison sentence, continue to be ignored? Assuming this will not be the case, the mentally ill and vulnerable within our prison system deserve greater attention. A multi-agency approach is required with sufficient funding to help identify those who require the appropriate care. Those who need to be diverted should be, and in to hospital care. Those with lesser disabilities ought to be diagnosed and treated earlier. Prison healthcare staff require better training so that they can provide better care. Every attempt should be made to reverse the sentiment expressed in 2009 by Dr Peter Selby, president of the National Council for Independent Monitoring Boards, who said that ‘there is no more distressing a mismatch in our criminal justice system than mental illness and prison.’
Building more prisons is not the answer. This will just increase the problem. Plans to build new prisons should be scrapped and the funds instead put into providing appropriate accommodation and care for the mentally ill and vulnerable.
David Wells is a senior partner at Wells Burcombe LLP
Comments about this article
7/7/2010 carolyn burton -
I totally agree any funds should be invested in appropriate accomodation and care of the prisoners with mental health issues. AS it states in this article there are 90% of prisoners with these problems from mild to more severe.Money should also be invested in the appropriate training for staff to give them a better understanding and compassion for these inmates as these inmates do not understand what they are going through either so it's just as distressing for the inmates.
I have a good clear understanding of the mental health effects,and the need for the correct treatment.
Carolyn Burton
16/7/2010 Kate Wildish -
My son is in a YOI and has Tourette's Syndrome. He is called 'blinky' by both other inmates AND staff. He has failed to progress to the Enhanced Scheme as he accrued written warnings for 'failing to keep his mouth shut'. He has his property stolen reguarly by other inmates, regularly has bruises to his lower back from 'kidney punches' and when he has mentioned to staff he is told he is over six foot and needs to sort it out himself. He waited 4 months after entering custody to get a continuation of Sulpuride, due to 'staff shortages'. If he was cared for properly I believe he would be able to progress through the prison system as any other inmate would.17/7/2010 Margaret Alsop - - www.adhddorset.btik.com
Sadly so many young people who have ADHD (Attention Deficit Hyperactivity Disorder) or an Autistic Spectrum Disorder are detained within of our Young Offenders Institutes without accessing the appropriate health care and education to that of their needs. The Youth Offending Teams in the community have a duty to assess all YO's for mental health problems but not all do, if they do they are not assuring that these young people are then referred on to the Child & Adolescent Mental Health Services.Should the appropriate services be delivered within the community, these young people could achieve! By provision of supported housing providing 24/7 support in order to assure that services engage with them and do what they are meant to do, then I believe that less will enter our penal establishments.
Local authorities should be scrutinising the services they fund to ensure that they are delivering the goods they pay for and that the needs of young people with ADHD or ASD are met!
9/8/2010 bobby faiers -
My son has a mental disorder called either schizoffective disorder or schizophrenia. He has been sectioned 3 times for the usual 28 days, medicated and then sent home. he invariably stops taking medication and then the whole process starts again, he tries to work but gets the sack after a couple of days due to his paranoia and hallucinations.He recently was in an extremely bad way and maybe I should have tried to get him sectioned again, but if he was OK for the hour that he was assessed by professionals then he could not have been sectioned. he has got himself into a lot of trouble with 7 charges against him; and we are awaiting medical reports so that he can be heard at a magistrates court.The argument will be, was he unwell at the time of the offenses.This means that it could go to crown court and all that encompasses. He has now been taking his medication and knows the difference between well and unwell and is co-operating fully with the CMHT. Prison would be a devastating experience for him. the whole situation is extremely stressful.Does anyone know about these new mental health courts that I have heard about.
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