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9. RECOMMENDATIONS
9.1 Prison is not the most appropriate environment for a significant number of individuals with severe and enduring mental health problems. Alternative environments which can provide appropriate treatment, intervention and support should be identified.
9.2 Current provision for prisoners with severe and enduring mental health problems in prison is varied and inconsistent and dependent on the resources available to individual establishments. A clear recognition of the extent of severe and enduring mental health problems should be made, it should be afforded a high priority and there should be more consistency in provision across Scotland.
9.3 There is no shared understanding across SPS about the nature and scale of severe and enduring mental health problems. This lack of shared understanding should be addressed.
9.4 Overcrowding affects people with severe and enduring mental health problems, particularly when such prisoners are located in mainstream residential halls. The practice of locating prisoners with severe and enduring mental health problems in mainstream halls should be reviewed.
9.5 The identification of severe and enduring mental health problems in the Reception is not consistent and coherent. An early, systematic, exploration of mental health issues should take place in an environment which supports and enables the disclosure and identification of severe and enduring mental health problems.
9.6 The Multi Disciplinary Mental Health Team is designed to provide an effective forum for discussing prisoners with severe and enduring mental health problems, but not all cases are brought to the meeting. All new cases where severe and enduring mental health problems are suspected should be brought to the MDMHT, and should be regularly and systematically reviewed at subsequent meetings.
9.7 In some prisons, the input of non-healthcare staff is sought as part of the assessment process. This should happen in all prisons.
9.8 Some aspects of the treatment, intervention and support available to prisoners with severe and enduring mental health problems depend on the prison to which they are sent. Minimum standards of treatment, intervention and support should apply to all prisoners with severe and enduring mental health problems, regardless of where they are located, and staff should have relevant training and be provided with information to ensure that they are able to deal with issues arising.
9.9 Prisoners with severe and enduring mental health problems must have access to a regime which meets their needs.
9.10 Structured and sustained support should be provided to both male and female prisoners with severe and enduring mental health problems who are survivors of childhood sexual abuse.
9.11 The Residential Care Unit in Barlinnie is starting to become a de facto national resource. The number of places likely to be required in a high dependency setting similar to that provided in the Barlinnie Residential Care Unit, and the best means of meeting the needs for these places should be established.
9.12 The segregation unit in a prison is sometimes used to house prisoners with severe and enduring mental health problems. This practice must stop and alternatives to holding prisoners with severe and enduring mental health problems for long periods of time should be found.
9.13 Very few prisoners are given the opportunity to identify their own needs and provide feedback. This should be addressed.
9.14 Very few prisoners with severe and enduring mental health problems are aware that they have the right to access advocacy, and not all prisons provide an advocacy service. Advocacy must be freely available and understood.
9.15 Psychiatrists need to have adequate access to prisoners with severe and enduring mental health problems, or to appropriate facilities to conduct assessments.
9.16 Staff in some prisons are unaware of the criteria used by psychiatrists in determining whether or not a prisoner with severe and enduring mental health problems should be transferred to hospital. A clear and well understood policy should be communicated to all staff.
9.17 There is no standardised approach to preparation for release for prisoners with severe and enduring mental health problems. A formal, multi agency planning process should be put in place to identify the needs of prisoners with severe and enduring mental health needs on release, and to ensure that arrangements are made for continuity of care.
9.18 The provision of mental health specialist staff varies widely across prisons. Some prisons have a full time resource, others have little or none. Overcrowding in particular has led to increased pressure on healthcare staff generally. Mental health specialist staff and resources should not be diverted to other duties at the expense of the provision of mental health support.
9.19 Prison staff have an increasing role to play in relation to prisoners with severe and enduring mental health problems, but do not always feel adequately trained or prepared to do so. This can lead to significant pressure and stress. Structured training and support should be provided to prison staff working with prisoners with severe and enduring mental health problems.
9.20 A wide range of conclusions is highlighted at the end of each chapter of 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.
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