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8. RECENT IMPROVEMENTS AND THE USE OF PRISON FOR PEOPLE WITH severe and enduring MENTAL HEALTH PROBLEMS
8.1 This chapter summarises the nature and impact of improvements to the response to severe and enduring mental health problems amongst prisoners in recent years, and also the use of prison for people with severe and enduring mental health problems.
IMPROVEMENTS IN RECENT YEARS
8.2 There have been developments to the services available and to the processes for identifying and addressing mental health needs. There have also been improvements to the basic care provided, and the overall approach. This includes the development of the role of mental health nurses and some of the facilities, as well as a greater recognition of the role of healthcare staff in meeting the range of prisoner needs, and the improved involvement of these staff in addressing other issues. There are also increased options available in some cases, as well as better accommodation and conditions generally. In relation to local and regional secure mental health facilities, there have been changes to the overall forensic estate, which were continuing at the time of the inspection.
8.3 There have been improvements to joint working, with closer working relationships and better co-operation between disciplines. Multi-disciplinary working, positive relationships and the work of the MDMHTs were highlighted as particularly positive initiatives in addressing severe and enduring mental health problems.
8.4 Progress has also been made in throughcare, and in the development of improved communication with external organisations. The level of understanding of mental health issues in prisons has also increased.
8.5 More broadly, there is a growing recognition of the need to address these issues within the prison system:
"We are very slowly starting to recognise that it is in our interests to have positive strategies to address mental health illness and ensure mental health promotion to maintain good mental health."
8.6 The development of knowledge and awareness amongst prison officers is particularly important in this context. Some, but by no means all, officers are now more likely to recognise the potential links between a prisoner's behaviour and mental health problems, and the development of training has had a role in this. Some staff are now talking openly about mental health and want to do more. The changing role of officers was also acknowledged, and more officers now see the provision of care as an aspect of their role, although their involvement in actually addressing mental health problems is limited.
8.7 There is a greater acceptance of the mental health team in prisons than in the past. More generally, the stigma associated with mental health problems has reduced, both inside and outside prison, although there were examples from prisoners of continuing mixed experiences, and of inappropriate attitudes and assumptions from some staff and community members. Stigma remains a major issue. Alongside some changes to attitudes, there is also an increased willingness of those experiencing mental health problems to identify these and to come forward.
THE USE OF PRISON FOR PEOPLE WITH SEVERE AND ENDURING MENTAL HEALTH PROBLEMS
8.8 The use of imprisonment is inappropriate for people with severe and enduring mental health problems. All prisons have concerns about this:
"Prison should never be a place for people with severe and enduring mental health problems. They should never be here."
8.9 Reasons given for this are that a prisoner's primary need is his or her mental health and the appropriate place to address this is in a hospital. Another reason relates to the unsuitability of the environment and the lack of treatment and services available, with concerns that imprisonment can do little to tackle the problems of prisoners with mental health problems. Many examples were given of individual prisoners who had been imprisoned when they required hospital treatment, and concerns were expressed about prisoners who were sometimes "very unwell". It was also suggested that there could be a high risk in trying to manage people who are acutely ill in prison, where there are not facilities for this.
8.10 People with severe and enduring mental health problems may be being sent to prison because there is no viable alternative in the community:
"Care in the community has become care in the prison system."
8.11 Prisoners should receive appropriate care in a hospital setting. It is important to ensure that they receive appropriate treatment outside prison and are not left unsupported in the community, or placed in other inappropriate facilities.
CONCLUSIONS
8.12 In terms of overall developments and improvements, the main conclusions are as follows:
8.12.1 There is some positive work taking place with prisoners with severe and enduring mental health problems, despite some of the difficulties and constraints. There is also potential for further developments.
8.12.2 There have been developments to the services available in prisons, in terms of the basic care provided, the overall approach to mental health, and conditions for prisoners. There have also been changes in local and regional secure mental health facilities, in terms of the composition of the overall forensic estate.
8.12.3 Progress has been made in terms of throughcare, and in the development of improved communication with external organisations.
8.12.4 The level of understanding of mental health issues in prisons has increased, and the knowledge and awareness amongst some officers has also increased.
8.12.5 The stigma associated with mental health problems has reduced, both inside and outside prison, but it still remains a major problem.
8.13 In terms of the use of prison for people with severe and enduring mental health problems, the main conclusion is as follows:
8.13.1 The use of imprisonment is inappropriate for people with severe and enduring mental health problems. Their primary need is their mental health and the appropriate place to address this is a hospital.
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