| 4: SCOTTISH PRISON
SERVICE |
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| The Scottish
Prison Service is committed to commissioning health
services, including mental health services comparable
within the constraints of imprisonment, to those
available to other citizens. |
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| Provision in
Relation to Prisoners |
| 4.1 In the
light of the guiding principles outlined in
paragraph 1.5 problems of mental illness among
prisoners require a coherent response from the Scottish
Prison Service, the health service and local authorities.
This should take the form of a care management approach
to the extent that the problems of individual prisoners
warrant it and the constraints imposed by imprisonment
allow. This could be facilitated by service level
agreements between prison managers and health providers
and between prison managers and the relevant social work
departments. The aim should be the provision of a
continuous, integrated throughcare package which
maximises access to community based services at each
stage: health, community care services and specialist
voluntary sector services. So far as possible within the
constraints of resources and of imprisonment, the
Scottish Prison Service aims to provide or commission
services for prisoners with mental health problems in
line with best practice in the wider community. The
number of registered mental nurses within Scottish
prisons continues to rise, and they should be involved in
the assessment of those suspected of suffering from a
mental disorder. |
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| The Nature and
Scale of the Problem |
| 4.2 The
Prison Service will deal both with prisoners whose mental
disorder may be appropriate for medical intervention and
those whose disturbed behaviour is not the result of
mental disorder as defined earlier. While the number of
prisoners with psychotic illness who might be accepted
for transfer to hospital is quite small, research
suggests that the rate of psychological disturbance in
Scottish prisons could be at least twice that in the
general population and perhaps even higher among female
prisoners. Experience suggests that prisoners are most at
risk of developing, or suffering exacerbation of, mental
health problems in the period immediately following
reception, whether on remand or after sentencing. The
loss of social acceptance, of material possessions,
general medical conditions and separation from family,
friends and other social supports can be expected to have
a detrimental effect on mental health. |
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| Identifying and
Responding to the Problem |
| 4.3 Those
entering prison with a current mental illness problem
pose particular difficulties. For others, a period in
prison may expose an underlying condition, while some
prisoners may develop a mental illness for the first time
during custody. All such individuals need accurate
diagnosis and appropriate health and social care. Local
authorities will have an important contribution to make
towards identifying and helping these vulnerable
prisoners. For prisoners with mental illness, prison
managers in preparing such agreements will consider what
contribution might be made by relevant social work
services available within the community,
eg community care teams, mental health teams,
hospital social work, specialist voluntary sector
programmes, befriending schemes etc. |
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| The Mental Health
Needs of Prisoners |
| 4.4 The
following groups of prisoners, whether sentenced or on
remand, may seek health service intervention for problems
related to mental disorder, or be referred to medical
staff by concerned staff: |
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| (1) Those
who have a mental disorder which falls within the
categories set out in section 1 of the 1984 Act.
Prisoners in this group should transfer to hospital if
they meet the statutory transfer criteria of the 1984
Act. (2) Those who
have a mental disorder but who do not meet the criteria
for transfer to hospital.
(3) Those who ask for the
help of the caring agencies within the prison system,
although they may not specifically fall within
categories (1) and (2) above.
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| Psychiatric
Assessment and Treatment, including Transfer to Hospital |
| 4.5 Mentally
disordered prisoners need access to psychiatric care in
prison and, if their condition merits it, admission to
hospital services which offer an appropriate level of
security. Prisoners who do not meet the criteria for
hospital admission need to be treated in prison under a
suitable regime agreed with the psychiatric services or
on an "out-patient" basis. Specialist forensic
psychiatric care should be provided to all prisons with
links to local forensic and general psychiatric services.
Just as many in the wider community will receive
psychiatric care from a general practitioner, so many
prisoners will receive psychiatric care from the medical
officer (generally a visiting general practitioner). As
some offenders will develop a mental disorder while in
prison, The Prison Service must be able to identify those
who need psychiatric care and, where appropriate, to
arrange a transfer under the 1984 Act. |
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| 4.6 A person
who develops a mental disorder while in prison on remand
may not meet the statutory criteria for transfer to
hospital under the 1984 Act. In such cases access to
health and social work services in the community can be
arranged if the court agrees. The proposed system for
co-ordinating court reports (see paragraph 3.11)
will enable the courts to make full use of alternatives
to imprisonment. In order to ensure that those within the
Scottish Prison Service responsible for looking after the
needs of those who may be mentally unwell are able to do
so, it is proposed that copies of the psychiatric court
report accompanies the prisoner from court to prison.
This should be the responsibility of the Sheriff Clerk.
Reports should be marked "Confidential" and to
be opened only by health care professionals within the
prison. It is also essential that the prison medical
officer is able to access essential information about a
prisoner’s psychiatric history. Links should
therefore be formalised between prison medical officers
and psychiatrists who previously have been responsible
for a prisoner to ensure that relevant information is
made available to the prison medical officer. |
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| 4.7 Prison
managers should make suitable arrangements with health
boards for the rapid assessment and transfer of prisoners
suspected of suffering from a mental disorder. It is
proposed that prison managers should arrange appropriate
accommodation within the prison for psychiatric
assessment and prison medical officers should ensure that
full medical information on the prisoners being assessed
is available to visiting psychiatrists. |
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| Return to prison |
| 4.8
Prisoners transferred to hospital who recover from their
mental disorder within the period of their sentence are
required to return to prison. Similarly patients, to whom
the new hospital direction applies, will, when hospital
treatment is no longer needed, be required to transfer to
prison to complete their sentences. Effective liaison
should therefore exist between the responsible medical
officer and The Prison Service. It is proposed that
service commissioners should require treating responsible
medical officers to submit regular progress reports on
prisoner patients to the prison medical officer, visiting
psychiatrist and The Scottish Office, Department of
Health forensic psychiatric adviser. These reports should
provide an early warning for both the visiting
psychiatrist and the prison medical officer of any
intention to return the patient to prison so that the
necessary care and support can be allocated on the
prisoner’s return. At the point of return the
responsible medical officer should provide the prison
medical officer and visiting psychiatrist with an updated
report. The majority of such prisoners will be subject to
a restriction order and therefore cannot be returned to
prison without the approval of the designated Scottish
Minister. A warrant for this purpose should be requested
from The Scottish Office. |
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| Social Work
Services |
| 4.9 National
standards require prison-based social workers to give a
high priority to those prisoners identified as being
vulnerable, including those at risk of self-injury or
with other mental health problems. However, not all
prisoners falling within categories (2) and (3) of
paragraph 4.4 make use of social work services either
from choice or because of the priority that can be
afforded to the large number of prisoners received on
remand or for short sentences. |
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| 4.10
Prison-based social workers must be alert to the
possibility of mental health problems and possess the
skills to identify and assess the needs of such
prisoners, or have access to someone who can so advise.
They need to be able to recognise those factors which
have been identified as associated with increased
vulnerability amongst prisoners, eg isolation, lack
of contact with family and community supports, previous
contact with psychiatric and community-based mental
health services, previous self-harm, erratic behaviour
etc. It should be standard practice for those preparing
social enquiry reports to alert the social work unit in
prison to any concerns they may have about the mental
health needs of remand prisoners. This will allow
prison-based social work staff to respond accordingly.
They already have the obligation to alert prison
management where they consider a prisoner may be at risk
of self-harm. Equally, where prison social workers have
concerns about the mental health of a remand prisoner,
this information should be available to those preparing
social enquiry reports. Information about mental health
problems of prisoners, whether on remand or sentenced
should be shared between prison social work staff, prison
staff and health professionals on a need to know basis: arrangements
will need to be in place to ensure that this happens. |
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| 4.11 Once
community-based multi-disciplinary assessment procedures
are established as proposed in section 3 (paragraph
3.11), these could be used to assess offenders remanded
in custody who have mental health problems, to put
together individual care plans and increase the disposal
options available to the courts. |
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| Aftercare on
release |
| 4.12 Local
authority criminal justice social work staff have lead
responsibility for pre-release planning and assistance
with resettlement in the community for those prisoners
who will be subject to statutory supervision on release.
Where prisoners with mental health problems and those not
subject to supervision on release seek assistance with
resettlement in the community, decisions about whether
the lead responsibility for an individual care plan
should rest with health or community care social work
staff will be determined by the severity and complexity
of the prisoner’s mental health problem. In either
event, local authority and health personnel will require
to work together to ensure that the health and social
care needs are adequately met. Consultation with other
agencies which might have a contribution to make towards
the care plan is an essential part of joint work
involving housing, education, employment, social security
and specialist mental health organisations. |
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| 4.13 Where
prisoners are released on statutory licence, including
extended sentences, it is the responsibility of the
supervising officer to ensure that the conditions of
supervision are met, including any conditions which
require medical or psychological treatment and that any
such medical treatment is taking place. If it is not,
whether through non-compliance by the supervised person
or for some other reason, the supervising officer has to
decide what action to take, wherever possible in
consultation with the relevant health professional. Where
the supervisor considers there is a risk of self-harm or
harm to others as a consequence of failure to comply with
any of the conditions, this should normally result in a
report to the Parole and Miscarriages Review Division, of
the The Scottish Office Home Department along with a
recommendation on what action might be appropriate. In
the case of supervised release orders the supervising
social worker will report back to the court in every case
where treatment is not being provided, irrespective of
the degree of risk arising from the absence of such
treatment. |
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| Serving prisoners |
| 4.14 The
Scottish Prison Service is aware of the benefits of
developing multi-disciplinary supportive interventions
for prisoners with mental health problems. This involves
clinical psychologists, psychiatrists, mental health
nurses, occupational therapists, social work, residential
and education staff. The experience of the
Barlinnie Mental Health Project ("Open
Doors") suggests that this approach may offer a
useful model for improving the quality of mental health
services in penal establishments and may provide useful
lessons for wider application - both in terms of
preventing the inappropriate use of custody for remand
prisoners and improving access to community-based
services following sentence. |
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| 4.15 In
terms of regime development, under the sentence
management scheme the Scottish Prison Service is
developing further opportunities for group work
programmes and cognitive/behavioural learning. Assistance
with social support networks in the community and the
development of pre-release planning (as noted above, para
4.12) will also be important. |
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| The Service
Requirement |
| 4.16 The
Scottish Prison Service is developing service level
agreements with local authority social work departments
for the provision of all social work in prison, including
that in respect of prisoners with mental health problems.
Prison governors will enter service agreements with local
health service providers for a forensic psychiatric
service which will match the operational requirements of
penal establishments. The service level agreements will
cover the purchase of appropriate services from health
and social work. These agreements will specify the
identification and assessment of mental disorders, crisis
intervention and continuing treatment on the basis of
individual care plans, for those for whom transfer from
hospital is either not possible or delayed, and effective
programmes of aftercare. There should also be a specified
requirement to have local NHS beds available for
admission if required. The service specification should
also require a response within 24 hours for emergencies,
with urgent cases being dealt with within a week and
routine cases within 4 weeks of referral. |
