5. MAJOR CUSTODY ISSUES

Introduction

5.1 In his initial briefing at the start of the inspection, the Governor outlined his major concerns for the establishment, which were as follows:-

5.1.1 Until comparatively recently, there had been very little financial investment in the fabric of the prison, though latterly there had been the much needed introduction of integral sanitation in both Halls, the construction of a new gymnasium and the provision of excellent Mandatory Drug Testing (MDT) facilities. However, additional accommodation was now needed in order to cope with rising population levels. Whilst this overcrowding could not be met by external expansion, the Governor’s view was that an extra cell-block could and should be built within the present five square acre perimeter. The Governor had, in fact, concluded that if numbers continued to rise and no additional accommodation was provided, the prison might be unable properly to fulfil all its functions within the next 2-5 years - or that many remand or convicted prisoners might have to be held elsewhere (eg, at Peterhead or Perth).

5.1.2 Various option appraisals had been undertaken and had identified the following additional requirements:-

• A separate, self contained Operations Room and expanded visits facilities (both of which had been central recommendations in our previous formal report). Such a development could incorporate a new staff facility, which had also been identified as requiring expansion.

• A Day Care Unit (DCU), following the recent publication of a new National Suicide Strategy (see also paragraph 5.31).

• In addition:-

(i) the Health Centre greatly required expansion; and

(ii) the worksheds urgently required to be upgraded.

5.1.3 Drug misuse had risen significantly in the community in recent years, which in turn had contributed to overcrowding due to the increase in local crime. There were indications that misuse had also increased in the prison, but the Governor and staff thought that their tough enforcement policies were having an effect on prisoners and that illegal substance use inside the prison might be on a lower scale than found elsewhere.

5.1.4 Suicides and incidents of self-harm had been increasing in recent years and were a source of constant concern to Management and staff.

5.2 Our observations on the issues raised by the Governor - and other issues - are shown below.

Investment/Overcrowding

5.3 Average overcrowding rates since the last formal inspection are as follows:

5.4 At the time of inspection, the population was 212 which had resulted in an overcrowding figure of 43%.

Comment

5.5 We support entirely the Governor’s view that despite the introduction of integral sanitation, other investment was failing to keep pace with the population growth. In the course of our inspection we were confronted by the fact that most prisoners were now having to double up in cells designed for one; in addition, we were concerned to find that remand prisoners were frequently being held in the convicted Hall, as well as being doubled up - a situation that cannot be sustained indefinitely.

5.6 Convicted prisoners were also prevented from taking part in a variety of activities, such as drug reduction and other offending behaviour programmes, because there were insufficient resources to support their inclusion. Equally, visit facilities - which were extremely cramped - were now reaching the unacceptable stage (see paragraphs 6.54-60). As we have noted in other establishments, pressures caused by overcrowding inevitably meant that staff were on occasion unable to devote sufficient time to those prisoners who were in most need of attention - particularly YOs, individuals in the early stages of sentence or those being held on remand.

5.7 We agree with the solution suggested by the Governor, though we recognise that the construction of a new accommodation block - whether a temporary arrangement (such as Letham Hall at Barlinnie) or a permanent construction - would be a major commitment for the SPS. We therefore recommend that a detailed survey of local custodial trends be undertaken, accompanied at the very least by much more robust contingency planning for a burgeoning prisoner population; this should include staffing levels as well as buildings.

Drug Abuse

5.8 In the report of our previous inspection, there had been passing reference to drug abuse. Four years later, however, it had become apparent that this had been on the increase in the North East of Scotland with the result that individuals were arriving at the prison gates with well established habits or addictions. Recent MDT results were showing that 36% were producing a positive sample, though we assessed that the overall number of those resorting to drugs in custody was probably higher than this figure. Three types of probable users were identified:-

• Occasional drug users - probably the majority - who it would appear, were smoking mainly cannabis for recreational purposes.

• Regular abusers of a variety of drugs which included the chasing and smoking of heroin (or cannabis if there were no other supplies available or shortages of silver paper for chasing, etc).

• An indeterminate but probably small number of injectors - including those with a previous history of injecting and/or those resorting to opportunistic injecting in the absence of certain types of drugs. (Whether or not needles were being shared could not be assessed.)

Other evidence of increased drug abuse since 1993 included:-

• The number of disciplinary cases coming before the Governor (see also paragraph 4.4) of which more than 10% were MDT related.

• The number of drug finds - though this could be evidence of much improved intelligence targeting. In the last 12 months there had been 104 drug finds (including 24 syringes) which had taken place either during visits or as a result of finds in the Halls.

• An increase in the number of visitors being excluded from the prison and the number of prisoners being confined to closed visits (though both are also an example of tough enforcement - see paragraph 5.10).

Anti-Drug Strategy

5.9 The prisons anti-drug strategy relied on the following elements:-

• Supply Reduction

• Demand Reduction

• Harm Reduction

(i) Reducing Supply - Deterrence and Punishment

Searching

5.10 The Governor had set extremely demanding standards for searching, a fact which was frequently echoed by staff, prisoners and some families throughout the course of our visit. However, illegal drugs were still getting into the prison - including some which were being thrown over the wall - though overall we concluded that prisoners could not rely on the regular supply of any particular type of drug. Limiting the access of vehicles to the prison might be an area worthy of further examination.

Mandatory Drug Testing

5.11 The MDT Unit had been operational since February 1997 and enjoyed spacious and well equipped accommodation. Its complement was two full time Officers, assisted on a part-time basis by two female Officers for the testing of women prisoners.

5.12 Prisoners who were selected for testing were collected by Unit staff who then supervised the process from start to finish, including the issuing of charges to those found to have tested positive. Remand prisoners were included in the programme, testing had recently been extended to the week-end and in November 1997, testing was extended to the reception stage. Unit staff also participated in the induction programme.

5.13 Since it had opened, 320 prisoners had been tested. Of that total, 129 had tested positive, though 45 of that total had been discounted for medical reasons, resulting in 84 prisoners actually being charged. Additional detail is shown on the chart at Annex 1.

(ii) Demand Reduction

5.14 A drug reduction programme (DRP) had been in operation for two years until February 1997. During that time, 220 prisoners had been through a programme which had originally consisted of extensive education/counselling and group work in addition to detoxification. However, overcrowding and the consequent over-stretching of resources had prevented its continuance in such a comprehensive form - more especially in drug education - and had also prevented the creation of a permanent location for the DRP within the prison.

5.15 At the time of inspection, prisoners on admission who admitted to drug dependency were referred to the drugs co-ordinator (see paragraphs 5.19-21) for assessment and initial counselling. Confirmatory urine tests were made to establish the drugs being used and in cases where prisoners were being maintained on drugs prescribed in the community, contacts were made with the relevant general practitioner. (No medication was given to prisoners prior to the results of the confirmatory tests, unless they were suffering symptoms of acute withdrawal.) However, once the facts of drug usage had been established, prisoners were offered a two week detoxification programme, which could involve dihydrocodeine, benzodiazapines or occasionally, lofexidine.

5.16 The only exceptions to this drug management protocol were those who previously were on a methadone maintenance programme in the community and were to be in prison for less than seven days. Once confirmation of prescriptions was received, such prisoners were offered methadone (up to a maximum of 50 millilitres per day).

5.17 Prisoners were expected to sign a contract on entry to the detoxification programme and remained in their Halls throughout its duration. Blood tests for HIV and Hepatitis were available to prisoners on a voluntary basis and part of the work of the drugs co-ordinator was to provide some counselling both before and after such tests.

5.18 Prisoners who completed a drug detoxification programme were offered subsequent support by the drugs co-ordinator and his team. Nevertheless overcrowding meant that it was not possible to provide a drug free area within the establishment, which greatly reduced the long term value of programmes.

(iii) Harm Reduction - Drug Addictions Work

5.19 A prison drugs co-ordinator had recently been appointed, whereas previously the work of co-ordinating the anti-drug abuse programme had been carried out by a part-time drugs worker employed by Drugs Action and funded by Grampian Health Board. At the time of inspection, that latter person was still in post, but only in an advisory capacity to the new drugs co-ordinator until such time as he had gained sufficient experience.

5.20 The drugs co-ordinator was based in a small office on one floor of a temporary building, though in our opinion permanent accommodation would be a more suitable arrangement. He was assisted by part-time drugs officers who were members of the Residential staff and whilst they did their best to help with liaison, the demands of their custodial work greatly restricted the amount of time spent on dealing with drugs issues.

Comment

5.21 We were most impressed by the overall commitment to the tough drug enforcement policies which undoubtedly were having a considerable effect on the regular supply of drugs into the prison. Meanwhile, we recognise that the DRP was currently in a transitional phase. Previously, there had been a period of considerable development involving the original drugs worker, which had included the participation he had brought in from community based drug groups. We hope, therefore, that in the months ahead, the DRP will be able to consolidate, to renew its impact and to even up the balance in the prison’s overall drug strategy. However, in view of the fact that the demands of custodial work are having an impact on the amount of time currently available for counselling and health education, we recommend that the two part-time drug officer posts be made full-time as soon as possible.

5.22 Finally, it should be recognised that a combination of the prison’ compactness, its tough enforcement policies and a future revitalisation of its rehabilitation programmes could provide valuable opportunities, perhaps not available elsewhere in the local community, for those with serious drug problems. Our suggestions for other improvements include the following:-

• To help give it the priority it deserves, the Deputy Governor should chair a reconstituted Drugs Strategy Group (see paragraph 8.2) which should also include regular input from outside agencies to ensure cross fertilisation and to maintain contact with developments in the local community. Further possibilities for joint funding should also be re-examined.

• Drug Education Groups should be reconstituted - as per the week long programmes previously in place.

• A drug awareness programme should be developed for all staff, including members of the Visiting Committee (VC).

• Further drug surveys should be instituted and followed by much more clear and flexible policies for detoxification.

• Better counselling facilities are needed (ie a proper, dedicated room).

• There should be more incentives/alternatives for prisoners to remain drug free - including more accommodation to allow for the establishment of proper drug-free areas, coupled with more physical activity and sport and less boredom at week-ends.

• There should be an expanded Hepatitis B Strategy which should also give consideration to the vaccination of appropriate prisoners, cost notwithstanding (the possibility of joint community funding might be investigated).

• More comprehensive information on how to avoid Hepatitis C should be provided.

• More information for families is required and consideration should be given to involving them in the prison’s anti-drugs strategy; this is particularly relevant as the release stage approaches.

• Throughcare arrangements need to be more thorough and should, for example, involve community drugs workers.

Suicide

5.23 Since 1993 there had been four deaths in custody, all of which (subject to the findings of Fatal Accident Inquiries) were suicides.

5.24 Specifically as regards suicide, in the three years preceding our 1993 formal inspection there had been no such fatalities; however, it would appear that this had subsequently risen to four, three of which had occurred within the last 18 months and all of which had involved prisoners on remand.

5.25 The overall responsibility for suicide risk management within the prison was undertaken by the Suicide Risk Management Group (SRMG). Meeting every two months, the Group was chaired by the Deputy Governor with membership comprising the Psychologist, Psychiatrist, Senior Social Worker and Drugs Co-ordinator as well as representatives from the Health Centre, Chaplains and Management. More recently the Samaritans had also been included (see paragraph 5.29). Meetings of the Group normally received reports from the MO, Clinical Supervisor, Psychiatrists, Psychologist and Social Workers.

5.26 Prisoners who were considered to be possible suicide risks were seen daily by the MO and by members of the nursing team. The frequency of psychiatric clinics provided additional support for those giving cause for concern, with approximately 85% of prisoners at risk being seen by a psychiatrist. The present arrangement for monitoring those who were thought to be at risk of self-harm was to place such individuals in ligature free cells, this being the the only option as the prison did not have its own separate ward facilities.

5.27 Female prisoners who required suicide observation posed a particular problem as there were no suitable facilities for their management in the Female Unit. For that reason, it was necessary for any individual who was considered to be at risk to be transferred by road to HM Institution Cornton Vale, a journey of some 120 miles. As an overnight holding operation, a female prisoner might be kept in the Segregation Unit if it was too late in the day to transfer her immediately. In our opinion, however, these arrangements were far from satisfactory, a view which was shared by the Governor. We suggest, therefore, that proper facilities should be provided for female prisoners requiring suicide observation.

5.28 From the information provided it appeared that during the course of the year, up to 200 - 250 prisoners had been under some form of observation. In the previous 12 months, 17 prisoners (including one female) had been admitted to hospital as a result of an incident involving self-harm.

5.29 A revised national suicide strategy was currently under consideration and had been translated into a comprehensive policy document at local level. The Samaritans, who previously had been unable to provide regular help, were also becoming more involved - mainly through additional staff training and awareness. They were also considering the possibility of training some longer term prisoners as ‘Listeners’.

Comment

5.30 The meetings of the SRMG appeared to be well attended, whilst the minutes of recent meetings indicated a willingness on the part of its members to share information and to maintain a very high standard of care for vulnerable prisoners.

5.31 However, the poor physical arrangements for prisoners requiring observation were exacerbated by a lack of 24 hour nursing cover - see paragraphs 8.17 and 8.22 - and the lack of a therapeutic environment. Given the present incidence of self-harm (17 attempted suicides in the last 12 months) in such a comparatively small prison, a DCU - as already established at several other comparable prisons - is the obvious solution and consideration should now be given to creating such a facility.

Violence

5.32 Statistics for the twelve months prior to our inspection were as follows:-

Comment

5.33 Contrary to the disturbing picture we had seen at several other local prisons, we were pleased to note that serious violence was on a relatively reduced scale, a situation which reflected well on staff/prisoner relationships. Whereas elsewhere we have tended to see a connection between drug abuse and violence, it would seem that this did not apply to the same degree at Craiginches. How much this could be due to the compactness of the prison and/or the nature of local prisoners was, however, more difficult to determine.