The Mental Health of Prisoners
2003
by Luke Birmingham
Psychiatric Bulletin of The Royal College of Psychiatrists

ABSTRACT

Mental health problems are the most significant cause of morbidity in prisons. Over 90% of prisoners have a mental disorder. The prison environment and the rules and regimes governing daily life inside prison can be seriously detrimental to mental health. Prisoners have received very poor health care and, until recently, the National Health Service (NHS) had no obligations to service this group, which was the Home Office’s responsibility. The NHS is expected to take responsibility eventually, following a new health partnership with the Prison Service. NHS psychiatrists will have to be much more active in the development and delivery of health care to prisoners who now have the right to equal health care. There are positive developments but concerted and determined action is required to bring prison health care up to acceptable standards.

EXTRACTS:

The current state of prison health care means that in-patients with mental disorder are liable to experience unacceptable restrictions and spend their days with little in the way of constructive activity (Reed & Lyne, 2000). Indeed, it is not uncommon to find that mentally disordered offenders held in prison health care centres are provided with less access to association, exercise and other facilities than are prisoners housed on ordinary location. Such restrictive practices, often surpassed only by the segregation regime in place, do little to address the treatment and rehabilitation needs of these individuals. Furthermore, low staffing levels and procedures for opening cells out of hours mean that it can take over 10 minutes to gain access to a prisoner in the health care centre at night. For prisoners with mental illnesses who are experiencing suicidal thoughts, this situation is quite unacceptable.

Segregation and close-supervision centres
Segregation is sometimes used as a punishment for prisoners who infringe prison rules. Some higher-security prisons also have close-supervision centres for the detention of inmates who are very disruptive and dangerous. Prison Service standard 55 (segregation units) requires that ‘the use of segregation achieves the correct balance between the requirement to maintain order and discipline and the respect for dignity’. In reality, the best a prisoner can expect in segregation is a basic level of provision offering minimal comfort combined with a highly restrictive regime. Some of the worst segregation units provide conditions that are filthy and inhuman (Her Majesty’s Inspectorate of Prisons, 1999b).

Prisons are unremittingly grim places that provide conditions wholly unsuitable for those with severe mental disorders. Despite this, the prison system in England and Wales probably houses thousands of people with serious mental illness and many more with other forms of mental disorder. This no doubt reflects a number of facts: offenders are particularly vulnerable to developing mental health problems; people with mental disorders are vulnerable to imprisonment; imprisonment is detrimental to mental health; and relatively few prisoners with mental illness are transferred to hospital for treatment.

Conditions vary enormously from establishment to establishment, but many prisoners have to endure unpleasant conditions and abide by strict regimes. Discrimination and bullying, isolation from friends and family, and long periods spent in confinement can place a considerable strain on a remand prisoner who faces uncertainty about the future or a convicted prisoner who is looking forward to a lengthy sentence. Illicit drugs with the capacity to exacerbate or induce mental disorder are also widely available in prison. The prospects for mentally disordered offenders are particularly bleak: in the majority their mental illness remains undetected and untreated and, if they transgress the rules, they risk disciplinary action resulting in loss of privileges and possibly even a period in segregation.