Promoting and Safeguarding the Mental Health of Prisoners held in Segregation Units

Research

Research into the mental health of prisoners held in solitary confinement indicates that for most prisoners, there is a negative effect on their mental well being and that in some cases the effects can be serious. A study by Grassian & Friedman (1986) stated that, “Whilst a term in solitary confinement would be difficult for a well adjusted person, it can be almost unbearable for the poorly adjusted personality types often found in a prison.” The study reported that the prisoners became hypersensitive to noises and smells and that many suffered from several types of perceptual distortions (eg. hearing voices, hallucinations and paranoia). The study also found that many of the prisoners were prone to losing their temper easily and committing random acts of violence against themselves and others. Most prisoners had not experienced any of the above observations prior to entering solitary confinement.

The importance of treating prisoner’s as individuals and taking into account their personal circumstances when making decisions was emphasised in the judgment of the European Court of Human Rights in Keenan v. the United Kingdom (April 2001). The court held that Article 3, “No one shall be subjected to torture or inhuman or degrading treatment or punishment” had been breached. It said, “The lack of effective monitoring of Mark Keenan’s condition and the lack of informed psychiatric input into his assessment and treatment disclose significant defects in the medical care provided to a mentally ill person known to be a suicide risk. The belated imposition on him of a serious disciplinary punishment (cellular confinement)… is not compatible with the standard of treatment required in respect of a mentally ill person.”

Promoting mental health

The importance of safeguarding and promoting the mental health of prisoners held in segregation can be clearly concluded from the research evidence and the Mark Keenan case.

A prisoner on an open F2052SH must only be kept in segregation under exceptional circumstances.

The following list provides some suggestions as to how establishments can put measures in place to safeguard / promote the mental health of a prisoner held in segregation. The operational manager (or controller in a privately managed prison) who authorises initial or continuing segregation must show on forms Governor’s Authority for Initial Segregation / Governor’s Authority for Initial Segregation (Juveniles) or Segregation Review Board – Governor’s Continued Authority for Segregation (up to a maximum of 7 days) / Juvenile Segregation Review Board what measures they are putting in place.

1. Removal from segregation – if the mental health of the prisoner is so at risk as to suggest that they will be totally unable to cope with segregation then they should not be kept in the segregation unit. They could be kept as a patient in the Healthcare Centre instead (in seclusion if deemed necessary in the patient’s best interests). A suggested method of identifying these prisoners who are most at risk is given in the Segregation Safety Algorithm / Juvenile Segregation Safety Algorithm. Prisoners who are awaiting transfer to a secure NHS facility should not normally be kept in the segregation unit.

2.  Management of significant cases – where individual cases pose one or more difficult issues the nurse, doctor or governor may wish to seek further advice before deciding on any action. This may best be achieved by holding a case conference of appropriate professionals who can consider the balance of the issues and agree a way forward (which may involve seeking other opinions eg. from a psychiatrist, in-charge governor).

3.  Increasing the level of medical support – If there are concerns about how a prisoner is coping in segregation the number of visits by a registered nurse or doctor should be increased.

4.  Increased staff observations – staff could be asked to observe and speak to the prisoner at frequent intervals eg. every 3 hours / every hour / every 15 minutes / constant watch / cell with an overt CCTV camera etc. For prisoners on an open F2052SH the level of observation should be as stipulated in their support plan.

5. Opening an F2052SH – In the event of any incident of self harm or cause for concern that the prisoner may be at risk, an F2052SH will be opened.

6.  Listeners – Prison Listeners should be made available to prisoners in the segregation unit on a rota system. This needs to be advertised clearly within the segregation unit and include how prisoners should go about requesting a Listener. (Listeners are not used for juvenile trainees).

7.  Use of dedicated Samaritan phone – some establishments now have mobile telephones that connect directly to the Samaritan’s. This telephone should be made available to prisoners in segregation on request.

8.  Keeping in touch – prisoners should be encouraged to keep in touch with their families and friends as they will be able to provide support through difficult periods. Establishments must ensure that prisoners in segregation are able to receive visits, use the telephone and write letters (with assistance where necessary).

9. Exercise - prisoners should be encouraged to take any exercise periods that are offered to them. Establishments should consider allowing a prisoner in segregation to attend some PE / gym sessions in addition to the minimum daily exercise requirement in the open air. This is particularly important for juvenile trainees and young adult offenders.

10.Relaxation - prisoners’ mental well being will benefit from having access to things that they enjoy doing eg. watching TV, listening to the radio/CD’s, reading magazines/newspapers. Consideration must be given to allowing prisoners in segregation access to some of these things (which may represent privileges / incentives as detailed in Segregation Review Board – Governor’s Continued Authority for Segregation (up to a maximum of 7 days) / Juvenile Segregation Review Board

11.Education / hobbies – prisoners should be encouraged to do in-cell education or in-cell hobbies whilst they are in segregation if there are any concerns about their mental well being. This can help prisoners to avoid becoming bored.

12. Talking to someone – prisoners must be encouraged to talk about how they feel (particularly if they are feeling low or worried) to someone that they trust or feel able to confide in. This could be a segregation officer, personal officer, chaplain / religious leader, psychologist or any other person in the prison.