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The mental health crisis in prisons will continue unless root and branch reform takes place, a report by the Justice Committee has found.

A disjointed and incoherent approach to care has left many prisoners suffering from mental health issues undiagnosed and unable to access care. It calls on the NHS, Ministry of Justice and the Prison and Probation Service to implement a system of integrated care, that improves identification of mental health issues, provides seamless care while in prison and supports transition to care in community settings on release. 

• Read the full report (HTML)
• Read the full report (PDF)
• Read the report summary
• Read the report's conclusions and recommendations
• Find all publications related to this inquiry, including oral and written evidence

The report further calls for an end to practices that see prisons used as a safety net for when mental health services are inadequate or missing in the community. The Government must address the lack of capacity to support community orders with mental health requirements that means it is not a sentencing option in many parts of the country. The Committee also welcomes Government proposals to end the concept of prison as a ‘place of safety’ for those with acute mental health needs and calls for this practice to be abolished by 2022. 

Chair's comment

Publishing the report, Chair of the Justice Committee Sir Robert Neill MP said: 

“Mental health in prisons is not treated with the focus it needs. When there isn’t sufficient data to even give an indication of the scale of the problem it is clear that there needs to be concerted and systemic reform. We do not know how many people are missing out on the help they so desperately need or how effective current mental health support systems are and this needs to change fast. 

“We are calling on the Prison and Probation Service, NHS and Ministry of Justice to work together to develop an integrated approach to mental health in prisons. It must ensure that all prisoners with mental health needs are identified and guided to support services. Care must be seamless, both in accessing different physical and mental health support, and in ensuring a smooth transition to community care when leaving prison. 

“We have a duty of care to those who are in prison and we must do more to live up to it.” 

Understanding the scale 

Roughly 10% of the prison population are receiving treatment for mental illness, however as many as 70% may be suffering from mental health issues. The true scale of the mental health crisis is not well understood because data collection, on the extent of mental health issues and spending on treatment, is poor. Without this benchmark data it is not possible to develop strategies to improve support or assess the current quality of intervention programmes. 

The NHS should assess what shortfalls exist in mental health services in prisons and develop plans to ensure the level of support is equivalent to those outside, also taking into account the specific needs of those in a prison environment. 

Staffing 

Problems recruiting and retaining experienced, well trained staff need to be addressed or they will continue to impact on the ability of the prison and health service to provide mental health support.  

The Prison and Probation Service and NHS should develop plans that set out the steps they will take to improve staffing levels and publish these by the end of the year. Pre-employment checking processes should also be speeded up, where possible, to ensure that successful applicant can start work as soon as possible. 

Models of care 

More work is needed to implement integrated healthcare across the prison estate. Delivering healthcare seamlessly in a patient centred way, removing barriers between primary, secondary, mental and physical care, has proven successful in isolated programmes, such as SECURESTAIRS in the youth system. 

The NHS should commission integrated healthcare across the prison system so that prisoners can access the right mental and physical healthcare without undue delay.  

Prison as a mental health safety net 

No one should be in prison simply because mental health support in the community is not available. Too many offenders are sent back in prison because community orders with mental health requirements are unavailable in many areas. The Government needs to be much more ambitious and ensure that these orders are available in all parts of England and Wales by 2023, not its current target of 50%. 

The Government is right to end the use of prison as a ‘place of safety’ for people with acute mental illness. Prison is not a safety net for when health service provision is inadequate elsewhere. It should proceed with planned reforms set out in the Mental Health Act Reform white paper and ensure that the use of prison as a ‘place of safety’ is ended by 2022. 

Screening prisoners 

One in 12 prisoners do not receive a health screening appointment within 24 hours of arrival in prison, and BAME prisoners are less likely to have a mental health condition identified than white prisoners. The NHS needs to identify which establishments have a poor record for screening prisoners and put in place action plans to improve performance. It should also review the standards for carrying out health screenings to ensure that they are overseen by competent mental health professionals with experience of the criminal justice system. 

Prison officers and other operational staff play a crucial role in identifying prisoners in need of mental health support and directing them towards appropriate treatment. The Prison and Probation Service must ensure that staff are fully trained to ensure prisoners with mental health needs are supported, and provide regular refresher training. 

Continuity of care 

The transfer of information between community and prison support services needs to be improved. It is vital that prisoners maintain their care, including medication, when they enter or leave prison. The Ministry of Justice, Department for Health, Prison and Probation Service and NHS England should introduce arrangements to ensure prisoner medical records are swiftly available between prison and community settings. They should agree a target date for completing this work and develop a timeline for achieving it. 

Covid-19 

Covid-19 has placed additional pressures on both inmates and staff. Increased restrictions on their daily lives to prevent the spread of infections, as well as the anxiety of becoming ill are likely to have caused an increase in demand for mental health support. The NHS, Ministry of Justice and Prison and Probation Service should take urgent steps to increase mental health services over the coming year to deal with any increase in demand caused by the pandemic. Occupational health services should also be boosted to support prison staff.