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HM Chief Inspector of Prisons
The use of imprisonment is inappropriate for people with severe and enduring mental health problems.
A thematic inspection report by Her Majesty's Chief Inspector of Prisons published yesterday highlights:
- At least 315 prisoners have a severe and enduring mental health problem (4.5 per cent of the prisoner population excluding HMYOI Polmont).
- The number of prisoners with these problems is rising.
- The fact of imprisonment and the nature of imprisonment do real harm to these people.
- The harm is exacerbated by overcrowding.
- There are a number of gaps in the identification of mental health problems and needs in prison.
- The use of segregation as a response to mental illness in prison is wrong.
- Some prisoners with severe and enduring mental health problems are released from prison with few if any links to continuing support in the community.
- There is some positive work taking place, despite the difficulties and constraints.
- Prison is an inappropriate environment for people with severe and enduring mental health problems.
Dr Andrew McLellan said:
"Over four in every hundred prisoners in Scotland was found to have a severe and enduring mental health problem. The number of prisoners with less severe forms of mental illness is likely to be much higher. The most common problems were schizophrenia and bi-polar affective disorder. Prison is unlikely to lead to an improvement in these conditions, and may exacerbate the problem, particularly when such prisoners are held in inappropriate locations such as segregation units.
"Prisoners with severe and enduring mental health problems can cause problems for staff and for other prisoners. They are resource intensive; can cause disruption; and lead to a charged atmosphere. The problems are exacerbated by overcrowding.
"There are a number of gaps in the identification of mental health problems and needs in prison including difficulties for prisoners in disclosing issues and problems with staff being able to identify issues. This can mean that some prisoners may not access assessment and referral.
"There are also a number of concerns in relation to existing provision: including variations and gaps in practice and treatment and a lack of day care facilities.
"Some work is carried out in prisons to assist prisoners in preparing for their release and in accessing support, but the nature of this varies, particularly in relation to the level of formalised planning undertaken. In many cases, prisoners being released have to approach organisations at their own instigation. Some prisoners with severe and enduring mental health problems are released with few if any links to continuing support in the community, and without any arrangements for the continuation of any work which had started in prison.
"In all prisons, residential and operational staff have an important, and increasing role, to play in relation to prisoners with severe and enduring mental health problems. Their role is less well defined than mental health specialists and a number of concerns were raised that staff: lack specific training; may lack confidence; may feel that they have not had sufficient guidance; may have insufficient time to interact with prisoners; and may lack information about the prisoner's problems and the impact of any steps they take in working with them.
"There is some positive work taking place, despite the difficulties and constraints. There have been developments in terms of the basic care provided; the overall approach to mental health; and conditions generally for prisoners. There have also been changes in local and regional secure mental health facilities in terms of the composition of the forensic estate. Progress has been made in terms of throughcare, and in the development of improved communication with external organisations. The level of understanding of mental health issues in prisons has increased, and the knowledge and awareness amongst some officers has also increased. The stigma associated with mental health problems has reduced, both inside and outside prison, but it still remains a major problem.
"Even with these improvements, prison is not the most appropriate environment for people with severe and enduring mental health problems. Their primary need is their mental health and the appropriate place to address this is in a hospital."
Under the terms of Section 7 of the Prisons (Scotland) Act 1989 (as amended) it is the duty of the Chief Inspector of Prisons to inspect or arrange for the inspection of prisons, legalised police cells and prisoner escort arrangements in Scotland. Following each inspection the Chief Inspector reports to Scottish Ministers on the treatment of prisoners and conditions in prisons. The Chief Inspector submits an Annual Report to Scottish Ministers. The Chief Inspector may also report on any matter connected with Scottish prisons as directed by Scottish Ministers. The report published today is a thematic inspection report on severe and enduring mental health problems in Scotland's prisons.