Improving the mental health of prisoners

Issues ranged from poor monitoring of compliance with medication and lack of encouragement to take prescribed drugs, to inappropriate care plans which were not reviewed and updated.

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Ombudsman says mental health is a priority for improvement

An important new (19 January 2016) report from the Prisons and Probation Ombudsman shares the learning about prisoners’ mental health issues sadly gleaned from the PPO’s investigations into a number of deaths in custody between 2012 and 2014.

Learning from PPo investigations: Prisoner mental health is based on reports of 199 self-inflicted deaths, in 70% of which the prisoner had been identified as having mental health needs.

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Identification of mental health issues critical

The review makes clear the importance of identifying mental health issues, as without accurate diagnosis, it is very difficult to provide appropriate treatment and support. Once a need is identified, effective intervention is required.

However, the identification and treatment of mental health issues among prisoners was variable and many areas for improvement remain.

One particular challenge for prisons is that some mental health conditions cause sufferers to present very challenging behaviour, which staff may deal with as a behavioural, rather than a mental health problem. This may lead to a punitive, rather than a therapeutic, response. Often this only worsens the prisoner’s underlying mental ill-health, further compromising their ability to cope.

It is disappointing that this situation continues to persist despite the fact that everyone involved with the prison system is well aware of the very high levels of mental health problems among the prisoner population. The report reproduces the figures from Singleton’s studies of 15 years ago:

mental health prevalence in prisoners

Other findings

The report sets out key learning through 18 different case studies of prisoners who sadly killed themselves. Among other findings, the report found a number of cases where:

  • there was poor information sharing, failure to make referrals to mental health professionals, inappropriate mental health assessments and inadequate staff training;
  • there was a lack of coordinated care, with little evidence of prison staff and healthcare staff working together or a lack of joined-up work between primary healthcare, mental health in-reach and substance misuse services;
  • issues such as length of sentence and IT literacy were found to be barriers to treatment; and
  • prisoners with mental health needs sometimes find it difficult to understand the importance of taking their medication and staff did not always remind or encourage them to do so.

Prisoners with personality disorder or a dual diagnosis of substance misuse and mental health were considered to be at a high level of risk.

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Conclusions

Although the Ombudsman’s report was very critical of much mental health practice, it is also at pains to say that investigations highlighted a substantial number of cases where:

staff went to great lengths to ensure that prisoners in crisis received excellent care.

Nigel Newcomen, The Prisons and Probation Ombudsman, concluded that despite these many examples of very good practice:

there were also too many cases where practice could and should have been better. Issues ranged from poor monitoring of compliance with medication and lack of encouragement to take prescribed drugs, to inappropriate care plans which were not reviewed and updated.

There have also been investigations in which we found that the provision of mental health care was simply inadequate.

Given the scale of mental ill-health in prison and the pressures in the system, it is perhaps not surprising that this review identifies significant room for improvement in the provision of mental health care.

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