The long wait
Last month the Independent Monitoring Boards published a report highlighting the prison service practice of using segregation as a way of managing and caring for prisoners with severe mental health needs owing to a lack of alternative provision. Yesterday (6 February 2024) HM Inspectorate of Prisons published a thematic review of delays in the transfer of mentally unwell prisoners.
Entitled “The Long Wait”, the report found that just one in seven (15%) prisoners with severe mental health needs which could not be met in prison were transferred to a secure hospital within the required 28 day period.
Chief Inspector, Charlie Taylor, makes it clear in his introduction, that the level of harm and distress inflicted on unwell prisoners, their peers and the staff trying to care for them is almost unimaginable to those with no experience of the prison environment. Below are a number of excerpts from the report:
“To be clear, we are not talking about those who have the will and capacity to accept support during a mental health crisis or when they are at risk of self-harm. These include people whose psychosis or paranoid delusions can make them so violent they are held in isolation in the segregation unit, requiring multiple officers to unlock them just to deliver their meals. Or those so driven to harming themselves they have repeatedly blocked their own airways with bedding, removed teeth or maimed themselves to the point of exposing their own intestines, frequently causing life-changing injuries.”
“At Low Newton women’s prison in Durham the screams from the inpatient unit where the most mentally unwell women were held were so distressing that other prisoners told us they were put off going for their medical appointments. An experienced and dedicated prison officer told me, with palpable frustration, about his attempts to look after these desperate women without either the training or the resources to support them.”
“In almost every men’s prison I have set foot in since becoming Chief Inspector I have seen desperately unwell men awaiting transfer to hospital while being held in the bleakest of conditions.”
Only 15% of patients in the sample examined by the inspectorate were transferred within 28 days and waiting times for a bed were too long. The average wait was 85 days from the point it was identified that their mental health needs could not be treated in prison, with a range of three to 462 days.
The report highlights an additional seven key concerns:
- Despite a service within local courts to divert patients with acute mental health issues to community services, we continued to find people being placed in prison for their own protection, who were arriving in prison very unwell.
- There were delays for two-thirds of the patients waiting for a referral once it was identified that their mental health needs could not be treated in prison. In some prisons there were considerable delays for patients waiting for an initial referral.
- There was little oversight or accountability for the long waiting times for assessment and transfers, of the responsible commissioned health providers. Data describing access and waiting times for beds were not publicly available. There were no comprehensive national data on the number of patients awaiting transfer under the Mental Health Act and their waiting times.
- An urgent referral as a result of a patient’s rapid deterioration in mental or physical health did not guarantee prompt transfer, despite guidelines requiring a more rapid response.
- The outcomes for and experience of patients were not central to the transfer process. Patients did not receive an independent assessment which was accepted by all commissioned services, meaning that the process often included multiple unnecessary assessments.
- Patients, other prisoners and staff were coming to harm during the time it took to transfer patients. Patients’ conditions deteriorated, staff suffered assaults and the effect of supporting patients with a level of need for which they had not been trained.
- Very unwell patients were still being released back into the community while waiting for an access assessment for admission under the Mental Health Act. This meant that they were being detained by the community mental health team at the gate on release.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here