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Mental health crisis forces prisoners into inhumane isolation
IMB report highlights 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.

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Inhumane treatment

The Independent Monitoring Board (IMB) has today (25 January) published a report compiling the repeated failings that local IMBs have raised over recent years, as they continue to find mentally unwell men in care and segregation units (CSUs). The report says that owing to a lack of alternative provision, the prison service is too often using segregation as a way of managing and caring for prisoners with severe mental health needs.

The report

Independent Monitoring Boards (IMBs) monitor and report on the conditions and treatment of those detained in every prison in England and Wales. They have specific powers and responsibilities in order to effectively monitor the conditions and treatment of those in CSUs. Boards are notified when a prisoner is segregated, can speak to prisoners in CSUs in private, are invited to attend segregation review boards (SRBs), and can access and review all records.

This report provides an overview of outcomes for men in closed adult prisons with mental health needs who are being held in CSUs. It is based on:

  • A survey completed by IMBs at over 30 closed adult men’s prisons in England for four weeks during late Autumn 2022 
  • A follow up survey six months later in Spring 2023 completed by IMBs who had previously identified segregated prisoners waiting for transfers to more appropriate secure settings.
  • Findings from IMBs’ most recent annual reports.
  • Several IMBs’ recent correspondence to ministers, senior HMPPS officials and healthcare bodies raising serious concerns over the care of prisoners with mental health needs in CSUs.

Key findings

  • In recent years, almost all IMBs monitoring in prisons holding adult men have repeatedly raised concerns over CSUs not being a suitable or appropriate place for prisoners with mental health needs.
  • Prisoners with mental health needs were often held for prolonged and long-term periods in CSUs. IMBs found that this was mostly due to:
    • Men struggling to cope or refusing to reintegrate back onto the residential wings (referred to as ‘normal location’)
    • Lack of capacity in prison healthcare units or prisons with specialist functions
    • Delays in referral, assessment, and transfer to a secure hospital
    • There being no alternative, often because of a lack of diagnosis or men not having met the threshold for admission to a secure hospital.
  • Although most IMBs understood why CSUs were deemed the most appropriate place for these men to be held out of the limited locations available in prisons, there were still widespread concerns that CSUs were the only alternative for those who were acutely unwell and in need of specialist care.
  • For men who were already struggling with their mental health, their wellbeing and behaviour often deteriorated further while being segregated for prolonged periods.
  • Prisoners with mental health needs were often moved between different CSUs, healthcare units, or were returned to wings for short periods which made it harder to track the cumulative time some prisoners spent segregated.

Delays in transfers to secure hospitals

Prisoners with severe mental health needs who require care in a secure hospital or psychiatric intensive care unit (PICU) should be transferred within 28 days, as set out by NHS England guidance. During this time, prisoners should be referred for an assessment by the prison mental health team, assessed by the inpatient service and, if admission is required, transferred to a secure hospital or PICU.

Many IMBs have continually reported their concern that these target timelines were not being met and, as a result, prisoners who were acutely unwell with severe mental health needs were held for long periods in CSUs while they awaited transfers. This was a national issue, reported by IMBs across England.
IMBs found delays throughout the whole process: at referral, assessment, and transfer stage.

Consequently, there are frequent instances of IMBs reporting that prisoners in CSUs have waited over 100 days for a transfer to a secure hospital or PICU. Some IMBs have reported waits of over 200 days, with one IMB reporting a wait of over 500 days from start to finish.


It is clear that the decision to segregate any prisoner, especially those with mental health needs, is not taken lightly by individual prison governors. Despite this, the wider findings of IMBs in England show that CSUs are a frequently used tool.

Many of these issues are in no way the fault of prison governors or staff working in CSUs, who IMBs generally found to be compassionate, understanding and patient in challenging circumstances, often without sufficient training or resources. Overall, staff went to extensive efforts to support prisoners whose mental health was deteriorating, to keep prisoners at risk of self-harm and suicide safe, and to liaise with healthcare professionals to get more appropriate care.

While the prison service does need to find more humane and effective ways of caring for men with complex and severe mental health needs, the solution mainly lies outside of its remit, with a need for more appropriate mental health provision in the community. An increase in the number of mental health hospital beds of appropriate security levels, tighter controls on the transfer target and more effective monitoring of transfer time frames is necessary.

As is so often the case, prisons are having to fill the gaps created by a broken system.


Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here

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