The Mental Health Effects of Being in Prison

As the NHS England’s Director of Health & Justice, I believe you will find this of great interest. It is commonly known that inadequate mental healthcare in prisons in the UK has been an alarming issue, with increasing mental health illness among prisoners. According to the House of Commons Committee of Public Accounts, a staggering figure of 90% of prisoners is of those with a mental illness, including actions of suicide and self-harm. As stated by the Prison Reform Trust, which aims to inform the public of prison standards and improve treatment of prisoners, 40% of prisons had ‘inadequate or no training’ years 2016-17 for officers whose responsibility it is to refer prisoners for support.

It is no wonder that the PPO (Prisons and Probations Ombudsman) discovered that in 29% of suicide cases, no mental health support referral was made even after such needs were initially identified. Overall, as much as 70% of prisoners who committed suicide had been identified with mental illness. This suggests that it could have been prevented with a robust and effective scheme for mental health support, as the current basic training is insufficient.

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This is a current issue highlighted by the abundance of campaigns to improve care in prisons such as: ‘Inside Reform’, ‘Care not Custody’ and ‘Too little Too late’.

Particularly the ‘Care not Custody’ campaign was inspired by a tragic death of a young prisoner who took his own life in Manchester prison. He suffered from schizophrenia and did not receive the necessary treatment. Ginn (2012) expands on these issues in the article ‘Dealing with Mental Disorders in Prisoners’ from the BMJ.

Criticising the short and basic mental health examinations of prisoners coming into the prison, Ginn reinforces that this fails to identify many mental health disorders in inmates, especially those more severe ones. These are also said to be undertaken by insufficiently trained staff, which appears to be a consistent back fall of prison’s ability to provide support. Firstly, the outstanding issue of a lack of trained staff working with vulnerable inmate needs to be addressed. A mandatory scheme should be implemented to raise awareness, knowledge and the competency of prison staff in terms of mental illness in their institutions. All current and future prison workers, who’s responsibility it is to make assessments of prisoner’s mental health and refer interventions, should complete a specially designed training course. They then should be overlooked by senior members of staff to ensure this is being undertaken appropriately.

Secondly, a thorough assessment should be made upon arrival all prisoners, this way everyone can be monitored. Especially since the Human Rights Watch (2003) suggested that suicide is at its biggest increase in the first week, mental stability needs to be assessed early on. Also, because there is evidence for early intervention being beneficial in reducing symptoms of depression and anxiety (Sorensen, Larsen, Bording and Munk-Jorgensen 2013) as well as schizophrenia (McGlashan 1996). Following on from this, a scheme should be implemented where every 3 months, prisoners are checked up on to ensure their needs are not being neglected. The time between check-ups should vary depending on the mental illness severity and needs of the individual. Goodman, McKay & DePhillippis (2013) found evidence for progress monitoring significantly improving mental health by making treatments more effective. Not only this but trust and engagement in the treatment is also shown to improve.

Feedback should also be implemented given to the prisoners about their progress, as this is also a strong factor which results in positive outcomes of treatment (Goodman et al. 2013). This would not only benefit the prisoners themselves, but also their families if their loved ones are given the appropriate support. The society could potentially become a safer and one of less crime, since there is evidence research for treatment leading to less reoffending in some offenders. For example, one third of experimental studies into treatment and reoffending across the world showed strong effects of treatment on the reduction of repeating sexually motivated crimes (Brooks-Gordon and Bilby 2006). Other types of offenders which threaten the society are gang members. Placido, Simon, Witte, Gu & Wong (2006) found that following an intensive cognitive behavioural therapy programme, gang members repeated offences significantly less. Such treatment is an expense, but Placido et al. (2006) estimates that it outweighs the cost of reoffending as well as human costs of not implementing such treatment.

Therefore, such treatments can be considered valuable and rewarding. In closing, it is clear that there are overwhelming benefits to the mentioned changes. The three aims are to improve training of workers to ensure effective identification and treatment of disorders, conduct mandatory and thorough assessments of all prisons upon arrival and to organise regular check-ups on prisoners’ mental state whilst they’re in prison. It should be seen as a righteous investment into the dignity and well-being of the citizens in our society. Recidivism rates and mental illness will not decline if changes aren’t employed to help the vulnerable. I hope you will carefully consider this as a matter which needs immediate action.