Record high levels of prisoner self-harm a 'damning indictment' of failures in mental health provision in jails

'Deteriorating' prison estate, long-standing understaffing and prevalence of drugs led to 'deep-rooted failures' in management of prisoners’ mental health, Public Accounts Committee finds

Government accused of 'deep-rooted failures' in management of prisoners’ mental health (Shutterstock)

Record high levels of self-harm in prisons are a “damning indictment” of the current state of the mental health provision in jails across England and Wales, MPs have warned.

A report by the Public Accounts Committee (PAC) reveals that long-standing understaffing and increased prevalence of drugs in jails have led to “deep-rooted failures” in the management of prisoners’ mental health.

While the Ministry of Justice (MoJ), HM Prison and Probation Service and NHS England have a duty of care to prisoners, the report finds that they do not know where they are starting from, how well they are doing or whether their current plans will be enough to succeed.

Self-harm in prisons in England and Wales reached a record high in October, with figures showing there had been more than 41,000 incidents in a year amid a surge in violence.

It comes after an analysis by The Independent of recent Osted reports found that children in custody were facing a “significant shortfall” in mental health provision, with some given no access to psychology services and having to wait more than half a year for treatment.

People in prison are considerably more likely to suffer from mental health problems than those in the community, and helping them meet these needs is an essential step to reducing reoffending and ensuring that those who are released from prison can rebuild their lives in the community.

Yet the Committee found that Government’s efforts to improve the mental health of those in prison so far have been poorly co-ordinated, and information is still not shared across the organisations involved – not even between community and prison GP services.

Prisoners miss an average of 15 per cent of medical appointments, largely because of a lack of staff to escort them, with the loss of prison staff already outstripping recruitment in some prisons, states the report.

Inmates with acute mental health problems should wait no more than 14 days to be admitted to a secure hospital – but the majority wait far longer than this. In 2016-17, two-thirds of prisoners who needed treatment waited longer than 14 days to be transferred – with some waiting more than a year.

The PAC also raised concerns over the fact that there is no reliable or up to date data on the prevalence of mental health issues in prison due to failure to establish effective screening procedures, with the most commonly used estimate – that 90 per cent of prisoners have mental health issues – now 20 years old.

The increased availability of drugs in prisons has also contributed to the increase in mental health issues of prisoners, with drug seizures in prisons having risen from 2,500 in 2015 to just over 10,500 in 2016. The number of seizures of spice has soared from 408 in 2015 to nearly 3,500 in 2016, figures show.

The MPs found that NHS England’s oversight of its contracts to provide mental health services had been weak failing to monitor the quality of mental health care delivered by private providers or the outcomes these services achieve.

NHS England was unable to tell the PAC how many cases there had been where a provider’s failure to provide adequate mental health services had contributed to an individual taking their own life. A recent National Audit Office report highlighted two examples where NHS England had continued to pay for services that the contractor had not delivered and had not acted to recoup any costs.

Meg Hilier, chair of the Public Accounts Committee, said there were “deep-rooted failures” in the management of prisoners’ mental health, reflected in what she said was an “appalling” toll of self-inflicted deaths and self-harm.

“Failing to attend to the mental health needs of inmates can also have devastating effects beyond the prison gates. The evidence is stark but there is no realistic prospect of these serious issues being properly addressed unless Government rethinks its approach,” the Labour MP said.

Urging that this must start with a meaningful assessment of the scale of the problem, she added: “Without adequate data it is simply not possible to determine whether Government action is making a difference – yet, incredibly, the most commonly used estimate of prisoners’ mental health problems is 20 years old.

“This is clearly not good enough and implementing more robust health screening processes must be a priority.

“There are long-standing issues with understaffing in prisons and, as the Government seeks to address these shortfalls, we will expect it to demonstrate swift progress with plans to provide enhanced mental health training.

Deborah Coles, director of charity INQUEST, which supports families of people killed in state-related deaths, said: “This report highlights the shameful record of self-inflicted deaths and self-harm in prison and the shocking admission by Government that it has no reliable data on how many people in prison have mental ill health.

“Tackling mental health in prisons means a dramatic reduction in the prison population, investment in alternatives and a more therapeutic response to those for whom prisons is the last resort.”

Responding to the report, an MoJ spokesperson said: “Every death in custody is a tragedy and we are redoubling our efforts to support vulnerable offenders, especially during their first 24 hours in custody.

“All prisoners are subject to health screening when entering prison and their mental health is monitored closely while they serve their sentence.

“In April this year we introduced new suicide and self-harm reduction training – over 11,000 staff have embarked on the new training. We continue to support the prisoner listener scheme, as well as providing extra funding for the Samaritans.

“We will continue to work closely with NHS England to improve services in a number of areas, including the process for prisoners who require transfer to secure hospitals.”

The spokesperson added that the Government was investing £100m to increase staffing by 2,500 officers and is taking “unprecedented action” to tackle drug use.

An NHS England spokesperson said: “In providing mental health care to people in prison, medical professionals deliver help in extremely challenging conditions to some of the most vulnerable people in our society, who often face complex health needs.

“Whilst of course we will always seek to make improvements working with government, the prison service and Public Health England, the National Audit Office recently stated that ‘the overall standard of healthcare in prisons is good’.”