cell doorMental health services for prisoners need further improvement because there are still too many cases of poor practice, according to a report by the prisons and probation ombudsman.

Ombudsman Nigel Newcomen’s review on prisoner mental health, arising from his investigations into deaths in custody, found that while there have been some improvements in mental health services, many issues remained, including compliance with medication and inadequate staff training.

Mental ill health is one of the most prevalent and challenging issues in prisons and is closely associated with high rates of suicide and self-harm in custody. Mental health needs range from mild depression to psychotic illnesses and severe personality disorders. Echoing previous research, the review found that 70% of the prisoners who took their own lives had one or more identified mental health needs. 

The report considered the deaths of 557 prisoners between 2012 and 2014, including 199 self-inflicted deaths, where the prisoner had been identified as having mental health needs. 

The review makes clear the importance of identifying mental health issues, as without accurate diagnosis it is 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 people to present challenging behaviour, which staff may deal with as a behavioural, rather than 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.  

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 and healthcare staff working together or a lack of joined-up work between primary healthcare, mental health in-reach and substance misuse services

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 mental health needs can sometimes be very difficult to manage. Commendably, investigations also found impressive examples where staff went to great lengths to ensure prisoners in crisis received excellent care. 

“While there were many examples of very good practice, there were also too many cases where practice could and should have been better,” Newcomen said. “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.”