Mental health in prisons

Around one in four adults are diagnosed with a mental illness during their life and many more will experience changes in their mental well-being. Most research suggests that people in prison are more likely to suffer from mental health problems than people in the community. Complex social and personal issues such as history of unemployment, substance misuse or trauma are more common among the prison population, and being in prison can exacerbate poor mental health and well-being. Prisoners are less able to manage their mental health because most aspects of their day-to-day life are controlled by the prison. Many prisoners also move in and out of prison, or between prisons, which makes the job of providing healthcare more difficult. Prisoners whose mental health needs are not addressed may be more likely to reoffend.

Rates of self-inflicted deaths and self-harm have risen significantly in the last five years, suggesting that mental health and well-being in prison have declined. The number of self-harm incidents rose by 73% between 2012 and 2016. In 2016 there were 40,161 incidents of self-harm in prisons, the equivalent of almost one incident for every two prisoners, although some prisoners will self-harm multiple times. There were 120 self‑inflicted deaths in prison in 2016. This was almost twice the number in 2012, and higher than any previous year on record. In 2016, the Prisons and Probation Ombudsman found that 70% of prisoners who had taken their own life between 2012 and 2014 had been identified as having mental health needs. In February 2017, the Royal College of Psychiatrists stated that “rising deaths and other harms show there are failures in reaching prisoners who need general medical and specialist mental healthcare”.

Until 31 March 2017, the National Offender Management Service (NOMS), was responsible for prisons. On 1 April 2017 NOMS was replaced by a new executive agency called Her Majesty’s Prison and Probation Service (HMPPS). HMPPS retains NOMS’ responsibility for the operational management of prisons, but the Ministry of Justice will take on NOMS’ responsibility for prison policy and commissioning. This report refers to NOMS, as NOMS was the responsible body at the time of fieldwork and writing, but makes recommendations to HMPPS.

Responsibilities for mental health and well-being in prison are outlined in a partnership agreement, signed by NOMS, NHS England and Public Health England. It contains six objectives for health services in prisons, of which four relate to mental healthcare services:

• Prisoners should receive an equivalent health and well-being service to that available to the general population, with access to services based on need.
• Health and well-being services in prison should seek to improve health and well‑being, tackle health inequalities and wider determinants of health and contribute to protecting the public and reducing reoffending.
• Prisoners should expect to experience improvement in their health and well-being.
• Prisoners should expect continuity of care between custodial settings and between custody and community (including across the border with Wales).
NOMS (now HMPPS) is also responsible for ensuring that the prison environment is safe, secure and decent.