In 1784, when John Howard – a prison reformer noticed the increasing number of inmates with mental illnesses in English prisons, he wrote that “no care is taken of them, although it is probable that by medicines, and proper regimen, some of them might be restored”. 233 years later, Howard’s statement rings particularly loud in the ears of our country’s prison system: a flawed framework that despite seemingly discouraging the continuation of violent behaviour has paradoxically exacerbated the mental wellbeing of inmates in British prisons with quite often, life-threatening consequences for some of society’s most ostracised demographics.
Against the backdrop of cuts to mental health services, the rate of prison suicides has long been on an upward trajectory; an increase of 32% within the last two years alone represents one of the highest surges on record. Therefore, the need for specific, sensitive and comprehensive mental health data within prisons in the UK is glaringly obvious. However, the National Audit Office claims that no data has been collected on the current prevalence of mental health illnesses by the Government, meaning that providing an appropriate budget for mental health support and services within prisons that is sufficient to meet the requirements of more than 85,000 inmates, is extremely difficult. How is it possible to make effective improvements within prison mental health services if there is no quantification of inmates’ mental health? How is it possible to know whether objectives have been met and whether prison mental health targets are realistic within specific time frames? Despite The Ministry of Justice estimating that the total health budget for adult facilities within prisons in 2016-17 was £400m, this value is not broken down into spending on physical versus mental healthcare spending, reflecting the neglect of prisoner wellbeing at a systemic and structural policy level.
Exacerbated by overcrowding and a reduction in prison staff across the UK where prison management funding fell by 13% in the last six years, the prevention of violent inmate behaviour is becoming more difficult, threatening the safety of both guards and prisoners. This likely source of stress contributes to the findings of the 2009 Bradley report that nearly half of all prisoners in the UK are at risk of anxiety and depression.
Deficient collaboration between healthcare staff and prison officers has increasingly meant that mental health and general services are not integrated, resulting in a growing number of inmates remaining in prisons despite their clinical symptoms requiring transfer to a secure hospital. Indeed, despite official regulations stating that prisoners with mental disorders should not have to wait more than 14 days to be admitted to a secure hospital, 35% of cases were not transferred within this time frame and 10% of cases had to wait longer than 140 days to be relocated. In these situations, prisoners can be a severe danger to both their own lives and others: a threat to the need for prisons to be safe environments for the recuperation and personal growth of inmates.
If the aim of prisons within a society is to try and prevent re-offence as well as discourage violent behaviour and violations of the law, then surely we should not in turn, violate the basic health rights of prisoners. Access to mental health services should be inclusive of everyone, including those who are incarcerated, the wellbeing of whom is important not only at the individual level but to communities as a whole.