Mental Health Problems are Rife in Prison
It will come as no surprise to any serving prisoner that many prisoners are affected by mental health problems and difficulties.
Within the main prison estate, up to 3\4 of men have been identified as suffering from two or more mental health problems.
A recent examination of Issue by the Prison Reform Trust and the Mental Health Charity MIND showed that 2\3 of men in prison are diagnosed with a personality disorder up to 2\5 show symptoms of such disorders as depression, anxiety and phobias.
In addition, men in prison have an extremely high rate of severe mental health problems such as Schizophrenia. Up to l\10 have such disorders and up to 1\5 men are prescribed medication such as antidepressants or antipsychotic medication.
1\5 male prisoners have attempted suicide at some stage in their life and a similar proportion being admitted for in-patient psychiatric care.
The situation within the women’s estate is at least as concerning if not more so.
As will be readily understood by those in prison, the regime in prison does little to help prisoners with difficulties. Many of whom are locked up for 23 hours a day. Prison staff are not trained to cope with mental health problems and are not mental health professionals. The Home Office have admitted that there are thousands of prisoner who should be immediately transferred to a secure psychiatric setting.
It seems that with the rise in indeterminate and longer sentences and the increasingly punitive approach of the Criminal Justice system the prison population is increasingly being made up of some of the most vulnerable members of society.
The Chief Inspector of Prisons was previously estimated that based on visits to local prisons that some 41% of prisoners being held in health care centres could and should be in secure NHS accommodation.
Transfer to Hospital
It is possible for serving prisoners to be transferred to hospital and to serve their sentence and be released from hospital without returning to prison. This is true for both determinate prisoners and fixed term prisoners and also lifers and IPP prisoners.
Nick Wells says, “It appears from my experience that many healthcare centres in prisons and psychiatrists are reluctant to properly assess and refer prisoners because of the costs”. It can be expensive to refer a prisoner for assessment to a Senior Consultant Psychiatrist and there appears to be a reluctance to do so. There is a tendency for healthcare staff and visiting psychiatrists in prison to try and manage prisoners within the prison estate and provided they are willing to take medication or accept treatment and are not too disruptive then they will try and hold them in the prison healthcare system or on the wings rather than refer them to secure mental health facilities.
This can have the effect that those who are more difficult to manage get referred to hospital for hospital admission rather than those who perhaps have the most need.
In certain circumstances it can be possible for a solicitor to obtain funding to refer a prisoner for a mental health assessment. This can usually only be done as part of the proceedings such as Parole Board Reviews etc, obtaining a positive opinion from a Doctor that hospital admission is appropriate can kick start the whole process and lead to transfer to hospital.
What happens on transfer to hospital?
In order for a transfer to hospital to take place under Section 47\49 of the Mental Health Act l983 it is necessary for two psychiatrists to submit reports to the Mental Health Unit at the Home Office that the criteria for transfer and detention in hospital are met. One of those writing the report will have to be offering a bed at a secure unit. The Mental Health Unit at the Home Office then authorises by means of warrant a transfer to hospital.
In respect of fixed term prisoners, a prisoner cannot be released by the hospital until their automatic release date. At that point it is important to realise that the hospital can still continue to detain the prisoner under what is called Section 37 (N) if they are still convinced that if the prisoner is still so ill that he needs to be detained in hospital for appropriate medical treatment. After that point the Doctor from hospital can release the prisoner or there is a right to appeal to the Mental Health Review Tribunal.
With indeterminate sentence prisoners, the prisoner will not have an automatic release date. It is still possible to be released without returning to prison. If the hospital and doctors feel that sufficient progress has been made that they would be considering release the Mental Health Review Tribunal can be asked to sit and confirm this view. The Tribunal will also make a direction that the prisoner should not return to prison because he or she would deteriorate and this will then trigger the Parole Board to come and sit at the hospital and to consider the case in the usual way.
There are a group of prisoners who very much do not wish to be transferred to hospital. These are mainly prisoners who have been identified as presenting a high risk of reoffending and who are on fixed term sentences.
It is very unfortunate that having often held these prisoners within the prison system for most of their sentence, they are often referred to secure units close to the end of their sentence and indeed most prisoners will have been aware of others who have been taken to hospital shortly before their automatic release date and detained in hospital thereafter. It is very difficult to prevent such a transfer provided there are two psychiatrists who are willing to say that the individual meets the criteria for detention under the Mental Health Act. Upon transfer however, the prisoner does have the right to challenge the decision by applying to the Mental Health Review Tribunal and in the course of these applications independent psychiatric reports can be obtained.
It is important that prisoners try and seek help. Research suggests that prisoners are twice as likely to be refused treatment for mental health problems inside prisons than outside.
The information above is just a brief overview of the position of prisoners who have mental health difficulties. Each prisoner’s case is unique and has their own individual set of circumstances and needs careful advice regarding what is best for them as individuals.
Part I of a 2 part Article on Mental Health.
Next is about what happens to prisoners who are transferred and the structure of Mental Health facilities.
Nick Wells and Joanna Dean at Swain and Co. Liverpool office and Adrian Syms at Southampton and Melanie Land at Havant have extensive experience of representing clients in Mental Health matters.