Mental Health and the Criminal Justice System

Men, and to a lesser extent women, with mental health conditions constitute a considerable proportion of the prison population. The National Institute for Health and Care Excellence (NICE) approximate that 39% of people detained in police custody, and 29% of those serving community sentences, have a mental health issue.

Furthermore, an estimated 76% of female, and 40% of male, remand prisoners have been diagnosed with a mental health disorder. Worryingly prison environments are strongly associated with mental health crises and the rates of self harm and suicide continue to rise in most UK penal institutions.

In response, the Government and various public bodies have undertaken measures to improve mental health support for those involved in the criminal justice system (CJS) and minimise discrimination, as well as unfair criminalisation. In 2017, NICE published guidance on assessing and managing the mental health requirements of adults involved in the CJS, offering recommendations on the organisation of services and planning of care, but sadly their enactment in the prison service has been under-resourced and consequently slow.

More needs urgently to be done, therefore, to improve the identification and understanding of mental health problems across the CJS to ensure safe and effective care for people transferring from one custodial setting to another. Although the prison population is predominantly male, women in the CJS are especially vulnerable to mental ill health. Suicides among recently released female prisoners are forty times higher than in the general population. The widespread usage of ‘Spice’ and other similar psychoactive substances within the prison system is almost certainly exacerbating the problem.

Clearly much more needs to be done to improve the current dire situation. Do add your comments and suggestions to this blog.

Comments (7) Add yours ↓
  1. gordon muir Urology Consultant

    Mental health is not the only issue. It is always depressing when an inmate fails to attend for prostate cancer follow up (and of course the prison population has a higher risk of the disease due to the disproportionate number of black men who are incarcerated.)

    Whether due to moving prisons, poor social status on release or underlying MH problems their continuity of cancer care must be among the worse in the UK

    July 23, 2018 Reply
  2. Michael Wills Retired

    Highlight longstanding problem and one too long marginalised by policymakers. Effective remedies need significant upfront investment and even though the long term returns should more than repay this both financially and in creating a more humane society, for the last ten years politicians have found it difficult to make this short term/long trade off

    July 24, 2018 Reply
  3. Ben Challacombe consultant urologist

    Roger
    thanks for highlighting this. I have always found it very challenging dealing with prisoners coming into my clinics. They have a really bad deal from the start with often no warning that they are coming until they set off, no family support, examination and counselling with guards in the room, and of course the added burden of their frequent mental health issues. We need to be cogniscent of these issues and make sure they have more support not less from the whole team and a clear treatment plan.
    With regards to addressing the actual mental health problems it sounds like there should be a liaison psychiatrist linked to every prison with regular clinics to try and improve these awful suicide and self harm outcomes. Mr David Sellu’s recent emotional account of his incarceration at the BAUS meeting also highlighted these important issues for those in custody.

    July 24, 2018 Reply
  4. Christian brown Consultant urologist

    I share these concerns. King’s College Hospital serves a large London prison and I have seen through my career at King’s areas of concern. As a surgical SHO I remember abscesses and acute abdomens managed in the prison and only coming to hospital when the patients were severely sick.

    Elective diagnostics are also delayed with high DNA rates and failure to complete for example haematuria investigations. I have always found the attending prison guards helpful and we compete the documentation but what happens next it anyone’s guess….this must cause severe distress to the patients adding to their already fragile mental state.

    July 27, 2018 Reply
  5. Bobby Head Content

    Thanks for posting this information with us Roger, this is helpful!

    July 28, 2018 Reply
  6. Roger Kirby Professor of Urology

    A meeting worth attending: https://trendsinmenshealth.com/events/improving-the-mental-health-of-those-in-contact-with-the-criminal-justice-system/

    August 1, 2018 Reply
  7. Roger Kirby Professor of Urology

    Criminals suffering from mental illness, alcoholism and drug addiction will be diverted away from prison and into compulsory treatment under a government pilot. The Ministry of Justice aims to reduce reoffending by replacing “ineffective” short prison sentences with programmes that “will tackle the root causes of criminality”.

    A judge said the scheme could help “nip in the bud” some of the major causes of crime, as statistics show significant proportions of offenders have mental health problems, or are affected by drug and alcohol addictions. David Gauke, the justice secretary, has been pushing against the use of short prison sentences amid a crisis driving drug abuse and record self-harm and violence in overcrowded jails.

    “We are all clear that we need to do more to support vulnerable offenders in the community,” he is to say while announcing the programme in Northampton. “I want to improve confidence in community sentences, and early evidence from these sites has shown that treatment requirements can have a significant impact in improving rehabilitation and addressing the underlying causes of offending. We need to do more to raise awareness and increase confidence in treatment requirements and I look forward to exploring how these sites progress.”

    Plans drawn up with the NHS, Public Health England and Department of Health are being tested in five areas before the government hopes to roll them out nationwide. They see psychologists stationed in courts to assess offenders whose crime makes them eligible for a community order, while local panels of judicial and health officials will liaise with magistrates and judges.

    August 10, 2018 Reply

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