The issues relating to imprisonment of individuals with mental health problems in the UK has attracted considerable attention, as the number of self-inflicted deaths has risen to the highest number since records began in 1978. With a rate of one prison suicide every three days, the director of the Howard League described the current rate as having reached “epidemic proportions”. The steady rise of deaths in custody has prompted a series of inquiries in recent years, and has drawn scrutiny from UN bodies and Special Procedures, and more recently, UN Member States as part of a periodic review of its human rights performance. However, despite this, little progress has been made.
In view of this reality, the Joint Committee on Human Rights launched an inquiry into mental health and deaths in prison in 2016 in order to determine whether a human rights based approach can help to prevent deaths in prison of individuals with mental health conditions i.e. one that satisfies acceptable standards as laid down by national and international human rights law, and recognises the particular position of vulnerability in which detainees are placed. The inquiry specifically looked at why previous recommendations had not been implemented. To this end, the Committee received both oral and written evidence from authors of the various domestic inquiry reports and individuals whose lives have been directly affected by the issue, including relatives of individuals who had committed suicide in prisons.
However, the inquiry was unexpectedly cut short as a result of the decision to call a snap election.
The upcoming election has also placed serious doubts over the possibility of enacting broader planned prison reforms. Nevertheless, the Committee published its preliminary findings, which present important opportunities for improvement, particularly its call for an independent oversight mechanism. Recommendations for reform need to be taken up quickly after the election is decided.
The clear need for reforms
The inquiry centred around three themes: 1) whether vulnerable offenders including those with mental health conditions and/or learning difficulties should be placed in prison in the first instance; 2) treatment of prisoners with mental health conditions; and 3) developing an understanding of how to ensure that future lessons are learned and mistakes are not repeated, and that good practice turns into common practice.
The Committee made several observations broadly relating to these three themes. Of particular note, the Committee found that on many occasions individuals with acute mental health problems were inappropriately placed into prisons as a ‘place of safety’, such as the widely reported case of Dean Sanders, which involved a number of “significant failings”. It observed that there are not enough resources being funneled into community alternatives to prisons for offenders with mental health problems, nor are these alternatives being adequately used, especially for offenders that are serving shorter sentences.
Additionally, there is a great difference between mental health services available in prisons compared to those available in the community, with some prisons lacking necessary services such as clinical psychology. Further, the documented reduction of prison officer training has left several unable to identify and respond to prisoner mental health issues.
The Committee also noted that Prisoners serving IPPs (imprisonment for public protection sentences) – a form of indeterminate sentence whose abolition in 2012 was not made retrospective in effect – were especially at risk of mental ill health.
Moreover, it identified that the increase in new psychotic substances has undermined the mental health of prisoners and general prison safety- in this regard, it should be noted that the former chief inspector of prisons, Nick Hardwick, stated that new psychoactive substances are now “the most serious threat to the safety and security of jails.”
Underpinning these suggestions is the Committee’s belief that there is a clear need for an independent oversight mechanism to handle the implementation of past recommendations, so as to ensure that lessons are actually learned. This was something that was dismissed as unnecessary by the government following the Harris Review in 2015. However, as explained in written evidence to the Committee by Inquest, the current framework is inadequate:
(2.1)… How the State reacts to the deaths of citizens in its care is an indication of how seriously it takes the protection of human rights. One important function of an Article 2 investigation and inquest is that systemic failures and evidence of any inhuman and degrading treatment that relates to the circumstances of the death, alongside the procedural duty to reduce risks and learn lessons, should be examined. Multiple inquests, inquiry reports, Inspectorate and monitoring reports, jury findings and coroners’ reports have made recommendations putting the State on notice of risks to the health and safety of people in custody. And yet no framework exists to ensure that these warnings are adequately responded to. This not only discredits the process but creates a culture of complacency…
At present, there are fragmented, ad hoc initiatives lacking in continuity. Recommendations are not monitored or followed up in any systematic way …
… there is an overwhelming case for the creation of a national oversight mechanism tasked with the duty to collate, analyse and monitor learning outcomes and their implementation arising out of custodial deaths. …
It is perhaps the possibility of not implementing this suggestion that will be most keenly felt.
The Committee made a number of important and practical recommendations, which would have addressed the identified shortcomings. In particular, a number of measures to improve the availability of staff and familial support were recommended, including a statutory duty to preserve a minimum ratio of prison officers to prisoners in each prison facility; a legal obligation for the prison service to provide every prisoner with mental health problems with a key worker; the ability to make free phone calls to a designated family member/ friend; and a mechanism to make the Secretary of State accountable to Parliament for maintaining fixed staffing levels (para.19).
Finally, the Committee planned to suggest an amendment to the purpose clause in the Prisons and Courts Bill, which would have made clear that one of the aims of prison is “to treat prisoners with humanity, fairness and respect for their dignity” (para. 20).
Resuming efforts to implement necessary changes
The need to resume the Committee’s work following the election outcome and further develop and push through these recommendations in order to effectively bring together and implement the findings of past inquiries is evident– and indeed, the scope for such a mechanism should perhaps go beyond deaths in custody and incorporate cross-cutting issues that permeate across the various kinds of detention, which have all come under great scrutiny and share a number of shortcomings.
It should be emphasised that the Committee’s recent call for better treatment of prisoners with mental health problems has emerged against a backdrop of increased concern for the improvement of mental health services more broadly, with many now pointing to the rise in mental health problems in the general population. Viewed in this way, there is clear momentum to make substantive changes sooner, rather than later.
It is perhaps fitting to end with the Committee’s final urge to the government to make the required changes, which must be appropriately responded to: “[t]here is a moral obligation on the Government to take effective action to reverse the alarming rise in the number of people with mental health conditions who lose their lives while in prison” (para. 23).
Munira Ali is the author of this post and a Senior Research Officer at the Human Rights Centre, University of Essex.