Source · Select Committees · Justice Committee
5th Report - Mental health in prison
Justice Committee
HC 72
Published 29 September 2021
Recommendations
3
Accepted
Para 26
Set out plans to bridge fragmented healthcare service gaps for prisoners
Recommendation
Healthcare services can be fragmented, meaning people receive no or inadequate care. NHS England and NHS Improvement should set out how they intend to bridge existing gaps in care and resolve the problems that result from fragmented service provision to …
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Government Response Summary
The government response details that healthcare provision is commissioned through a robust procurement process guided by Public Contracts Regulations (2015) and NHS England Standing Financial Instructions, which ensures a balance of cost and quality.
Ministry of Justice
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4
Accepted
Para 27
Set out how to balance cost and quality criteria when procuring services
Recommendation
Cost and quality are essential criteria on which to assess bid submissions in procurement processes. All commissioned services need to be cost effective and provide value for money, but cost should not be prioritised at the expense of quality. NHS …
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Government Response Summary
NHS England and NHS Improvement are reviewing existing service specifications for mental health, substance misuse, and primary care, aiming for readiness by April 2023. They are also developing guidance for Integrated Care Systems on prison population healthcare responsibilities.
Ministry of Justice
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12
Deferred
Para 53
Review mental health services specification for competent professional screening of prisoners
Recommendation
The NHS should review its mental health services specification so that mental health screening is always carried out by a competent mental health professional with experience of the criminal justice system.
Government Response Summary
The government's response details the support mechanisms available for HMPPS staff wellbeing, including access to therapies for trauma, reflective sessions, and a specialist 'Post Covid Syndrome' service. It does not address the recommendation for the NHS to review its mental health services specification for prisoner screening.
Ministry of Justice
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15
Deferred
Para 62
Develop and establish regular refresher training for staff on identifying prisoner mental illness
Recommendation
HMPPS should (with the Royal Colleges and other experts in the field of prison mental healthcare) develop training for prison officers and other operational staff on how to identify mental illness and how to support and signpost prisoners to treatment. …
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Government Response Summary
The government committed to automatically transferring health records between community and prison health services for the male estate by April 2023 and the female estate by the end of 2023, rather than committing to specific training for prison officers.
Ministry of Justice
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21
Accepted in Part
Para 79
Increase immediate availability of mental health inpatient beds for prisoners facing transfer difficulties.
Recommendation
The Ministry of Justice should work with the Department for Health and Social Care and the NHS to increase immediately the availability of mental health inpatient beds for prisoners from those prisons that have the most difficulty transferring prisoners within …
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Government Response Summary
The government acknowledges delays in transfers and is implementing revised guidance, committing to a 28-day statutory time limit for transfers once guidance is embedded. They also cite investment in community mental health services and the NHS Long Term Plan aiming to improve overall access to inpatient services.
Ministry of Justice
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22
Accepted in Part
Para 80
Publish monthly data on prisoners awaiting mental health inpatient transfers, including waiting times.
Recommendation
HMPPS and the NHS should gather and publish monthly information for every establishment (without naming establishments to protect patient confidentiality) on the number of prisoners awaiting transfers to inpatient care for mental illness and for how long they have been …
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Government Response Summary
The government states they already gather and monitor monthly data on transfers, using it to address delays, but explicitly rejects publishing this data publicly due to patient confidentiality concerns.
Ministry of Justice
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24
Accepted
Para 88
Introduce urgent arrangements for swift availability of prisoners' medical records between prisons and community.
Recommendation
As a matter of urgency, the Ministry of Justice, the Department for Health and Social care, HMPPS and NHS England should introduce arrangements so that all prisoners’ medical records are swiftly available between prisons and between the community and prison …
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Government Response Summary
The government commits to automatically transferring health records between community and prison health services, with implementation for the male estate by April 2023 and the female estate by the end of 2023.
Ministry of Justice
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26
Accepted
Para 90
Systematic mental health assessment lacking for parole-eligible prisoners before application.
Recommendation
Prison healthcare providers should systematically assess the mental health of prisoners 30 Mental health in prison coming up for parole and make sure that any needing support and treatment have it in good time before they make an application.
Government Response Summary
HMPPS is introducing a formal process to identify and support prisoners with mental capacity issues during parole, including legal representation and capacity assessments, and launched a Mental Health Streamlining Pilot to expedite reviews for restricted patients.
Ministry of Justice
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27
Accepted
Para 91
Persistent challenges arranging mental health treatment packages for parole-eligible prisoners identified.
Recommendation
NHS England should liaise with the Parole Board to identify local areas where there are problems arranging mental health treatment packages for prisoners under consideration for parole. NHS England should then work with the new NHS Integrated Care Systems and …
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Government Response Summary
NHS England is developing guidance for Integrated Care Systems on their responsibilities for the prison population's care pathways, which will incorporate the interface between prison healthcare, the parole board, and continuity of care upon release.
Ministry of Justice
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29
Accepted in Part
Learning from RECONNECT pathfinders and partnership pilots needs swift acceleration and publication.
Recommendation
The NHS should learn early lessons swiftly from its RECONNECT pathfinder projects and accelerate roll-out of the most important features across all prisons in the interim between now and 2024 when it intends to have completed the full roll-out. Similarly, …
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Government Response Summary
The government confirms a 'Lessons Learned' exercise for RECONNECT pathfinders has been done and a full evaluation is commissioned. For Health and Justice Partnership Coordinators, a process evaluation is underway with a report due Autumn 2022, and expansion to all probation regions is intended by 2024/25.
Ministry of Justice
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31
Deferred
Para 98
Establish viable alternatives to eliminate prison as a place of safety by March 2022.
Recommendation
The Government must, as a matter of urgency, see through its proposal to establish viable alternatives so that prisons are no longer used as a place of safety under the Mental Health Act 1983. We recommend that the Department of …
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Government Response Summary
The government confirms its commitment to ending the use of prison as a place of safety, but rejects the immediate target, instead establishing a working group to understand the complex issues and develop a cross-departmental response by September 2022.
Ministry of Justice
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33
Deferred
Amend Bail Act 1976 by March 2022 to end remands for protection or welfare.
Recommendation
The Government should bring forward legislation by 31 March 2022 to amend the Bail Act 1976 so that it is unlawful to remand anyone to custody simply for their own protection or welfare. (Paragraph 104) 32 Mental health in prison
Government Response Summary
The government states it is currently reviewing the use of the power to understand its impacts and alternatives, indicating they will not bring forward legislation by the recommended deadline of March 2022.
Ministry of Justice
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Conclusions (21)
1
Conclusion
Accepted
Para 20
While there have been improvements in prison mental healthcare, provision is still not adequate. The high unmet need for treatment for mental illness in prisons is surprising and disappointing. Around 10% of prisoners were recorded as receiving treatment for mental illness with one suggestion that as many as 70% may …
Government Response Summary
The government has commissioned a National Mental Health Needs Analysis by the Centre for Mental Health, due by end of 2021/22, which will inform a review of NHS England's prison mental health specification starting by April 2022 to identify and address service gaps.
2
Conclusion
Acknowledged
The NHS should use its prison mental health treatment ‘needs analysis’ to quantify shortfalls in mental health services, make plans and allocate resources so mental healthcare in prisons is at least equivalent to services outside prisons, having taken account of the specific needs of the prison population. (Paragraph 21) Commissioning …
Government Response Summary
The government states the Mental Health Needs Analysis will be used to identify service gaps and inform the upcoming review of the national prison mental health service specification and mental health indicators to ensure appropriate care.
5
Conclusion
Accepted
Para 38
Initiatives such as integrated healthcare, the trauma-informed approach in the women’s estate, SECURESTAIRS in the youth estate, and the intensive programmes used on the Offender Personality Disorder pathway, are all welcome as far as they go. The comparatively few such services as yet provided within the youth estate have been …
Government Response Summary
The government agrees on the importance of tackling substance misuse and violence, detailing a zero-tolerance approach and plans from the Prisons Strategy White Paper. They are investing £120 million through the 10-year Cross-Government Drugs Strategy and rolling out enhanced gate security to 42 high-risk sites by March 2022.
6
Conclusion
Accepted
Para 39
The NHS should expand on its work to commission integrated healthcare across all three estates so that prisoners can access proper physical and mental healthcare services at primary and secondary level as appropriate and without undue delay.
Government Response Summary
The government states Drug and Alcohol Treatment Requirements and secondary care Mental Health Treatment Requirements are already available, with efforts to raise awareness. Through the Community Sentence Treatment Requirements Programme, they are on track to introduce primary care MHTRs to half of England by 2023.
7
Conclusion
Accepted
As the covid-19 restrictions in prisons are released, HMPPS (including the Youth Custody Service), should have plans ready for how it will reinvigorate its measures to control unwelcome and unintended issues such as substance abuse and violence in prisons. (Paragraph 40) 28 Mental health in prison Mental illness in prison
Government Response Summary
NHS England and NHS Improvement, as commissioners, currently review performance indicators like screening completion to identify underperforming providers. They then work with prison establishments to develop action plans to improve performance in healthcare provision.
8
Conclusion
Deferred
Para 43
Too many offenders are imprisoned because community orders with mental health treatment requirements are unavailable in many areas. The Government’s target that community orders with mental health treatment requirements should be available across 50% of England and Wales by 2023 is insufficiently ambitious. It is unacceptable that in many parts …
Government Response Summary
The government's response focuses on existing NICE guidance and service specifications for mental health screening, assessment, and treatment within prisons. It does not address the availability or ambition of community orders with mental health treatment requirements as an alternative to prison.
9
Conclusion
Deferred
Para 44
The MoJ and the NHS should accelerate plans to increase the availability of Community Sentence Treatment Requirement orders, so these orders are available options for sentencers in all parts of England and Wales by 31 March 2023.
Government Response Summary
The government's response focuses on tackling racial disparity in mental health services, mentioning a National Mental Health Needs Analysis that includes ethnicity. It states this will inform service specification reviews to reduce health inequalities, but does not address the recommendation to accelerate the availability of Community Sentence Treatment Requirement orders.
10
Conclusion
Accepted
Para 51
It is unacceptable that one in 12 prisoners do not have a health screening appointment within 24 hours of arrival and that Black, Asian, and other Minority Ethnic prisoners who have a mental health condition are less likely to have that identified than their white counterparts.
Government Response Summary
HMPPS is committed to improving mental health identification and support by providing introductory training for new staff, refreshing safety training, and exploring enhanced mental health training. They are also commissioning a Core Capabilities Framework and developing bespoke learning products, including a specialised recruitment and training proposal for staff supporting vulnerable women.
11
Conclusion
Acknowledged
Para 52
The NHS should identify why some establishments have difficulties screening prisoners within 24 hours of arrival and should put in place action plans with the healthcare providers at those establishments to remedy this.
Government Response Summary
The government highlights mental health as a priority, mentioning ongoing collaboration and efforts by governors to ensure timely healthcare access. HMPPS is looking at promoting positive wellbeing and will recommence a programme of future regime design, but does not commit to the NHS identifying specific reasons for 24-hour screening failures or implementing targeted action plans to remedy them.
13
Conclusion
Deferred
Para 54
The NHS should accelerate its work to understand why there is a racial disparity in identifying mental health issues in prison and implement a solution.
Government Response Summary
The government's response addresses delays in transferring prisoners with severe mental health needs to hospitals, stating revised NHS England and NHS Improvement Guidance was published in June 2021. It commits to a new statutory 28-day time limit for transfers once the guidance is embedded, with progress to be monitored monthly. It does not address the recommendation regarding racial disparity in identifying mental health issues in prison.
14
Conclusion
Deferred
Para 61
Prison officers and other operational staff play a vital role in identifying and supporting prisoners who need mental healthcare and signposting prisoners to this treatment. Having the time to talk to and listen to prisoners is a key part of this, particularly those with difficulties absorbing written information due to …
Government Response Summary
The government describes ongoing work by NHS England and MHCS to monitor and improve the timeliness of transfers of prisoners with mental health issues to hospitals, including data analysis and targeted interventions, but does not address training or time for prison officers.
16
Conclusion
Accepted
Para 68
We recognise that prison staff have been under extra pressure during the pandemic and may face uncertainty as the prison restrictions are eased. We would like to express our appreciation again of all those who work in prisons.
Government Response Summary
HMPPS is introducing a formal process to identify and support prisoners with mental capacity issues during parole, including accessing legal representation. Additionally, a 12-month Mental Health Streamlining Pilot was launched in November 2021 to expedite release suitability reviews for certain restricted patients.
17
Conclusion
Acknowledged
Para 61
Prisoners have shared the anxieties of the general population about possibly becoming ill themselves with covid-19 or their loved ones becoming ill. This has been combined with the most severe restrictions on their daily lives, going beyond those experienced by the general population. For example, family contact was restricted, and …
Government Response Summary
The government stated NHS England and NHS Improvement are developing guidance for Integrated Care Systems to manage the continuity of care pathways for the prison population and will incorporate the interface between prison healthcare and parole into a review of the mental health service specification.
18
Conclusion
Accepted
Para 62
The Ministry of Justice, HMPPS and NHS England should take urgent steps to increase provision of mental healthcare services over the coming 12 months so that prisoners whose mental health has deteriorated because of the pandemic can be treated.
Government Response Summary
The government welcomed the ongoing roll-out of NHS England's RECONNECT service for prison leavers and is commissioning an evaluation for 2022/23. HMPPS has introduced Health and Justice Partnership Coordinators in four probation regions and plans to expand them to all regions in England and Wales by 2024/25, with an evaluation report due in Autumn 2022.
19
Conclusion
Deferred
Para 63
HMPPS should build on its existing management guidance and occupational health services to increase its support for the mental well-being of those who work in prisons.
Government Response Summary
The government's response addresses its commitment to ending the use of prison as a place of safety for individuals with severe mental health issues and details the establishment of a cross-departmental working group to understand this issue and make recommendations by September 2022, unrelated to staff mental well-being.
20
Conclusion
Acknowledged
Para 78
It is inappropriate that severely mentally ill prisoners are kept in prison, sometimes in segregation. Despite the best efforts of prison staff this can result in periods of inhumane treatment. We welcome the proposal to introduce statutory time limits for transferring prisoners with acute and severe mental illness to appropriate …
Government Response Summary
The government stated it is currently reviewing the use and impact of the power that allows severely mentally ill individuals to be kept in prison and considering alternative measures to avoid harm to vulnerable defendants, without committing to specific steps to address the shortage of facilities.
23
Conclusion
Accepted
Para 87
Making medical information systems interoperable between prisons and the community is challenging but vital if appropriate care (including the correct medication) is to be provided from arrival in prison through to release. Progress has been made during covid-19 and this should be built on.
Government Response Summary
The government commits to automatically transferring health records between community and prison health services, with implementation for the male estate by April 2023 and the female estate by the end of 2023, building on interoperability.
25
Conclusion
Accepted
Para 89
Some parole decisions are delayed because prisoners applying for parole have undiagnosed mental illness that limit their participation in the parole application process. There are further delays due to insufficient co-operation from community mental health teams in arranging packages of services for prisoners for their release.
Government Response Summary
The government acknowledges problems causing parole delays and is implementing a formal process within HMPPS to identify and support prisoners with mental capacity issues, alongside a Mental Health Streamlining Pilot to expedite reviews for restricted patients.
28
Conclusion
Accepted
Para 92
Despite longstanding difficulties arranging continuity of healthcare for prisoners on their release, the NHS RECONNECT programme, which is meant to resolve these problems, is in its infancy. In the meantime, prisoners who have been receiving treatment in prison for mental illnesses are often released to find that there are no …
Government Response Summary
The government welcomes the roll-out of NHS RECONNECT for prison leavers and is expanding Health and Justice Partnership Coordinators to improve local pathways to mental health and substance misuse services across all probation regions by 2024/25.
30
Conclusion
Deferred
Para 97
We welcome the proposal in the Mental Health Act Reform white paper to end the use of prison as a ‘place of safety’ and the recognition that this must be supported by investment in alternatives. Problems with access to emergency mental health services (including a shortage of beds on general …
Government Response Summary
The government confirms its commitment to ending the use of prison as a place of safety and to legislate via the Mental Health Act Reform Bill, but states a cross-departmental working group is being established to fully understand the issue and develop a response by September 2022.
32
Conclusion
Deferred
The Courts use the provisions in the Bail Act 1976 to remand people to prison for their own protection or welfare only because proper alternatives in the community are not available. We are concerned about the lack of safeguards under this provision, the length of time men, women and children …
Government Response Summary
The government acknowledges the need to consider impacts of repealing this power and states they are currently reviewing its use and alternatives to prevent vulnerable defendants from harm.