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 …
Read more
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
View Details →
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 …
Read more
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
View Details →
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 …
Read more
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
View Details →
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
View Details →
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 …
Read more
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
View Details →
Conclusions (10)
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.
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.
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.
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.
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.
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.