Mental Health Crisis Referral Delays

HMP Doncaster was rated the top local prison nationally, demonstrating strong performance in areas like refurbishment and support services. Despite an improved regime and full staffing, significant challenges persist, including increased prisoner violence due to overcrowding, and persistent, prolonged delays in mental health transfers. The IMB highlights critical issues such as national probation staffing deficits, property management concerns, and unanswered cell bells, calling for urgent attention from government and prison management.

HMP Altcourse remains a generally safe and humane prison, showing a reduction in self-harm and violence, and improved healthcare facilities. However, significant concerns persist regarding the containment of severely mentally unwell prisoners in unsuitable conditions and chronic staffing shortages impacting various services. The Board also highlights issues with the national food budget and a lack of external support following a 'cluster death site' designation.

HMP Channings Wood reported a largely settled year (Sept 2021-Aug 2022) despite a gradual return to a near-normal regime after Covid-19 restrictions. While self-harm incidents reduced by 17% and total assaults remained similar to the previous year, the use of force increased by 27%. Key concerns highlighted include the persistent challenges in mental healthcare, specifically accessing specialist placements, the ongoing issue of lost prisoner property during transfers, and the ineffectiveness of the key worker scheme in supporting sentence progression. The Board commended efforts in E&D, chaplaincy, and health and wellbeing initiatives while noting that many cells and showers need refurbishment.

HMP/YOI Brinsford is deemed a safe prison with generally fair treatment of prisoners, showing reduced levels of self-harm and violence. Key concerns include an unfit education contract, a lack of purposeful activity, significant delays in transferring mentally ill prisoners to specialist care, and the poor condition of the estate and IT infrastructure. The key worker scheme also requires improvement to return to pre-pandemic effectiveness.

This inaugural annual report for Derwentside IRC, based on weekly visits, finds the centre safe and well-run, with detainees treated humanely and with respect. However, its remote location and poor communications infrastructure contribute to unequal and sometimes inhumane treatment compared to male IRCs. Key concerns include delays in releasing vulnerable women due to accommodation issues, incomplete facilities, and a lack of mental health cover at weekends.

HMP Wakefield, a high-security prison, is generally considered safe and humane, with observed improvements in healthcare provision. However, the Board noted a significant increase in prisoner-on-prisoner assaults and ongoing concerns regarding staffing experience levels, which impact prisoner safety and support quality. Delays in mental health transfers to secure hospitals remain a major issue, alongside an insufficient purposeful activity regime and challenges with prisoner property management.

Yarl's Wood IRC experienced a challenging year with a marked increase in violence and self-harm incidents, linked to higher occupancy and a greater proportion of TSFNOs. The Board raised significant concerns about the length of detention, the fragility of the centre's infrastructure, and the unsuitable environment of the CSU for detainees with mental health crises. Despite staffing improvements, issues persist with communication about immigration cases and the oversight of Rule 35 reports.

HMP Chelmsford, a Category B local prison, reported three deaths in custody and a 4% reduction in self-harm incidents, though the total of 848 remains high. Operational capacity was 660, with 71% of the population being unsentenced, and overcrowding remains a significant concern, especially in the older Victorian wings. The prison saw a decrease in prisoner-on-staff violence but an increase in prisoner-on-prisoner violence and consistently high use of force incidents. Challenges persist with mental health provision due to a lack of specialist beds, property safeguarding, and staff conduct, while the Launchpad platform and improved dentistry services were positive developments.

HMP Belmarsh experienced a challenging reporting year with improvements in health and wellbeing provision and a commitment to safety, though HMIP noted safety had deteriorated. The prison addressed equality and diversity issues through dedicated leadership and improved data, but concerns remain regarding disparities in outcomes for protected characteristics. Staffing issues, particularly high ‘non-effectives’ despite target numbers, curtailed regimes and impacted key worker compliance, while lost property and prolonged mental health transfer waits persisted as significant and repeated concerns.

HMP Woodhill, a Category B training prison, faced significant challenges during the reporting year, primarily due to persistent staff shortages that severely impacted regime consistency and access to purposeful activity. Key concerns included high levels of violence, the deteriorating state of the prison estate, and overburdened mental health services leading to long waits for transfers. The IMB called for urgent action on staff recruitment, infrastructure maintenance, and improving opportunities for prisoner progression and resettlement.

HMP/YOI Brinsford, a resettlement prison, maintained low levels of self-harm and overall violence compared to similar establishments, with good provision of healthcare and fair treatment for prisoners. However, the report highlights significant ongoing challenges including an inadequate education contract, persistent delays in mental health transfers, and limited, unfulfilling purposeful activity. Infrastructure issues like heating problems and a long-standing leak in reception also remain key concerns.

HMP Featherstone, a Category C training prison, faced significant challenges during the reporting year ending October 2023, primarily stemming from the dilapidated state of its infrastructure and chronic staffing shortages across key departments like healthcare and the OMU. These issues led to regime disruptions, delays in medication, and a persistent problem with property management. While there were positive developments such as improved education outcomes and a reduction in violence, the Board raised serious concerns regarding the inappropriate housing of mentally unwell prisoners in the CSU and inadequate gate security.

HMP Bristol has demonstrated positive improvements in safety, with reductions in self-harm and staff assaults, and effective Covid-19 management. However, the prison continues to face significant challenges, including an insufficient staffing budget and high non-effective rates that frequently impact regime delivery, purposeful activity, and key worker provision. Concerns persist regarding the Victorian infrastructure, particularly poor disability access and heating issues, alongside prolonged waits for specialist mental health transfers and an ongoing problem with lost prisoner property.

HMP Erlestoke, a Category C training prison, held 467 prisoners with an operational capacity of 468 during the reporting year ending March 2023. The prison experienced a reduction in self-harm incidents to 215 and violent incidents to 102 (65 prisoner-on-prisoner, 37 prisoner-on-staff), with no deaths in custody. Key improvements included enhanced gate security and the introduction of in-cell laptops for prisoners. However, significant challenges persist, notably chronic staff shortages across healthcare, education, and key working, persistent issues with illicit substances, and an inadequate constant watch cell. Delays in essential building works and national issues like parole restrictions for IPP prisoners continue to impede progression and resettlement efforts.

HMP Berwyn faced staffing shortages and a more challenging prisoner cohort, impacting regimes and increasing violence in early 2023, despite overall reductions in self-harm and staff assaults. The Board noted positive staff-prisoner relationships, comprehensive resettlement services, and strong education/work provisions. However, significant concerns remain regarding healthcare (medication restrictions, mental health transfers, appointment attendance), estate maintenance, and the need for improved staff training and activity for vulnerable groups.

HMP/YOI Downview experienced a challenging reporting year marked by significant operational changes and an increase in prisoners with complex mental health needs, leading to increased self-harm and use of force incidents. While staff demonstrated compassion, issues like delayed mental health transfers, inconsistent medication distribution, and an un-embedded key worker scheme persisted. The Board expressed concerns about population pressures, property loss during transfers, and a reactive approach to the new transgender policy.

HMP Belmarsh operates as a Category A men's prison, holding approximately 650 prisoners with an operational capacity of 814. The report highlights both positive developments, such as improved induction processes, a new employment hub, and dedicated staff supporting vulnerable prisoners, alongside significant concerns. Key issues include persistent property loss, prolonged waits for mental health transfers, a restricted regime limiting purposeful activity for many, and staffing challenges impacting key worker provision and educational opportunities. The IMB urges HMPPS and the Governor to address these long-standing issues and improve the daily life and progression pathways for prisoners.

HMP Bristol faced significant challenges in the reporting year, marked by an increase in deaths in custody (9), self-harm, and violence, alongside persistent overcrowding at over 50% capacity in single cells. Staffing shortages severely impacted regime delivery, leading to increased time in cell and reduced access to purposeful activity. The Board expressed concern that the HMIP Urgent Notification Action Plan did not adequately address systemic issues such as occupancy levels or substantive staff numbers, hindering effective prisoner care and safety improvements.

HMP/YOI Eastwood Park, a closed local prison for women, faced significant challenges in staffing, self-harm, and the management of complex mental health needs during the reporting year. Despite positive recruitment efforts and a new regime increasing time out of cell, the Board highlighted concerns regarding delays in mental health transfers, a substantial rise in use of force, and the under-utilisation of new facilities. The report also commended improvements in social visits and property management, while calling for better support for remand and short-sentence prisoners and more reliable resettlement data.

Overall, HMP Cardiff has seen positive developments in safety, with significant reductions in self-harm and use of force incidents, and successful digital platform implementation. However, the prison continues to grapple with severe staffing shortages, particularly in healthcare, and the physical estate remains in poor condition, affecting prisoners with mobility issues and access to basic amenities. Concerns persist regarding delays in mental health transfers, lack of secure medication storage, and the underperformance of the key worker scheme.

HMP Chelmsford is a Category B local prison that faces significant challenges, particularly with overcrowding where 49% of prisoners share single cells, and an increasing use of force attributed to inexperienced staff. While positive developments include improved staff-prisoner interactions and an increase in key worker sessions, persistent issues like inadequate property safeguarding, frequent missed healthcare appointments due to officer shortages, and difficulties in transferring mentally ill prisoners require urgent attention. The IMB highlights these concerns and makes recommendations to the Minister, Prison Service, and Governor to address systemic failings.

Why are there often significant delays, caused by NHS practices, in making arrangements for prisoners requiring secure mental health provision, despite concerted efforts by prison and healthcare staff?

Delays in transferring severely mentally ill prisoners to secure establishments that provide more specialist treatment have been a longstanding concern of the Board. While the government’s positive response to Sir Simon Wessely’s mental health review is noted, transfer wait times for these vulnerable individuals have remained this year overall in excess of NHS England guidelines.

The long wait for psychiatric hospital placements (96 days in one case this reporting year) is of concern to prisoners, staff and the Board. What measures are being taken by the MoJ, working with other Departments, to reduce these waiting times?

Will HMPPS improve the length of time those prisoners who are very unwell wait for mental health assessments and the transfer to more suitable accommodation (see section 6.2 Mental healthcare)?

The transfer of seriously mentally ill prisoners to appropriate healthcare facilities continues to be a problem, with one particular prisoner spending over 300 days in segregation this year. This case was escalated to a national level. In addition we are concerned about the long-term legacy of the pandemic on prisoners’ mental health. Altcourse is already seeing more seriously ill men …

We have also seen many prisoners at HMP Bedford with such severe mental health issues that effective treatment by the local mental health team has not been possible. These men do not belong in prison: they get no better and take up an enormous amount of officer time. Transfer to an appropriate mental health facility is hugely difficult and the …

We urge the Minister to look at the problem of transferring mentally ill prisoners to a secure hospital setting again, as the establishment of the Transfer Time Limit Working Group (TTLWG) has not improved the situation for mentally ill prisoners at HMP Thameside.

Can the Minister liaise with other departments to create a detailed and funded plan for sufficient spaces in secure mental health units to reduce the number of seriously mentally ill being held in prison, especially in segregation units?

The Board has repeatedly raised concerns around the inhumane length of time prisoners experiencing mental health illness are kept segregated whilst waiting for transfer to an appropriate mental health establishment. A recent example is a prisoner who spent 377 days in the CSU waiting for a transfer, which the Board view as completely inhumane. What immediate action will the Minister …

How does the Minister plan to avoid this happening to other prisoners with mental health issues? [delay in transferring a prisoner with a significant mental health condition]

The Board is concerned that the length of time some prisoners have to wait to access specialist mental health services appears to be increasing. What can be done to improve the assessment and access to these services? Please can the Minister explain how the Government intends to address longstanding and yet unresolved problems with the assessment and transfer of prisoners …

The 28-day target for transfer from custody to a secure hospital was not met locally in five out of 29 cases. When will action be taken to address the gaps in hospital provision?

Women with mental health issues and complex needs would be better treated in the health system rather than the criminal justice system. Women with complex needs continue to have delays in transferring to a secure hospital. Are there plans to address this concern?

As commented on last year, the considerable rise in the number of prisoners being transferred to the prison, often from HMP Bronzefield, who exhibit more challenging mental health symptoms and consequent behavioural issues is causing safety concerns. Prison is not an appropriate environment for these women and staff do not have the appropriate training to manage them. The Board is …

The number of secure mental health spaces available is not adequate for the number of seriously mentally ill prisoners. Funding for more spaces is desperately required.

The Board is concerned about the waiting times for seriously mentally unwell prisoners to be transferred to secure psychiatric hospitals, due to a lack of beds.

What further steps is the Minister considering with a view to ensuring an improvement in assessment and transfer times to hospital for those requiring specialist mental health facilities?

As referenced in our previous report, what steps will the Minister take to ensure that prison is not used to house severely mentally ill people whilst they await a place in a suitable institution?

Can the Minister explain how the Government intends to address longstanding and yet unresolved problems with the assessment and transfer of prisoners who present with serious mental health and personality disorders from HMP Wakefield to hospital (section 47, Mental Health Act 1983)?

The Board would like the new Minister to look at the continued lengthy delays in transferring mentally ill patients from a custodial setting to a secure hospital setting, an issue highlighted by this Board and the majority of other IMBs across the country for several years. In the Board’s view, these delays are not only inhumane for the patients involved …

It takes too long to transfer mentally ill prisoners to secure mental health facilities. This often means that they have to be held in the Care and Separation Unit (CSU) for their own safety for extended periods of time. What is the Minister doing in conjunction with the Department of Health to address the shortfall in secure mental health places?

Prisoners have been constantly located in the CSU due to their complex and challenging behaviour and mental health issues. Why is it taking so long to transfer these prisoners to an appropriate medical establishment?

What measures can be implemented to ensure mental health support is available within a reasonable timeframe to prisoners who require it?

The Board wishes to highlight their concerns about the number of women with severe mental health conditions who are being sent to the prison solely as a place of safety.

What will the Minister do to help accelerate the process of transferring prisoners with mental health issues to secure units?

The Prison Service is aware of the inhumane length of time some prisoners have been in the CSU at HMP Liverpool whilst waiting for transfer to an appropriate mental health establishment. In the absence of any change will the Prison Service seek to bring additional resources to the site?

Mental illness is a serious issue within prisons. The compassionate answer appears to be to locate some of these prisoners in isolation in the CSU, where largely untrained staff attempt to deal with them in a humane way. This is not acceptable and there needs to be a way of speedily transferring these prisoners to more appropriate accommodation that can …

When will the non-statutory independent role, referred to in the Minister’s response last year, improve the timely transfer of prisoners with serious mental health conditions?

When will the statutory 28-day time limit for the transfer to hospital of prisoners requiring inpatient mental health treatment come into effect?

While the proportion of transfers to external mental health facilities has improved this year, there were still too many patients (two-thirds) transferred beyond the 28-day limit. What concrete steps will the Minister take to address this issue and within what timeline?

Prisoners with significant mental health needs are being held for lengthy periods, often in segregated conditions, whilst waiting for specialist hospital care. Given that demand for inpatient care appears to exceed healthcare capacity, what specific actions will the Minister take to reduce delays, prevent the use of segregation for acutely unwell prisoners and ensure timely access to appropriate inpatient mental …

As referenced in our previous report, we again raise with the Minister the issue of the wellbeing of prisoners who are severely mentally ill. The Board remains concerned at the length of time it takes for suitable places in secure mental health hospitals to become available. This means that severely unwell prisoners are having to be detained in the care …

What is being done to ensure that the 28-day limit for transfer of prisoners to a mental health hospital is enforceable?

Acutely mentally unwell prisoners continue to arrive at the prison. They often face long delays in transfer to secure psychiatric units, following assessment and referral (6.1). How confident is the Minister that the statutory 28-day time limit for transfer from prison to hospital, envisaged by the Mental Health Bill, will be achievable, given the low number of suitable beds for …

The Board remains extremely concerned about the prolonged delays transferring mentally ill patients to secure hospitals. What steps will the Minister take to urgently review and address this issue?

Many prisoners entering prison have mental health problems - some of them severe - and they urgently need care in a specialist unit. However, there are not enough secure places to meet the needs of the prison population, creating a ‘log-jam’ in local healthcare units, where facilities are taken up by prisoners who should be elsewhere. This obviously impacts on …

When will the statutory 28-day time limit for the transfer to hospital of prisoners requiring in-patient mental health treatment come into effect?

The Board is of the view there remains a problem in relocating prisoners with mental health problems to more suitable mental health facilities. All transfers to a secure mental health facility from HMP Brinsford continued to exceed the 28-day stipulated time frame. Will the Minister take steps to ensure that sufficient secure hospital places are available?

To take steps to reduce waiting times for R35(3) assessments.

Too many prisoners with severe mental health problems get stuck in prisons, often in segregation units, because there are not enough place in secure psychiatric units (see paragraph 5.2.2). There is a desperate need for more of these places.

To ask the minister to work with ministerial colleagues in the Department of Health to ensure that delays in transferring prisoners to secure mental health facilities are reduced.

The Board has had to report that a prisoner was held for a long time in secure conditions with deteriorating mental health while waiting for secure hospital accommodation (see paragraph 5.2.3). Despite regular assurances from the National Health Service (NHS) commissioners that this area of concern was being addressed nationally, there have been no improvements to the speedy resolution of …

For the fifth consecutive year, the Board asks in its annual report what, if anything, is being done to increase the number of secure mental health hospital beds available to meet the needs of the complex YP who are in urgent need of such support, and for whom prison is clearly not the correct place? What is being done to …

The Ministry of Justice should work with the Department of Health to ensure that – following repeated recommendations and concerns expressed by this Inspectorate and others, including the Public Accounts Committee – effective action is taken to complete transfers under the Mental Health Act within the target time of 14 days. (S37)

The wait for a secure outside hospital bed for severely mentally ill prisoners held in HMP Thameside continues to be a serious inhumanity which requires greater government priority.

The Board has registered its concern about unacceptably long waiting times for assessment for transfer to prisons with inpatient beds. The Board supports the prison’s proposal to create a crisis unit within the prison’s decommissioned inpatient unit, to enable care to be provided appropriately on site while waiting for assessment and transfer under the Mental Health Act. The Board hopes …

Yet again, we remain concerned about the difficulties encountered in transferring prisoners with severe mental health issues to an environment where they can be effectively treated. Once again, the Board would like to see greater availability of more suitable locations for these prisoners.

The Prison Service needs to address the issue of residents with severe mental health problems waiting long periods of time in prison before transferring to more appropriate accommodation elsewhere.

The delays in transfer of seriously mentally ill prisoners to appropriate secure facilities is of great concern to the Board. Could the Minister assure the Board that this is given high priority for resolution?

The Board, once again, is concerned at the number of prisoners seen over the reporting year who are seriously mentally unwell and kept in conditions, be it accommodation standards or the regime, which are entirely unsuitable for their care or rehabilitation. The same applies to many of the prisoners with learning or other disabilities. Will the minister undertake a comprehensive …