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The long wait: acutely mentally unwell men and women trapped in prison

Published:

A new report by the Chief Inspector of prisons shines a light on the plight of desperately unwell men and women languishing in prison waiting for transfer to secure mental hospitals.

Only in hospital can they access care under the Mental Health Act which cannot legally be provided in prison. In that time, many are suffering irreversible harm. Some of these people should never have been sent to prison, which still remains a legal “place of safety” when a secure hospital bed is not available in the community.

Once the need for transfer from prison to hospital has been identified, people should be transferred within 28 days. However, inspectors found only 15% of people were being transferred within this timeframe, with some waiting over a year. In that time, because of the risk of violence to others or to themselves triggered by their illness, patients are held in solitary confinement in bleak cells overseen by prison officers with little or no mental health training.

“These desperately unwell men and women have no place in prison, but they remain there, out of sight, with nobody to advocate for them and no consequences for what is happening to them. These are people whose psychosis or paranoid delusions make them so violent multiple officers are needed just to deliver their meals. Some are so driven to harming themselves, we have, for example come across cases where prisoners have blocked their own airways with bedding, removed their own teeth or have maimed themselves to the point of exposing their own intestines. The longer people are denied access to the treatment that can only legally be provided in hospital, the more unwell they will become. This is a scandalous way to treat some of society’s most vulnerable people.”

Charlie Taylor, HM Chief Inspector of Prisons

Early treatment for mental health disorders is vital and delays in accessing care that cannot be provided in prison can cause irreversible harm. Given this, the current strain on prison places, and the psychological and physical challenge for prison officers attempting to care for such unwell people, their prompt removal from prison to secure hospitals should be a priority. Yet the inspectorate has been raising concerns about this issue for many years with no improvement.

We commented on this issue in three quarters of our inspection reports last year, and have been raising concerns on this for years, including a previous report on this issue in 2007. We visited 21 prisons for the fieldwork for this thematic, but we could have walked into any prison and we would have found similar cases.

The inspectorate has received assurances time and again from successive governments that there are enough secure beds and that processes will be expedited. But nothing has changed. People continue to suffer life-changing harm and they will continue to do so until prison and health authorities work together to put people before process.”

Charlie Taylor, HM Chief Inspector of Prisons

Notes to editors

  1. Read the full report, published on 6 February 2023.
  2. Acutely mentally unwell men and women, who do not consent or lack the capacity to consent, cannot legally receive the assessments, stabilisation and therapeutic interventions needed to treat them while they are held in prison. This level of care can only be provided in a specialist hospital ward. Prisoners requiring such care must therefore be transferred to hospital in order to access it. The legal framework underpinning this process is the Mental Health Act 1983.
  3. NHS England’s guidance The transfer and remission of adult prisoners under the mental health Act 1983: Good practice guidance 2021(NPGP) stipulates two timelines of 14 days by which a patient requiring care under the mental health act, should be transferred. The first commences at the point of referral which is initiated as soon as it is identified that a person’s mental health needs cannot be appropriately treated within a prison and the first psychiatric assessment (access assessment) and the second being the time between this assessment point and the transfer to hospital. All of which should not exceed 28 days.
  4. The Mental Health Bill 2022 sought to remove the use of prison as a place of safety and to reform the Bail Act to prevent courts from remanding defendants for own protection, solely for mental health reasons. The Bill also proposed a statutory time limit of 28 days to complete transfers under the Mental Health Act from prisons to hospital. However, the Bill was not included in the King’s speech in November 2023. These protections will therefore not be introduced.
  5. The fieldwork was undertaken between March and May 2023. It followed our standard inspection methodology and included an inspector from the Care Quality Commission (CQC) specialist team and three registered clinicians from HM Inspectorate of Prisons. CQC’s mental health policy lead supported this review.
  6. Health inspectors visited 21 adult prisons. The prisons were chosen to ensure a wide geographical spread, and at least one in each region was included, including one in Wales. Our sample included 12 category B prisons, three prisons in the long-term and high secure estate and four category C prisons. We also visited two women’s prisons.
  7. HM Inspectorate of Prisons is an independent inspectorate, inspecting places of detention to report on conditions and treatment and promote positive outcomes for those detained and the public.
  8. Please email media@hmiprisons.gov.uk if you would like more information.