The current state of mental health services in prison, and how the voluntary sector works to improve it, is examined in this blog by Clinks Practice Team Leader & Development Officer for Health and Justice, Hazel Alcraft.

The National Audit Office (NAO) last week published a highly critical report into mental health in prisons, concluding:

“Government does not know how many people in prison have a mental illness, how much it is spending on mental health in prisons or whether it is achieving its objectives.”

The headline findings are unlikely to come as a surprise to anyone who works in this area: the lack of reliable data on the mental health needs of people in prison; weaknesses in the screening process to identify people with mental health needs; delays in transfers to secure hospitals for those who need it; and the lack of continuity of care on release are all highlighted as key areas of concern. 

Clinks warmly welcomes the NAO’s resulting call for “a step change in effort and resources” to improve the mental health of those in prison.

Recent NHS reports such as the Five Year Forward View for Mental Health: One Year On have focussed on the expansion of liaison and diversion services for people in police custody and the courts as a significant area of progress for health and justice. Clearly, this is vital: Improving the response to, and support for, people with mental health needs before they enter prison is a key part of the picture. But one glance at the rising levels of suicide and self-harm in prison is enough to show the great need for improved care for people in prison as well.

According to the NAO report, around 10% of people in prison in England are receiving treatment for mental illness, but they estimate 37% of the average monthly prison population to have a mental health need (although one of the failings they highlight is the lack of reliable data to assess this need). Closing this gap will indeed require a step change in investment in mental health services; but using existing resources more effectively will also be essential, and we know that there are many ways in which voluntary sector organisations can help to do that.

Our members already provide a huge range of support for people with mental health needs in prison, from direct mental health interventions, to peer support, preventing mental health problems and promoting mental and emotional wellbeing. To cite just a few examples:

• The Voices Unlocked network run by Mind in Camden facilitates peer support groups for people who hear voices, see visions or have distressing beliefs in prison. This supplements overstretched and under resourced mental health services in the prisons, enabling people to draw on an alternative source of support, and to share experiences they may never have told anyone about before.

• Geese Theatre Company’s drama-based courses provide an opportunity to explore key issues through creative expression, which can be a valuable tool for relieving emotional distress – such as their recent Scratching the Surface and Journeyman pilot programmes aimed at promoting wellbeing and hope for prisoners with a range of vulnerabilities (see case study on p10 of this report from the National Criminal Justice Arts Alliance). As one project participant reflected: “I had 8 years in mental health with nothing that helped – Geese gave me techniques to help me help myself…”

• Recoop run activity groups, day centres and forums for older prisoners in a number of prisons, helping to reduce isolation and loneliness for older people in prison through offering them age-appropriate purposeful activity – an important factor in improving mental wellbeing:

And these are just a few small examples – almost a third of Clinks members provide support for people’s mental health, and there are so many more fantastic projects I could highlight.

The NHS Health and Justice Commissioning Intentions for 2017/18 include a “significant review of mental health provision for the secure and detained estate which will result in revised specifications for mental health services, more efficient hospital transfers and effective mental health pathways across the estate and into community provision.” We can but hope that they remember to draw on the expertise, insight and potential of the voluntary sector as they do so.