Once upon a time, in 2013, in England and Wales, there were 76 people known to have died by suicide in prison. This was a higher rate of such deaths than in the general population. It concerned everyone who tried to make prisons safe. We have evidence of a higher than average rate of mental disorder among prisoners. We also need to take special account of people with learning disabilities or severe developmental disorders, who may find it exceptionally hard to express their needs. All this made us think that, with service improvements, we could reduce the in-prison suicide rate, but health services can only do so much.
In 2013, over £56 million of public money was spent on severance pay for prison officers; in the previous three years it was £3-6million per annum. Across the prison estate in England and Wales, as the prison population continued to rise, prison officer numbers fell by over 40%. By November 2016 there were nearly 86,000 people in prison.
In the year to November 2016 over 100 people had died by suicide in prison. The new release of suicide figures confirms the full scale of this tragedy for prisoners and their families. In addition, at least 4,000-5,000 prisoners self-harm each year, with numbers also rising. There is also concern about homicide, assaults and other unrest in prisons in England and Wales, but let's focus on suicide.
It is a well accepted principle that all people living in England and Wales should expect equivalence of health care. This includes prisoners. The Department of Health in England and the Welsh Assembly Government have made achievements towards improving healthcare in prisons, not least by making prison health services part of the mainstream. Established health services reach in to prisoners, helping to increase service user confidence in the privacy of consultation and records as well as delivering optimum care.
The Royal College of Psychiatrists have fostered training developments to support specific knowledge and expertise and the College's Centre for Quality Improvement in psychiatric services launched a Quality Network for Prison Mental health Services in May 2015. Already over 40 services have joined, scrutinise each others' practice and promote improvements. Even good services are only useful, however, if they are accessible. The Royal College of Psychiatrists has become increasingly concerned about reports from its members across England and Wales that people given appointments for clinics within the prison cannot reach them because there are insufficient prison officers to escort them there. Worse, when psychiatrists have been told about a particularly distressed prisoner who appears to be ill, if the person cannot be brought to them, they try going to the person - only to be told that it would take four prison officers to unlock the person in safety and those numbers are not available.
Research worldwide has shown the risks to prisoners from underlying mental illness. Research in Wales has also shown how much simple qualities in the prison environment might reduce the severity and duration of symptoms. Pre-prison experiences were unrelated to depression levels in prison, but some in-prison experiences were. Getting on with staff, getting on with other prisoners and getting some exercise were all associated with lower depression ratings, poor relationships and little exercise with higher. The Howard League and Centre for Mental Health have just published similar findings and people's personal stories about how it feels to be suicidal in prison. Research informed developments, such as the introduction of 'psychologically informed prison environments' may help vulnerable people in prison but everything is contingent on getting a better balance between prisoner and prison staff numbers.
This can be achieved in part by reducing numbers of people sent to prison. The Bradley Report of 2009 highlighted the achievability of this for people with mental health difficulties. The Corston Report of 2007 focused on women in the criminal justice system, a very high proportion of whom could be better helped to stop offending as well recover from mental illness in health rather than criminal justice settings. Mental health services outside prisons have obligations to these groups too. Prisons will remain essential for periods in the lives of some offenders, in the interests of everyone's safety, but the combination of keeping these numbers to a minimum and staffing prisons better is necessary to real safety. A proposal for return to prison governors truly their own prison - and to be more accountable for it - could be positive for health services, but only with adequate budgets. While it is right that health services are visitors to prisons, and retain their hard won independence from involvement in the internal correctional process, we could engage a more available prison staff much more in detecting suicide risk, supporting the vulnerable and even enhancing rehabilitative prospects.Suggest a correction