I run a Suicide Crisis Centre in Gloucestershire where we provide face-to-face ongoing support. We get to know our clients well, and care very much about them.
It's difficult to express the conflicting emotions I felt as I watched one of our clients being led into court. He was brought up from the cells under the courtroom. It was the first time we had seen him in several weeks. Seeing him being brought up from the depths of the court building was somehow more painful, and startling.
I and one of his family members moved so that we were in his line of vision. He looked up at the public gallery, saw us and fixed his gaze on us for a while. It was important to us that he saw we were there, supporting him. Then he focused his attention on the judge.
Although it was extremely upsetting to see him in this environment, I also felt relief at seeing him alive. Indeed, when we first heard that he had been arrested and was in custody, both his mum and I thought "at least he is safe now".
I remember the very first time he came to our Suicide Crisis Centre. He had said to me "I wish I could go back to prison. I had mental health care in there." It may sound extraordinary: a person who is mentally unwell wishing to return to prison. We regularly hear in the media of the harsh environment and violence within prisons - surely not the right place for a person who is so vulnerable and unwell. But his words revealed how impossible he had found it to get any mental health care in the community - because he also uses drugs, and so he was only diverted to addiction services.
He had come close to death, many times, and particularly in the days before he was arrested. Sometimes it was as a result of a suicide attempt. Sometimes it was a deterioration in his physical health which put his life at risk. I had visited him in the general hospital and he was so weak and emaciated that we were concerned that he would not survive. He had made a suicide attempt the day before he was arrested.
Calum (not his real name) has a severe and enduring mental health condition.
We have seen other cases where clients have been diagnosed with or treated for mental health conditions while in prison, but then go back into the community on their release and receive no psychiatric support.
We know, however, that prison can have a profoundly detrimental impact upon the mental health of some people, and indeed may greatly increase a person's suicide risk. We have seen clients remanded in custody or imprisoned and have had to pass on our concerns about their suicide risk to staff.
In expressing concern for our clients, I would not wish to minimise in any way the impact upon the victims of their crimes, having been the victim of crime myself in the past. Indeed, Calum's mum herself expressed a concern to local mental health services that he may now be a potential danger to other people as he was so mentally unwell. She tried to forewarn services a few days before his arrest. Calum did not harm anyone - his crime was of a different nature - but his mum saw the possibility and tried to prevent it.
Calum remains unwell and we are very concerned that he is having to attempt to recover in such a harsh environment as a prison. However he does at least have access to mental health care there, which was totally absent on the outside.
The day before he was arrested, he attempted to end his life. I wonder if there was a part of him which subsequently saw prison as the only place of safety and refuge from a world which he was finding increasingly difficult to survive, and where he was consistently refused mental health care.
His solicitor felt that his deteriorating physical health alone would have caused his death within weeks on the outside.
Calum is grateful for the mental health input he is receiving. He has a very compassionate psychiatric nurse caring for him in prison, as well as a psychiatrist. But what does it say of the current mental health system, when the only way that this gentle young man could receive psychiatric help and stay alive was to go to prison?
For information about the Suicide Crisis Centre: http://www.suicidecrisis.co.uk