For a long time, we have known that the mental health needs of prisoners are substantial and persistent.
Yet there are major holes in our maps of need which affect our understanding of the current scope and impact of services. The Justice Committee’s recent call for evidence about needs and services highlights the uncertainties and points to a worrying future if the picture remains unchanged.
A landmark survey, published in 1998, found that over half the prisoners had a personality disorder and more than four in ten a neurotic disorder. Recent inspection reports have systematically shown that substantial proportions of prisoners reported mental health needs, notably in Category B prisons and the women’s estate, which were not being met. Yet the data are not clear enough to guide policy and provision.
Many prisoners have been subject to Adverse Childhood Experiences, as revealed by a recent prisoner survey in Wales. Personality disorders are linked with histories of abuse, and, though they are assumed to be hard to treat, research has suggested they can be treatable using psychological techniques. In addition to more accessible services, the prison system should be recast, so that it prioritises safe, trauma-informed relationships and care, reducing the potential for confrontation by increasing the capacity for better communication and understanding. A rights-based framework for care should better recognize the social disadvantage experienced by prisoners.
There is understandable concern about the impact of restrictions imposed as a response to the pandemic. Conditions under lockdown are understood to resemble solitary confinement, a known factor undermining mental health. Compensatory measures have been slow to arrive: provision to help family communication through videos was not universally available until early this year.
While disruptions to family contact affect prisoners adversely, they also damage children’s well-being. There is some evidence that services have become more difficult to access, though, for some prisoners, conditions are less stressful.
The remarkable confidence of current policymakers in a planned expansion of imprisonment must be placed in the context of these findings. If poor mental health in prisons is a marker of anything, it is that the formal language of justice – serving time, making amends, etc. – fails to come to terms with the realities. Underneath these calculations of sentencing lies a bleak expanse of feelings and experiences with which policymakers should engage.
The Justice Committee needs to be bold in grasping the challenge.