Hundreds of mentally ill prisoners denied urgent treatment in England

Hundreds of severely mentally ill prisoners in urgent need of hospital treatment are being left in prison cells due to bed shortages in secure NHS psychiatric units, an investigation has discovered.

Freedom of information (FoI) responses from 22 NHS trusts reveal for the first time that just over half of the 5,403 prisoners in England assessed by prison-based psychiatrists to require hospitalisation were not transferred between 2016 and 2021 – an 81% increase on the number of prisoners denied a transfer in the previous five years.

In some areas, the majority of mentally ill prisoners were not admitted, which could be the result of long delays or a trust refusing to take certain patients. Norfolk and Suffolk NHS foundation trust, which was rated inadequate by the Care Quality Commission last month, only admitted 16 of 41 prisoners referred in 2021. Essex Partnership University NHS foundation trust only admitted 24 of 57 prisoners referred in 2021. Lancashire and South Cumbria NHS foundation trust only accepted 18 of the 38 prisoners referred in 2021.

Peter Dawson, the director of the Prison Reform Trust, said the figures unearthed by the investigation suggested hundreds of very ill people were being denied the treatment they needed.

“It is shocking that a growing number of people are not getting the transfer to hospital that clinicians say is essential for their mental health,” he said. “Instead they are languishing in often overcrowded and dilapidated prisons. It is cruel and guarantees people will leave prison in a worse state than when they came in, with every likelihood that the behaviour that originally led to their arrest and conviction will continue.”

The joint investigation by the Guardian and BBC Radio 4’s File on 4 programme, which is broadcast on 10 May, also found that seriously ill prisoners faced long waits in breach of government targets. NHS guidelines state that inmates should be transferred within 28 days of an initial referral. But figures, obtained from the Ministry of Justice, show prisoners waiting as many as 104 days after the department received a formal transfer application – which doesn’t include the time it takes to assess prisoners.

These delays – in which prisoners’ mental health can rapidly deteriorate, with some self-harming and others being placed in segregation cells – are often caused by a lack of suitable beds in admissions wards in secure hospitals, where sentenced prisoners have to be treated. NHS figures released under FoI rules show that all of England’s high- and medium-security hospitals were operating above the Royal College of Psychiatrists’ maximum bed occupancy rate of 85% on a single day in February.

Russell Green, a consultant psychiatrist and medical director for Practice Plus Group, which provides mental health services in about 50 prisons, said he was “genuinely shocked” that so many sick prisoners were not being transferred. “The threshold for referring someone to hospital is high, so you only do it when you absolutely need to move someone,” he said. “These are people who have major psychotic illnesses or chronic personality disorders. They need specialist care, which they can’t get with the best will in the world in prison.”

Psychiatrists frequently struggle to find beds for prisoners, with only the most extreme cases referred to hospital. Most prisoners with mental illness are managed on a day-to-day basis by prison officers who are usually untrained. A survey of more than 380 prison officers by the Guardian and BBC found that 84% dealt with mental health problems every day, with half seeing prisoners they believed should be in hospital, yet only 4% had adequate training.

Mike Roberts, an experienced prison officer who works at an institution in the south of England, said at least a quarter of the prisoners he saw had mental health problems. But Roberts – not his real name – said that in 29 years in the service he had only been given a talk and some online “click-through PowerPoint” training about mental illness. “There aren’t that many secure units that have beds, so the prisoners are stuck in prison with us … prison officers who are not mental-health trained,” he said.

Dawson said the government should focus on preventing seriously ill people from going to prison in the first place, including expanding mental health treatment orders, which only make 0.5% of community sentences.

The government said it planned to change the Mental Health Act to ensure people in the criminal justice system could get the right care. “All individuals detained in custody are entitled to the same range and quality of health and social care services as individuals living in the community, including mental health services,” said a spokesperson for the Department of Health and Social Care. “Healthcare providers in prison have robust processes in place to identify, assess and treat offenders with mental health needs.”

An NHS spokesperson said: “The NHS is rolling out a mental health treatment programme across England which provides courts with qualified clinical staff who offer mental health interventions and an alternative to custodial sentences.”

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