Introduction
Research has repeatedly indicated that those in jail have greater rates of mental illness than the general population (Fazel et al 2016). However, a recent assessment by the National Audit Office (NAO, 2017) found a gap in mental health service provision in UK prisons, as well as a lack of parity of treatment with community services. New epidemiological study on the mental health of individuals in the criminal justice system is needed, according to both the National Audit Office Report (NAO, 2017) and the newly updated NICE guidelines on mental health in the criminal justice system (NICE, 2017).
Jail mental health in-reach teams have been developed in England and Wales during the last decade in response to rising levels of psychiatric illness among inmates and recognition of prior poor quality prison mental health services. They are mostly supplied by the National Health Service (NHS), which is responsible for the bulk of healthcare services in the United Kingdom. During the same time span, the jail population has reached new highs. This research gives an overview of mental health outreach services in UK prisons. This paper explores the mental state of United Kingdom (UK) offenders and also critically evaluates whether the services that are provided to offenders are sufficient. It then finds that the mental services provided to offenders in the United Kingdom are sufficient and effectively address the issue.
The Mental State of United Kingdom offenders
In Wales and England statistics show that about 31000 out of the possible 84000 people in prisons have made reports of not being well or having a mental health issue. In 2016 and 2017 about 1000 prisoners had to be taken to psychiatric facilities because they exhibited a high level of mental health disorder (National Audit Office, 2017). In 2016 Wales and England recorded a very high incidence of self-inflicted deaths. (National Audit Office, 2017).
Changes in sentencing procedures have resulted in a year-on-year population increase of 2.5 percent to 3.4 percent in England and Wales. People are staying longer in the prisons with time for sentences that are determinate also increasing in that in 1993 it was 16 months and in 2015 it was 19 months (Kingdom U 2016). It is important to ensure that mental health screenings begin ate the very early stages of introduction to the criminal justice system (Forrester A, et al 2018). With the high populations in prisons in Wales and England, the need to provide services such as screening, disease detection, and proper intervention when getting into prison and when leaving is important to ensuring a healthy nation free from mental health issues. It is very possible to provide treatment to offenders as they get into prison and as they leave (Till, A., et al. 2015).
Research by Bebbington and colleagues showed that 12 percent of the prisoners they sampled depicted signs of having psychosis, and those with alcohol problems were 33 percent of the sampled prisoners those who met the criteria for depression were 53 percent and 25 percent had been to mental care a year before being sentenced to serve jail term (Bebbington et al. 2017).
Results from prison reform trust in 2018 show that more than 15 percent of male prisoners had been to a mental care center in the years preceding their sentencings and more than 15 percent showed signs of psychosis in 2017, the House of Commons Public Accounts Committee deduced from their finding that suicides and self-harm among prisoners in Wales and England were more prevalent than those outside prison (Towl and Crighton, 2017).
Numerous researches have shown that inmates who are mentally ill may pose a lot of challenges to organizations in the health industry and the prison staff as well as the provision of treatment that is adequate. (Crichton and Nathan, 2015; Cassidy et al., 2020)
With 17% of all offenders and re-offenders, London appears to have the most number of offenders compared to any other place in Wale and England. (75,000 and 18,000 respectively). Probation services in London have a combined adult caseload of over 45,000 offenders. (MOPAC 2017) Mental illness that has gone untreated is a major component of the criminal justice system. According to the best available data, major mental health issues are far more common in the criminal population, both in jail and on probation. (Anders, P., et al 2016)
Research shows that women compared to men in prisons are more prone to mental illness. It is evident from the high rate of self-harm and suicide by female prisoners the British Medical Association concluded this they noted that about 52 percent of offenders that are female have been to mental medications before being convicted to serve prison terms including 46 percent who may have attempted suicide sometime before coming to prison this being compared to the general population which is at 6 percent (Fazel et al 2016).
several factors have contribute to the high number of mental health issues among offenders this factors is that widespread misconception that those who suffer from mental diseases are a risk to the general population, another factor is the failure of the general public to tolerate those with mental health diseases, another factor is the failure to ensure mental health cure is promoted among those suffering (Papalia et al 2019). The biggest most prevalent factor is the failure to provide enough resources and care for mentally heal patients more so those in prisons. Most of these problems exist before one gets to prison then intensify after the person is in prison however the conditions in prison can make one’s mental health worse because of various reasons including inhumane treatment by fellow inmates and prison officers.
Among the factors that contribute to a mental health issue in prisons include; inmates being insecure about how their lives will turn out when they get out of prison, lack of enough or proper health care, the lack of privacy, violence from maybe fellow inmates and enforced solitudes. The saddest thing about the effects of mental health issues is that it causes suicides. In many nations around the world and the United Kingdom, some people have been forced to serve jail terms because of the lack of enough mental health facilities to hold them which sadly also happens to old offenders (Haesen et al 2019). It sadly happens that those who have little mental health problems and resort to drug abuse and petty crimes end up being misdiagnosed and sent to prisons instead of rehabilitative centers.
Services provided to mental health offenders
The Mental Health Act 2007 serves as the proper legislation to address the issues of mental health among offenders in the United Kingdom. The Act stipulates that offenders with mental health issues should be treated before being punished and there by placing a responsibility on the sentencing court to ensure this is done properly. This Act was amending the 1983 Mental Health Act and making efforts to ensure that mental health providers are able to provide medical care to patients before it leads to serious harm to the person affected. This provision depicts a willingness to help mental health offenders unlike in other countries were prisons are used to dispose people suffering from mental health disorders (Hean et al 2015).
In England, the National Partnership Agreement for Prison Healthcare in England 2018-2021 acts as the authority that brings together several ministries responsible for the mental health offenders in the country for instance the NHS England and the ministry of justice and prescribes how the ministries will work in agreement (HM, Government 2018).
In the United Kingdom, service planning for offenders with mental illnesses has centered on diverting individuals from the criminal justice system to appropriate levels of psychiatric and social care throughout the previous decade. The federal government has made a deliberate effort to promote a better understanding of the requirements of offenders with mental illnesses and foster coordination amongst the necessary authorities, despite the fact that a seamless service system has yet to be built. Local health authorities have been urged to take a consortium approach to planning and delivery of specialty services, and a large research initiative has been launched . Among the services provided for inmates with mental health issues in the United Kingdom include providing special needs houses (Leaman et al 2017).
In attempting to improve the services of mental care in prisons, the National Service Framework for mental Health recommended steps to be taken that would ensure primary care and proper and adequate access to medication. They recommend the following; Provision of inpatient daycare services, services for primary care, wing services, inmates follow up treatments, and transfer to NHS facilities (Boland et al 2021). This report created a platform to advocate for special treatment of offenders in prison suffering from mental health issues. Among the suggestion was the creation of a platform completely similar to what the general population out of prison have the strategy was in efforts to ensure the standards of prisons are increased the concern was with the evidence that the prisons were failing in their efforts to rehabilitate prisoners. (Perera, B., and Courtenay, K. 2018) and that inmates were coming out without learning anything important from prisons such as education or training and the ability to address issues related to mental health. It was advised that when prisons introduce new models to ensure the betterment of inmates’ stay, prisoners should be the first to give their feedback on how these changes should be implemented or changed.
In Wale and England, there exist mental health outreach teams to serve in prisons. These are considered as part of the reforms that would ensure inmates with serious mental health problems receive proper care from experts in the field, which is to serve just like the community mental health teams deployed to the general public. As a consequence of various mental health developments, several new specialist teams have arisen. In reach teams are one of them. In reach teams are the most significant and unprecedented mental health accomplishment in jails to date. However, unlike the aggressive outreaches, proper training, and crisis resolution in the community teams the progress in jails has been quite disappointing (Brooker, and Webster, 2017).
It was obvious in the most recent national survey, conducted in 2016 that resources for providing mental healthcare in jail had grown. The average number of staff working in a prison mental health in-reach team was four in 2003, but by 2016, that number had risen to eight. Many people took the time to describe how mental health treatment is delivered as a full system. A phased care paradigm incorporating primary care, for example, was frequently mentioned. In comparison to prior survey periods, workforce resources had risen, and better mental healthcare organizational models had formed (Brooker and Webster, 2017).
In comparison to the general population, prisoners are a disadvantaged group with various complicated health requirements and poorer health outcomes (Fazel et al 2016) The impacts of the COVID-19 epidemic on the mental health of inmates have received little attention to yet, despite their high incidence of pre-existing mental illnesses, suicide, and self-harm, as well as the linkages between poor mental health, suicide, and self-harm and reoffending behavior (Chang et al 2015).
Various inmates have spent more time on remand as a result of the suspension of jury trials and delays in court proceedings in many nations, including the United Kingdom. The unpredictability of the COVID-19 pandemic might exacerbate offenders’ vulnerability during remand, when they commonly obsess about legal outcomes and experience anguish, uncertainty, and concern about their future (Sim J, 2018). These emotions could be exacerbated by the COVID-19 pandemic’s unpredictability. The amount of prison employees missing from work has increased in England and Wales, diminishing human contact for inmates, potentially restricting mental and physical health support, and making rigorous surveillance of convicts at high risk of self-harm or suicide more difficult. For COVID-19 testing, it is critical that jail officers be recognized globally as frontline employees.
Recommendations
With the big number of prisoners with mental health issues in the United Kingdom, the challenge of treating these people arises. Some of these convicts happen to be seriously ill and in dire need of help (Ward, and Merlo, 2016). Some may accept treatment by medicine while others may refuse inmates. Inmates should be provided care in the early stages for serious depressions and bipolar disorders the same way they could be treated early for their diseases not mental like diabetes.
All reform proposals begin with the notion that persons with significant mental disorders who require medical attention belong in hospitals, not prisons or jails. The utmost remedies to the issues raised in this paper involve having a sufficient number of public psychiatric beds for the stabilization of mentally ill individuals, as well as a fundamental realignment of the public mental illness treatment system, in which state and county public mental health officials are held accountable for any system failure (Lamb, and Weinberger, 2017). Here are a few recommendations; providing adequate care for convicts with significant mental illnesses in prison and jail, implementing and promote diversionary programs for those who are incarcerated, encouraging the use of outpatient treatment, employing cost-benefit analyses, providing a thorough intake screening procedure, addressing the diverse requirements of inmates, a model that provides primary mental health treatment for inmates should be designed and tested and, enabling care continuity beyond jail term and creating of a systems of information that ensure shared primary care of inmates health information between the prison health care system and the community system should be developed.
Conclusion
It’s a huge struggle to offer mental health care in jail that’s even close to what’s available on the outside. The mental health requirements of inmates are substantial, but funding has been inadequate up to lately when focus has been shifted to things like custodial and security concerns have taken precedent over health treatment. Nonetheless, the establishment of reach teams has undoubtedly resulted in significant advances to the health provisions provided to prisoners. While transitions to the NHS are still difficult, the review team was given the impression that this sector has improved. These advances have been aided by the policy attention given to this subject, as well as the advocacy on the ground by inreach teams.
Because of the significant need for counseling and advice, it was thought that non-statutory sector services, as well as primary care, may play a vital role in meeting these needs. Furthermore, mental health services at the front desk and screening should be improved to ensure that any emotional or mental health issues are handled as soon as possible. Personnel must be trained to ask convicts personal questions in a sympathetic manner and to be sensitive to underlying difficulties like abuse or violence, in addition to mental health skills.
Reference
Anders, P., Jolley, R., & Leaman, J. Rebalancing Act: A resource for Directors of Public Health, Police and Crime Commissioners, the police service and other health and justice commissioners, service providers and users. Revolving Doors Agency: London, 2016. Public Health England http://www. revolving-doors. org. uk/file/2049/download.
Bebbington, P., Jakobowitz, S., McKenzie, N., Killaspy, H., Iveson, R., Duffield, G., & Kerr, M. (2017). Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder. Social psychiatry and psychiatric epidemiology, 52(2), 221-229.
Cassidy, K., Dyer, W., Biddle, P., Brandon, T., McClelland, N., & Ridley, L. (2020). Making space for mental health care within the penal estate. Health & Place, 62, 102295.
Crichton, J., & Nathan, R. (2015). The NHS must manage the unmet mental health needs in prison. The Health Service Journal, 18th August.
Fazel, S., Hayes, A. J., Bartellas, K., Clerici, M., & Trestman, R. (2016). Mental health of prisoners: prevalence, adverse outcomes, and interventions. The Lancet Psychiatry, 3(9), 871-881.
Forrester, A., Till, A., Simpson, A., & Shaw, J. (2018). Mental illness and the provision of mental health services in prisons. British Medical Bulletin, 127(1).
Hean, S., Willumsen, E., Ødegård, A., & Bjørkly, S. (2015). Using social innovation as a theoretical framework to guide future thinking on facilitating collaboration between mental health and criminal justice services. International Journal of Forensic Mental Health, 14(4), 280-289.
HM Government. (2018). National Partnership Agreement for Prison Healthcare in England 2018‐2021.
Kingdon, U. (2016). Ministry of Justice. Story of the Prison Population 1993-2012, England and Wales. Ministry of Justice Statistics Bulletin. 2016.
MOPAC Justice Matters, 27 February 2017
National Audit Office (NAO). (2017). Mental health in prisons.
National Audit Office, (2017) Mental health in prisons London: National Audit Office.
National Institute for Health and Care Excellence (Great Britain). (2017). Mental health of adults in contact with the criminal justice system. National Institute for Health and Care Excellence (NICE).
Papalia, N., Spivak, B., Daffern, M., & Ogloff, J. R. (2019). A meta‐analytic review of the efficacy of psychological treatments for violent offenders in correctional and forensic mental health settings. Clinical Psychology: Science and Practice, 26(2), e12282.
Sloan, A., & Allison, E. (2014). We are recreating Bedlam”: The crisis in prison mental health services. The Guardian Newspaper.
Till, A., Exworthy, T., & Forrester, A. (2015). Integration and offender mental health. The Journal of Forensic Psychiatry & Psychology, 26(1), 11-21.
Towl, G., & Crighton, D. (2017). Suicide in prisons: Prisoners’ lives matter. Waterside Press.
Unit, S. E. (2002). Reducing re-offending by ex-prisoners.
Leaman, J., Richards, A. A., Emslie, L., & O’Moore, E. J. (2017). Improving health in prisons–from evidence to policy to implementation–experiences from the UK. International journal of prisoner health.
Boland, J., Abendstern, M., Wilberforce, M., Pitts, R., Hughes, J., & Challis, D. (2021). Mental health social work in multidisciplinary community teams: An analysis of a national service user survey. Journal of Social Work, 21(1), 3-25.
Perera, B., & Courtenay, K. (2018). Mental health services for people with intellectual disability in the United Kingdom. Advances in Mental Health and Intellectual Disabilities.
Ward, K. C., & Merlo, A. V. (2016). Rural jail reentry and mental health: Identifying challenges for offenders and professionals. The Prison Journal, 96(1), 27-52.
Lamb, H. R., & Weinberger, L. E. (2017). Understanding and treating offenders with serious mental illness in public sector mental health. Behavioral Sciences & the Law, 35(4), 303-318.
Sim, J. (2018). ‘Malignant Reality’: Mental Ill-Health and Self-Inflicted Deaths in Prisons in England and Wales. In Mental Health in Prisons (pp. 235-258). Palgrave Macmillan, Cham.
write