Sainsbury Centre for Mental Health

Criminal Justice and Mental Health

Approximately 70% of prisoners have either a psychosis, a neurosis, a personality disorder, or a substance misuse problem. Many prisoners have more than one of the above problems.

In addition, there are specific concerns about certain groups, such as women and people from black and minority ethnic communities and young offenders. The proportion of women in prison has increased dramatically over the past ten years and people from black and minority ethnic communities are over represented in the criminal justice system. The rate of self harm and suicide amongst women in prison, in particular, greatly exceeds that of the general population.

The prison population has soared in the last decade. The government has acknowledged the need to improve mental health care for prisoners and the NHS is now responsible for prison health care. It aims to give 'prisoners access to the same quality and range of health care services as the general public receives from the National Health Service'.

Prison health care policy

The key policies are:

• the Bradley review of people with mental health problems or learning disabilities in the criminal justice system (Department of Health) looked at the extent of possible diversion from prison to other services and the barriers to it.
• Improving health supporting justice started a consultation process on how health and social care services can be improved for people subject to the criminal justice system in England. The outcomes of the New Horizons consultation should apply equally to prisoners as well as the general public.

Putting these policies into practice presents a significant challenge. Overcrowding, lack of staff skilled in dealing with mental health problems and inability to effectively manage mental health problems have been identified as some of the key problems which need to be addressed.

There is a growing evidence base that prisons are not effective at reducing offending and that the costs (financial and social) of containing people in prison without access to appropriate health care are too high.

This has been particularly highlighted in relation to women prisoners and has prompted the Ministry of Justice to develop a National Service Framework for women offenders.

As mental health service providers develop mental health services in prison, services are required to work in a collaborative way, to ensure the efficiency of those services, that the service provision is formed according to the needs of the population it served, and that clear pathways of care are created to ensure that prisoners get the care they need in a timely fashion.