Prisoners with mental health problems spending months in isolation

Prisoners with serious mental illnesses are being kept in segregated facilities instead of being transferred to a secure hospital, a report has found

31st January 2024 about a 4 minute read
“While local IMBs found that overall staff worked hard to support prisoners in the best way that they could, collectively they have reported a disturbing picture of mentally unwell men spending lengthy periods in isolation, which often results in a deterioration of their mental health." Elisabeth Davies, national chair, Independent Monitoring Board

The prison service is too often using segregation as a way of managing and caring for prisoners with severe mental health needs, an Independent Monitoring Board (IMB) report has found.

Segregation is designed to be an option to manage poor behaviour. If prison managers want to maintain good order and discipline, they can remove a prisoner from the rest of the prison population and isolate them. Prisoners can also be moved to care and separation units (CSUs) for their own safety if they are at risk of violence from other prisoners.

In practice, local IMBs – made up of volunteers who monitor prison conditions – have found that CSUs are being used to house mentally unwell prisoners. Drawing on reports from the local IMBs, the new report found:

  • Prisoners with severe mental health needs were spending lengthy periods segregated, over 800 days in one instance. The mental wellbeing and behaviour of the men often deteriorated further during these prolonged periods.
  • Many IMBs repeatedly reported concerns over the 28-day target to transfer severely unwell men from prison to secure hospital not being met. Delays were found throughout the entire process – at referral, assessment, and transfer stage.
  • Prisoners were often moved back-and-forth to CSUs from prison healthcare units and wings, making it harder to track the cumulative time spent segregated.

Prisoner kept for nine months in CSU

IMBs found multiple cases of prisoners who have spent extended periods in CSUs:

  • At a category C training prison, a man with autism, a schizophrenia diagnosis and displaying severe ADHD symptoms, cumulatively spent almost nine months in the CSU, during which his mental health dramatically deteriorated.
  • At a category B reception and resettlement prison, serious concerns were raised by the Board about a prisoner with complex mental health needs who was segregated for 300 days while awaiting assessment for transfer to a secure mental health hospital. By the time he was assessed and transferred, he had spent over 550 days in the CSU – nearly 20 times over the target transfer time.
  • Several Boards had specific concerns about prisoners serving indeterminate Imprisonment for Public Protection (IPP) sentences and displaying serious mental health conditions who were regularly in the CSU, or were spending prolonged periods there.

The report cites several examples of segregation being used inappropriately. At one high security prison, an IPP prisoner with a personality disorder was segregated for over 800 days before being successfully transferred to an appropriate unit.

At a category B training prison, an IPP prisoner with a serious mental illness and physical and learning disabilities, was held in the CSU for over 250 days. The Board reported concerns over his deterioration, describing him as confused, tearful, unpredictable, and volatile.

The report suggests that the reason for the overuse of segregation is a need for more appropriate provision in the community, adding: “An increase in the number of mental health hospital beds of appropriate security levels, tighter controls on the transfer target and more effective monitoring of transfer time frames is necessary.”

The proposed reform of the Mental Health Act would have written the 28-day target for transfer to secure hospital into law, but the reform has been dropped for this parliament.

CSUs should not be ‘holding bays’

Responding to the findings, Elisabeth Davies, the national chair of the IMB, said:

“Segregating any prisoner, especially those with mental health needs, is not a decision taken lightly by prison managers. While they clearly feel that they have no other option, CSUs should not be used as holding bays for these vulnerable individuals.

“While local IMBs found that overall staff worked hard to support prisoners in the best way that they could, collectively they have reported a disturbing picture of mentally unwell men spending lengthy periods in isolation, which often results in a deterioration of their mental health.

“If anything is to change, the solution is, and has always been, providing appropriate mental health provision in the community and tighter controls around the transfer times from prison to hospital.

“Although it would not have solved the problem entirely, the proposed Mental Health Bill, which was due to make the 28-day transfer target a statutory requirement, would have taken us one step closer to this.

“In the meantime, segregation will continue to be used as the wrong tool to manage the mental health crisis in prisons.”

FCC Insight

The finding that prisons are inappropriately using segregation to manage prisoners with mental health problems is deeply worrying. According to the HM Inspectorate of Prisons, almost half of male prisoners have a self-reported mental health problem, while independent research suggests the proportion may be even higher. As the IMB report says, the reason for the use of segregation is the lack of alternative provision: we need far more beds in secure hospitals to make sure that severely mentally unwell prisoners are supported and treated appropriately. Reform of the Mental Health Act to mandate that prisoners spend no more than 28 days in isolation before being transferred to hospital would perhaps create the impetus to improve provision.