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Mental health care in prisons has improved but there are still too many gaps in provision and demand for mental health services will continue to outstrip the capacity of the NHS to meet the need, a report from the chief inspector of prisons has found.
The report, by Anne Owers, found that since the Department of Health took over responsibility for the provision of health care in prisons in 2003 “the quality and extent of treatment available to mentally ill prisoners” has improved. However, two findings “stand out starkly from this report.”
Ms Owers said, “The first is that there are still too many gaps in provision and too much unmet and sometimes unrecognised need in prisons. The second, equally important, is that the need will always remain greater than the capacity, unless mental health and community services outside prison are improved and people are appropriately directed to them: before . . . and after custody.”
Although she praises the efforts of NHS staff and the mental health in-reach teams that “rode to the rescue of embattled prison staff” she says “this infusion of skilled personnel” has established “beyond doubt not only the scale but also the complexity of the need.”
The report found that GPs working in prison were often doing so in isolation, with little or no specialist training. It found that relationships with mental health in-reach teams were good, but GPs had little contact with community based psychiatrists.
GPs interviewed in the study called for a better understanding of the link between substance misuse and depression and the need for psychological support for patients withdrawing from alcohol. They also warned of a lack of access to talking therapies and a reliance on drugs.
The report also found a gap in the provision of care to prisoners with less severe mental health problems.
This assessment was backed up by Redmond Walsh, a London based prison doctor and member of the BMA's civil and public services committee.
“The biggest number of people [with less severe mental health problems] are those who self harm, have a personality disorder, or are substance misusers. They create the most amount of pressure for healthcare staff, and there is no integrated approach on how we deal with them,” he said.
The report called for prison services to make more use of court diversion and liaison schemes, which divert prisoners to mental health units if necessary. Only two out of the 23 primary care trusts questioned were aware of such schemes, despite the fact that a 2002 study established that diversion from court to hospital was successful (www.homeoffice.gov.uk/rds/pdfs2/occ79outcome.pdf).
It found that of prisoners diverted there was a reoffending rate of 28%, compared with the general reoffending rate of 67%.
The Mental Health of Prisoners is available at http://inspectorates.homeoffice.gov.uk/hmiprisons.