Locked up thinking: prisoners and mental health

Following the execution last year of a British man in China, Ruth Patrick says it’s time to look closer to home at how British justice deals with people with mental health conditions

At the end of last year there was coverage of the outrage and disappointment following the execution by Chinese authorities of Akmal Shaikh. His family said it was well established that he had a mental health condition. Predictably, British officials were quick to condemn the execution. Gordon Brown declared himself “appalled and disappointed”.

While it’s right to criticise such a blatant disregard for the mental health dimensions of this case, there is rather less concern with similar problems closer to home.

Britain’s own criminal justice system sees thousands of vulnerable people locked up and punished in prisons, where mental health issues are exacerbated and many do not receive the specialist help, care and support which they so desperately need.

Here, as so often, the figures speak for themselves. In 2009, 72 per cent of male and 70 per cent of female sentenced prisoners had two or more mental health issues. What is more, at any one time, 5,000 prisoners are living with serious mental health issues. The problems with the unfortunate and frequent overlap between prison membership and mental health vulnerability are two-fold.

Firstly, prison worsens one’s mental health and some offenders will experience their first incident of mental health challenges such as depression or self-harm whilst in custody.

Ironically, however, mental health services are poorly resourced and hard to access in prison.

Prisoners are twice as likely to be refused treatment for mental health issues than if they requested such support on the outside. Further, where a prisoner’s mental health needs become particularly urgent, there is all too often a long wait before they are transferred from prison to appropriate, secure support in hospital.

Secondly and more broadly, it is questionable whether it is appropriate for those with enduring mental health issues to be placed in prison at all. Where someone is incredibly vulnerable, and their capacity to act is affected by their mental health issues, being convicted of a crime and consequently punished with a jail sentence is unlikely to be the right response. Better and earlier healthcare interventions would be more effective, and might have a better chance of longer-term success in helping individuals to lead independent, happy lives. Admittedly, this sometimes happens and mental health is given more import in prosecutions and sentencing than in the Chinese case. But it needs to happen much more!

Reflecting on the current state of play, Juliet Lyons, Director of the Prison Reform Trust, said: “The use of prison to warehouse people for their mental illness is a criminal use of our justice system, it makes ill people worse and disrupts the rehabilitative work of prisons.” Those in the disability movement should join Juliet’s voice and campaign for a more just approach.
Rethink, a mental health charity, is campaigning on these issues. See: www.rethink.org/cjs