Written by Charlotte Randall
Prisons have often been thought to be one of the most challenging places to deliver healthcare in the UK; a patient population with high levels of mental and physical health problems, as well as social needs and limited autonomy in the patients’ social and habitable activities has led to an environment that is considered to be “anti-therapeutic and counter- productive.” While UK prisons offer thorough primary and secondary care that is equal to the rest of the country, as well as counselling and programmes for addictions, it is arguable that the quality of this care is currently inadequate due to continuing mental illness after release and dissatisfaction of inmates. However, within an institutionalised place of punishment, it possible for perfect mental health to be achieved?
It is estimated that 90% of prison inmates have some form of mental health problem, which includes depression, addiction, anxiety and, very commonly, personality disorders. Many prisons offer extensive aid to those with these
issues. Indeed, many prisons have resident medical staff, including a GP and nurses. Prisons also offer therapies including counselling, art therapy, psychotherapy, 12 step programmes and therapeutic committees in conjunction with doctor and other healthcare worker consultations. However, issues have arisen associated with the organisation of the mental healthcare and, as within much of the NHS, the IT services. A report into prisoner mental health revealed that across the UK many in-reach mental health programmes were working in isolation and were poorly integrated with other services, meaning patients are receiving inconsistent care. Moreover, SystmOne, the medical record system used by UK prisons so information can be easily accessed by all prisons, has been notoriously difficult to use in the past among prison staff and there have been incidences of vital information on patients’ mental health being missed.
Healthcare and prison workers within the prisons have influenced quality of inmate-patient mental healthcare. Many reports indicate that most prison workers are relatively uneducated about mental health issues. While prisoners visit primary care doctors three times more frequently than the general public, they still see doctors far less frequently than they see the day-to-day prison workers. Many employees have few skills and experience in recognising and managing the symptoms of mental illness. Moreover, it is possible to argue that prison workers can misinterpret symptoms of mental illness for disruptive behaviour and may discipline the inmate rather than offer them aid. Interviews with inmates have also revealed that they compare themselves to “cattle” where they are rushed through the system of mental health assessment, especially upon entry to prison, asked a few basic questions and shuffled along so the next prisoner could be questioned. Moreover, prisoners feel that they receive a high level of mistrust from health care workers in prisons, and one prisoner reported that he was denied pain medication, as the healthcare workers did not believe he was serious. This suggests that the healthcare infrastructure and performance in prisons is poor and is arguably why some prisoners remain mentally unwell on their release.
However, this is only half the story.
In the outside world, treatment for mental illness involves, apart from medication, building a social network of support, doing enjoyable activities and being in a comfortable and calm environment. Not exactly prison atmosphere. The function of a prison is to be a place of punishment and the institutionalised rules form rudimentary routines that are a huge change in the lifestyle of inmates. This restricts inmates’ ability to able to do what they want when they want to. Moreover, prisoners are separated from
their families and only allowed to see them, supervised, for a few hours a day. Added to this, they are thrown into a hostile environment where they know no one. This creates a sense of isolation, which does not help in treating mental illness. Violence in prison can occur as well as hostility between inmates and this creates an atmosphere of tension, which can act as a catalyst for poor mental health. The prison atmosphere does not lend itself to helping to treat mental illness regardless of healthcare provided. As a side note, some inmates have deep rooted mental health problems that would be difficult enough to treat outside the prison environment without time limits but within the limitations of the prison sentence it is possible that there would not be enough time to properly treat their illness. Care outside the prison, if provided, may not follow on directly from previous treatment, suggesting that care may not be completed.
Solutions must be found to try to improve the current mental healthcare provision for this population. An obvious solution would seem to be to change the prison physical environment by allowing more visits from families, allowing prisoners more autonomy in their day-to-day lives and making prisons generally calmer and more relaxed places. However, is this right? The reason people are put in jail is because is because they have broken the law and consequently need to be punished. Within the eye of the wider community, these people deserve to be punished and have certain privileges taken away. Yet these people still have a right to healthcare, so it is important to address the flaws within the care system by educating prison workers properly. Moreover, addressing and improving mental healthcare will aid in the reduction in the number of prisoners who reoffend. Some mental illnesses can lead to actions and behaviours which result in imprisonment. Addressing and treating their mental illness will stop prisoners repeating their actions and allow them to live a free life.