Mental health services in Scotland’s prisons - urgent action needed

A new report published today by the Mental Welfare Commission is calling for urgent action on the care and treatment of prisoners with mental ill health in Scotland’s prisons.

The report follows visits by the Commission to all 15 of Scotland’s prisons, hearing from staff and prisoners.

Ten years after a similar series of visits, today’s document finds many changes to structures and organisation, but little improvement in the outcome for prisoners’ mental health.

The report looks at arrival and early days in prison, when people are particularly vulnerable. It examines the experience of segregation, the transfer of very unwell prisoners to hospital, mental health care, and addictions to drugs or alcohol. And it hears from relatives and friends.

The Commission found pockets of good practice, and found the workforce were committed to their roles. But the overall experience of mental health services in prisons continues to be in need of significant improvement. 

This is despite a range of existing guidance, policy and local arrangements to support the mental health and wellbeing of prisoners. 

Key findings

• The Mental Welfare Commission has been raising concerns about the use of segregation for prisoners with mental ill health. This is wrong. All prisoners who are seriously and acutely mentally unwell should be transferred to hospital care without delay, yet we found this is still not happening. Ten of the prisoners we visited were segregated; some were acutely mentally ill and unable to speak with us. Staff working in those units also told us they felt ill-equipped to manage severely mentally unwell prisoners.
• A significant majority - 77% - of the prison staff group who engaged with us reported that they had concerns about the provision of mental health support within the prison.
• 76% of prisoners had a history of mental ill health which was identified at reception screening. 60% had been receiving support for mental illness before arriving in prison.
• 89% of frontline staff said they would like more training in mental health, not only basic awareness training, but much more in-depth training for working with an increasing number of prisoners with complex mental health needs and presenting behaviours. 
• Of the 107 prisoners who spoke to us, 81 reported addiction issues, to alcohol or drugs. 
• All prisoners arriving into prison are screened for mental health as a mandatory standard, however we found that current reception screening has fundamental gaps which, if addressed, could significantly improve the mental health and wellbeing of prisoners, particularly in relation to learning disabilities, autism spectrum disorder and personality disorder. 

Coping with the pandemic

Prison governors acknowledged how well their staff had coped with the extreme difficulties they have faced. All struggled, however, with the loss of clinical and prison staff who were absent and isolating due to Covid-19.

Almost all of the staff who responded had concerns about the deterioration in the mental health of prisoners in their care during the pandemic, which they recognised led to an increase in self-harm and drug use within prisons.

Visiting restrictions and lack of contact with family and friends added to the loneliness and deterioration in the mental health of many prisoners. 

Recommendations for change

The report makes nine recommendations for improvement to the Scottish Prison Service or the NHS, or often to both. 

The report also makes one overarching recommendation to Scottish Government, asking that they monitor the delivery of those nine recommendations, and work with the prison service and NHS to deliver better outcomes for people in prison with mental ill health.

Suzanne McGuinness, executive director of social work, Mental Welfare Commission, said:

“Scotland has one of the highest rates of imprisonment in Western Europe, and the majority of people arriving at prison reception have a history of mental ill health. 
“Suicides in prison remain a serious concern in Scotland. 
“While we found some good practice, our overwhelming impression was of a prison population which is under served and under resourced. Our key messages of 2011 have not been realised 10 years on, and the anticipated improvements of health care responsibilities being transferred to NHS Scotland have not materialised.
“A joined up, whole system, approach to managing and supporting prisoners and staff across Scotland’s prison estate is needed as a matter of urgency.”

Background note

The Mental Welfare Commission visits and reports on individual prison mental health services regularly, but last visited all of Scotland’s prisons a decade ago, in 2011. 

At that time, we highlighted many areas that needed improvement. Also at that time, responsibility for the care and treatment of prisoners with mental ill health was transferring from the Scottish Prison Service to the NHS. In today’s report, we wanted to see whether the changes we’d called for then had been implemented, and whether the change in service responsibility had made a difference.