Women with mental ill health in prison in Scotland – new report finds further concerns, and calls for major change

A review of the records of nine women who received mental health care in prison custody in Scotland between 2017 and early 2020

In a new report published today, the Mental Welfare Commission expresses further concerns about care and treatment of vulnerable women with mental ill health in Cornton Vale prison.

Background

In October 2018 the European Committee for the Prevention of Torture (CPT) visited prisons and police facilities in Scotland. The report of their visit raised issues across the estate but specifically raised serious concerns about five women with mental ill health in Cornton Vale, including concerns about segregation for extended periods and the conditions in which the women were held.

The UK Government’s response, including the Scottish Government’s response, was published in October 2019. While action is being taken to build new facilities at Cornton Vale and a review of forensic mental health services has reported, the serious nature of the CPT’s findings drove the Commission to carry out this retrospective detailed review of the prison health records of the five women whom the CPT had raised concerns about, and to broaden this review to include four further women who were in the prison between 2017 and 2020. 

Scotland as a society needs to do more

While focusing on nine anonymised cases, today’s report raises questions about key stages of the wider prison system as they are now, and includes recommendations that are relevant across the prison estate.

Our findings

The Mental Welfare Commission’s report highlights the lack of available beds in specific units in Scotland’s mental health facilities – a concern that remains as relevant now as it did at the time of the CPT report.

Today’s report also raises critical questions about missed opportunities with early intervention, pathways from prison to the community, and the revolving door of prison.

Key points

Examination of the records revealed a distressing and disturbing picture, much in line with the CPT’s findings. A number of women experienced a significant deterioration in their self-care in the context of their mental disturbance.

A significant concern was women’s access to medication and the recording of this. There were gaps in the dispensing of medications for physical and mental health in individual cases, which amounted to significant gaps in treatment.

Several of the women were acutely unwell with psychosis whilst in segregation. In this environment, they may be locked alone in a cell for up to 22 hours a day or more. The records of all nine women indicated they were highly distressed whilst segregated in the Separation and Reintegration Unit (SRU). The severity of the women’s symptoms and level of disturbance appeared to worsen in this environment, as did their self-care and the opportunity for any meaningful interaction with others.

The Commission found examples of repeated inequalities, with women in prison being unable to readily access intensive psychiatric care unit (IPCU) beds or secure forensic female beds due to bed pressures in local services and a lack of provision of female medium secure facilities.

The Commission considered missed opportunities for earlier intervention for women who are acutely mentally ill at the point of going to prison. In a number of cases it found that women showed signs of being acutely unwell at the point of arrival in prison custody. In each of the cases the women’s mental state deteriorated further, and there were challenges and delays in transferring them for inpatient healthcare. While this review has highlighted a few cases, the healthcare team at HMP Cornton Vale advised the Commission that this situation continues to occur. This is a serious concern.

The Commission is also concerned about aftercare, and pathways from prison to community. It was evident from reviewing individual records that transition planning and arranging supports in the community could be challenging, particularly for women on remand.

The report has a series of recommendations for Cornton Vale itself, for the Scottish Prison Service (SPS) and for Scottish Government. One recommendation, which reiterates the CPT report, is that all prisoners, including those in conditions of segregation, should be afforded, as a bare minimum, at least two hours of meaningful human contact a day. 

Claire Lamza, senior manager (practitioners) at the Mental Welfare Commission, said:

“This document opens a window on the lives of some of the most marginalised women in society. It gives some insight into the irreparable damage that is being done to those individuals, and we can only imagine the wider impact on their families and communities. 
“We hope this detailed review will be read and acted upon by those who are examining Scotland’s future approach to the best ways to care for mentally unwell people in prison.  While changes are being made at Cornton Vale, the wider situation needs to be addressed, and Scotland as a society needs to do more.
‘We agreed with the CPT on many issues, particularly related to the environment of the segregation and reintegration unit.
‘Our review also raises critical questions about missed opportunities with early intervention, pathways from prison to the community, and the revolving door of prison.’
 

Notes to editors

1. Over the past 20 years, the Scottish prison population has been increasing. The number of women prisoners doubled between 2000-2010, to a daily average of over 400, and has remained around this level for most of the last decade. 
Scotland has had the second largest female prison population in Northern Europe since 2010. In 2019-20, the average daily prison population in Scotland was 8,198, and of those individuals, 402 were women (4.9%). 
Prison numbers reduced following the onset of Covid-19. At the time of writing this report, 291 women were in custody, of whom 207 were convicted prisoners, 73 were untried (on remand) and 11 were in custody awaiting sentence.

2. The Mental Welfare Commission issued this statement at the time of the CPT report.

3. An independent review of Forensic Mental Health Services in Scotland, commissioned by Scottish Government ministers, and chaired by Derek Barron, reported in February 2021. It found deficiencies in the female forensic estate and acknowledged this led to inequity in care for women. It made wide ranging recommendations for the reform of forensic mental health services including recommending that the Scottish Government re-establish female high secure provision at the State Hospital within nine months of the report being published. The Scottish Government’s response to these recommendations is awaited.