Prison population: mental health needs

Conclusions

There is overwhelming evidence that individuals in prison are more likely to have a range of mental health needs, which are often multiple and complex. Existing provision to support the mental health of people in prison in Scotland does not adequately meet these needs and that a change in approach is required.

Evidence from multiple elements of this needs assessment converged, indicating that most individuals in prison have, or will develop, mental health needs. Like individuals in the community, the COVID-19 pandemic has likely had a negative impact on the mental health and wellbeing of Scotland's prison population. Recognising this, and despite new challenges in service delivery resulting from the pandemic, many of which are still ongoing, this report found that the fundamental barriers to supporting the mental health of individuals in prison are likely longstanding. Professional stakeholders endorsed the view that individuals should leave prison better off and with greater opportunities than when they entered prison. To deliver this, however, there are substantial changes required in services delivered throughout the prison journey.

A mapping of current mental health service provision for people in and leaving prison highlighted that services in several establishments are insufficiently resourced. In those prisons, this equates to only an emergency service being provided, working with the most acutely ill, and leaving the majority of people in prison without support they could benefit from. NHS mental health teams are under-resourced and overworked, attempting to innovatively manage their workloads as effectively as they can within their limited resources. There are fundamental issues with attracting and retaining staff to work in prisons against the backdrop of high demand for services. Staff absences brought on by the pandemic have further exacerbated resource pressures. Professionals highlighted a number of challenges to meeting mental health needs of people in prison, but a common theme was observed in relation to difficulties in and barriers to coordinated and joint working across SPS, health and third sector organisations to support individuals in prison. All who work in prisons bear a duty to support the mental health and wellbeing of people in prison, and there are corresponding roles for all agencies in implementing the necessary actions to do so.

Several reports published in the last decade have highlighted concern around many of the same problems identified in this report and offered appropriate, evidence-based recommendations to address them (e.g. HMIPS, 2019; NPHN, 2014). Despite repeated scrutiny of the same issues, most recommendations have not been fully implemented. This suggests that current structures and operational arrangements do not facilitate the development of innovative practice or are too restrictive to enable the change required. A fundamental change to prison mental health services is required.