Healthy Prisons - A Contradiction in Terms?

Finally published today is the report of an investigation I’ve undertaken into the life-threatening attempted suicide of a remand prisoner at HMP Brixton. Since the disastrous incident in 2010, AC (I can’t use his real name) has been in a hospital having sustained a serious and long-term brain injury. It was obviously a tragedy both for AC and his family.

The incident itself was particularly distressing too for the staff on the wing. AC had barricaded his cell by moving a locker between the bed and the door preventing anyone else entering the cell. Attempts to remove a metal plate which enables the cell door to be opened outwards were frustrated as one of the screws could not be loosened. By the time a locksmith from the works department got it open- almost half an hour after the start of the incident- the damage had been done. 

Much has changed in the prison world in the last eight years- a lot of it for the worse of course. Brixton has a different role as a Category C Resettlement Prison.  Nowadays it receives about 25 prisoners a week all from other prisons, compared to three times that number from court back in 2010. But I hope the findings and recommendations – almost all of which have been accepted – have been of some use there and across the prison estate.  

Re-reading the report which was finished in 2015, it’s clear the case raises three broader questions about the ability of prisons to deal with the many vulnerable men and women they accommodate- particularly those with mental health and or drug problems.

First there’s the inevitable interruption to healthcare which goes with imprisonment. Although AC was not formally diagnosed as schizophrenic, both he and his GP in the community knew his mental health was improved by his taking anti-psychotic medication. After the first few days in Brixton, he never got any during the three months he was there. He was the victim of a “catastrophic lack of clarity about respective responsibilities” for prescribing between the prison-based GP, mental health and substance misuse teams. Following my report, the NHS seem to have taken on board the underlying issues, but it’s quite possible that the other problems I found - poor communication between medical personnel and failure lack of follow up when prisoners fail to attend GP appointments- may well continue to be a risk particularly in busy local prisons.  

Second is the obstacle imprisonment puts in the way of families providing support to prisoners. AC’s sister had been looking after him in the community and visited him regularly in prison. Staff at Brixton failed to acknowledge the key role she played in his care or to engage constructively with her during his period in custody. She tried to warn the prison her brother was heading for a psychotic breakdown via a handwritten note to a nurse.  AC’s community-based GP and solicitor both wrote too - but the response was too little too late. The report adds weight to Lord Farmer’s recommendation that “prisons should be able to show evidence that family or other supportive relationships play a role in intelligence gathering regarding a prisoner’s mental health, drug use (prescription and illicit), propensity to violence and risk to self”.

The way the prison did respond to AC was via the disciplinary system. He was involved in at least two assaults on other prisoners and smashed up his cell. I found that staff showed little interest in identifying what lay behind AC’s behaviour on the wing, for example the nature and extent of his debts. He regularly asked to move wings and was known to smoke tobacco and heroin which incurred costs. But this was a stone best left unturned.

When a serious assault brought AC before an Independent Adjudicator. AC said he was an emotional wreck, was being broken and couldn’t get his proper medication. There was no record of whether this information was passed on to staff.

The sanctions imposed on AC during his time at Brixton may not seem unduly harsh; but loss of canteen, association and television can have significant impact on a prisoner with mental health problems, reducing opportunities for social interaction, diversion and relaxation. I recommended that possible adverse consequences on a prisoner’s mental health should be considered when imposing punishments and forfeitures at adjudications- but remain concerned that this may not always happen.

There are probably many people in prison not unlike AC. He had been remanded into custody following charges of burglary. His first conviction was at the age of 17 and he had several spells inside unable to keep stable accommodation or find regular employment. One of his previous assessments described a man “more comfortable within prison than without”.

Whatever the truth of that, this is a case that surely argues for the creation of a much wider range of custodial, residential and community-based options than currently exist for those remanded for or convicted of offences.  The Female Offender Strategy has proposed a new form of residential centre for women offenders. Do we need to think about new forms of infrastructure for men like AC too?