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PPO releases Thematic Review of Deaths in Custody where Mental Health is a Feature

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The Prison and Probation Ombudsman’s role is to carry out independent investigations, in which recommendations and broader thematic lessons for improvement are made to contribute in making custody a safer environment for prisoners. On 19 January 2015 a further review was published focusing on those deaths where mental health is a feature.

Mental health disorders can range from mild forms of depression and anxiety to more serious, chronic conditions such as severe personality disorders and psychosis. A lack of knowledge in respect of many existing mental health conditions can result in difficulty in managing these conditions. Furthermore, a failure to identify and acknowledge that a prisoner’s presentation and behaviour is a manifestation of an underlying condition can result in prisoners feeling frustrated thus worsening their condition. This failure to understand can lead to a sense of loneliness and an inability to cope in an already challenging environment, and may result in the prisoner engaging in self harming behaviours as a coping mechanism. Prisoners may disengage with staff and their surrounding environment which on occasions can unfortunately incorrectly lead to punishment rather than therapeutic support.

Previous research conducted by the Prison and Ombudsman showed 70% of the prisoners who have killed themselves in custody have had one or more of the above identified mental health needs. What has to be borne in mind is this figure could be higher when considering the number of prisoners who have undiagnosed mental health problems. The failure to identify and appropriately manage a mental health disorder is not just something that exists within prisons. The majority of inmates who enter prison establishments also fail to receive appropriate care and treatment in the community. Cases illustrate how this leads to a downwards spiral whereby a person who should have been managed in a healthcare setting is then entangled in the criminal justice system where sadly, a failure to understand mental health issues dominates.

Alongside the specific issue of identifying mental health needs and managing a prisoner appropriately, the review mentions the broader issues which co exist and influence the wider failure to manage these vulnerable prisoners within prison establishments. The most common examples that are identified within prison and probation ombudsman’s reports and the inquests that follow include: poor information sharing, failure to make referrals to mental health professionals, inappropriate mental health assessments and inadequate staff training. Furthermore, the lack of a multi disciplinary approach and the lack of encouragement in complying with medication all contribute to the many concerns surrounding the substandard practices by staff which such reviews and recommendations aim to improve.

Lester Morrill’s inquest department is routinely instructed on cases where the above concerns and failures have been identified as one of the many prevalent issues which have surrounded a deceased’s care in prison. These have been supported by recommendations from the prison and probation ombudsman along with Coroner’s Prevention of Future Death Reports. It is undoubtedly promising that the ombudsman has indentified the seriousness of the inadequacies of mental health care within prisons however, whether this mere identification leads to intense changes on the ground is yet to be seen.

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