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Prisons: Mental Health

Volume 762: debated on Wednesday 24 June 2015


Asked by

To ask Her Majesty’s Government what steps they are taking to achieve parity of esteem between mental health and physical health in prisons.

My Lords, achieving parity of esteem between mental health and physical health in prisons is a government priority. Following the 2009 review by the noble Lord, Lord Bradley, we ensured that prisoners can access equivalent health services to people in the community. The Government’s mandate to NHS England has objectives to achieve parity of esteem, including in health and justice settings, and to develop better offender healthcare that is integrated between custody and community, including developing liaison and diversion services.

I thank the Minister for that Answer. I am sure he will be aware that a great deal of effort has been made to improve data accuracy and the quality of recording of mental health diagnosis in NHS trusts, including new coding standards, all as part of preparation for a national payment tariff for mental health, similar to those for people in hospitals with physical health conditions. Can the Minister describe, first, how this will be implemented in the prison setting? Secondly, what support will his department be giving to implement the standards for prison mental health services, which the Royal College of Psychiatrists published recently due to, as it said, the lack of a national blueprint for mental health services for people in the criminal justice system?

I thank the noble Lord for his two questions. On the first, about coding, it is very important that we get the tariff right and that it does not become just another measure of activity but that outcome is built into that tariff. Paul Farmer, the chief executive of Mind, is preparing a report for NHS England, which will include proposals for the tariff and payment systems. That will include health in prisons as well as outside prisons.

The second question was about the standards issued recently by the Royal College of Psychiatrists. The noble Lord, Lord Bradley, in his foreword to The Bradley Report Five Years On, referred to the importance of having a national blueprint, which of course is now possible given that NHS England is the commissioner of specialist services throughout the country. I will also draw those standards to the attention of Paul Lelliott, the chief inspector of mental health within the CQC. I am sure that the CQC will wish to incorporate those standards into its inspection regime

Can the Minister say what qualifications are now required of doctors who are recruited to work in prisons? Can he further say what proportion of those who are now employed to work in prisons have had formal psychiatric training?

I thank the noble Lord for that question. I hope he will think it acceptable if I reply to him in writing after this session.

My Lords, could the Minister explain why we lock up so many mentally ill offenders in prison institutions that are not fit for the purpose? Has he read yesterday’s report by the prisons inspector, which describes one prison as containing “shocking” squalor, high levels of violence and drug abuse, and high levels of staff sickness? Would the Minister explain how many mentally ill offenders are in our prison institutions and what efforts are being made to place them where proper mental health care and social care are available?

There are, as the noble Lord knows, some 85,000 people in prison, of whom more than 70% have two or more mental health conditions. Many of them suffer from drug or alcohol abuse, and I think it is generally accepted that a number of those people could be better treated outside a prison environment. He will also know that the liaison and diversion services that were so highly recommended by the noble Lord, Lord Bradley, now cover 40% of the prison population. There is a proposal that that should cover the whole population by the end of the year, subject to evaluation of those pilot schemes.

My Lords, it is vital that a prison has all relevant information about an offender’s health needs when they arrive at prison reception. Does the Minister agree that an evaluation of the current health screen should be undertaken to improve the identification of mental health problems at prison reception and that the identification of learning disabilities should be part of that screen?

The noble Lord raised this in his report five years ago and in the follow-up report that was published more recently. A very early assessment of a prisoner when he arrives in prison is of course extremely important.

My Lords, given the complex needs of so many prisoners and the fact that those needs have to be addressed consistently, does the Minister agree with me that the risks associated with such prisoners could be greatly reduced were all operational staff in prisons given training on mental health awareness?

The right reverend Prelate’s comments are true throughout the whole healthcare system and would also apply to nurses in physical health surroundings. Training in how to recognise and deal with people suffering from mental health problems would be a huge benefit.

My Lords, the figures that the Minister cited come from the last survey of psychiatric morbidity in prisons, published in October 1998. Since then, the morbidity profile has changed. Is there any intention to conduct another survey so that the figures are up to date and people know the size and shape of the problem with which they must deal?

I am not aware of any current plans to conduct a survey similar to the one to which the noble Lord referred from 1998.

My Lords, what action will the Government take in Wales, where health is devolved to the Welsh Assembly but prisons are part of the Home Office remit? How will those two different aspects of government work together?

The noble Lord raises an issue to which, I confess, I have not given sufficient consideration to give a proper reply today. Perhaps I may take that away and come back to him. The simple answer to that question is: dialogue.