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Suicide and Self-harm in Prison (England)

Volume 622: debated on Wednesday 1 March 2017

I beg to move,

That this House has considered rates of suicide and self-harm in prisons in England.

It is a privilege to serve under your chairmanship this morning, Mr Chope. I am pleased to have the opportunity to discuss the record levels of suicide and self-harm in our prisons in this timely debate.

Yesterday, it was announced that prison officers planned to strike today. The reasons they cited were:

“More and more members…being assaulted every day”


“the increase in self-inflicted deaths and daily security breaches…as a result of staff shortfalls and budget cuts.”

The industrial action has been blocked by the Secretary of State for Justice, who won an injunction in the High Court, but the serious concerns raised by the Prison Officers Association cannot be ignored. Yesterday, a report from the Institute for Government declared that spending decisions have pushed prisons “beyond breaking point”.

Our criminal justice system rests on the idea that a person who has committed a crime should be punished if necessary and, as a last resort, by the removal of their liberty. By removing a criminal’s freedom, we seek to protect the public from the criminal’s activities for the duration of their time in prison. We also aspire to provide meaningful opportunities for rehabilitation so that on release, the prisoner can rejoin society as a law-abiding citizen.

What we do not do in the United Kingdom, and have not done since 1964, is use the removal of a criminal’s life as a punishment, yet within our modern-day prison system an all-time record number of prisoners are paying for their crimes with their lives. Official data published by the Ministry of Justice on 26 January showed that 119 prisoners died by suicide during 2016—the highest number in a calendar year since current recording practices began in 1978.

Inquest, a charity that monitors deaths in prisons, has reported that already there have been eight recorded self-inflicted deaths in 2017, with a further seven deaths awaiting classification. On average, a prisoner dies by suicide every three days, and 12 women lost their lives through suicide in 2016. The Minister might be tempted to say that the increase in deaths by suicide is a reflection of the increase in the prison population as a whole, but that argument does not stack up when we look at the figures. The number of deaths by suicide has doubled in just five years, yet the size of the prison population, currently standing at a little over 85,000, has plainly not doubled since 2010.

The Minister might be further tempted to suggest that a prisoner who takes their own life in prison might have done the same on the outside, but a self-inflicted death is 8.6 times more likely in prison than in the general population, according to the Howard League for Penal Reform.

I congratulate the hon. Lady on securing this important debate. She has made some excellent points, to which I hope to hear the reply later. Does she agree that a suicide in a hospital would be a very serious issue and that a suicide in prison should be taken no less seriously? Urgent action is needed to reduce suicides that take place on prison premises.

I thank the hon. Gentleman for his intervention and for his commitment to the issue of mental health. Deaths in prison should be treated no differently from those in any other setting. Issues such as ligature points are contended with very differently in inpatient settings and in prisons. We could point to many things that should be treated in the same way as in any other element of life outside prison.

The number of self-harm incidents has also reached a record high of 37,784, which is up nearly 7,000 on the previous year.

One group that has been uniquely failed by the prison system is transgendered prisoners. There have been four deaths by suicide of transgendered people while in prison over a mere matter of months. That is from an estimated prison population of just 85.

We know that the prevalence of mental health conditions is much higher among the prison population. Prisoners are over three times more likely to suffer from depression, 12 times more likely to suffer from a personality disorder and 16 times more likely to suffer from psychosis.

For prisoners who need to be treated in a mental health inpatient unit, departmental guidance states that transfers under the Mental Health Act 1983 should take place within 14 days. I was appalled to learn from the answer to my written parliamentary question that in 2015-16, 1,141 prisoners—three in four—waited longer than that two-week window. Such ubiquitous failure would never be tolerated in the outside world.

With regard to data on mental health in prisons, it feels like a minefield trying to get hold of figures that give a true representation of the scale of the problems. I cannot help but feel that the Minister and his Department are trying to pull the wool over our eyes. When I resubmitted my question to get the most up-to-date figures, I was told that, in the space of just a few months, the data are now

“not held in the requested format”,

despite the wording of my question being identical. I hope the Minister will tell me why the collection of the data has changed.

When I finished drafting my speech shortly before we began this morning, the Department’s answers to four of my named-day questions were long overdue. The answers would have played a key part in my contribution, but, regretfully, I cannot hold the Government to account fully for them today. Just one example is a question I asked about what proportion of people who died by suicide in prisons were not on the assessment, care in custody and teamwork pathway for people who have been identified as being at risk. In 2015, only 35 of 89 people who died by suicide were on the ACCT pathway, suggesting that too many vulnerable inmates are not being identified early enough. I asked the question again on 31 January—over a month ago—and the Minister’s Department has still not come back to me with that vital information.

Prison should offer a unique opportunity to provide mental health treatment in a secure environment, but the Government are betraying the vulnerable people our criminal justice system is supposed to protect. I met representatives of the Prison Officers Association who told me that, despite having worked in the Prison Service for decades, they had never received any mental health training. A recent Royal College of Psychiatrists forensic faculty survey found that service cuts mean most prison psychiatrists do not feel able to deliver a basic level of care. It is clear that the mental health services in our prisons are buckling. On a recent visit to a local prison, I saw at first hand the lack of care and services available to inmates. A recent consultation by the Centre for Mental Health found that a decrease in prison staff meant inmates often missed psychiatric appointments because there was no one available to escort them, and consequently they could not get the treatment they needed.

This is the stark reality that has been created by decimating staffing levels in prisons. There are 7,000 fewer prison officers than when the coalition Government came to power in 2010. The impacts of such drastic cuts are not trivial. Our prison services are out of control. Assaults in prisons rose by a third in the 12 months to September 2016 and are the highest on record. There was a wave of prison riots in the final weeks of last year, including at Birmingham, Bedford, Swaleside and Lewes. The inconvenient truth for the Minister is that, as things stand, he cannot guarantee the security of anyone who sets foot in our prisons.

Her Majesty’s inspectorate of prisons has found that an increasing number of prisoners report feeling unsafe in prison. Yesterday, we heard the conclusions drawn from an unannounced inspection of HMP Featherstone. We heard that some prisoners felt so unsafe in the prison that they resorted to self-isolation, asking to be locked up for nearly 24 hours a day. In some instances, this had lasted for months.

Nationally, there has been a significant increase in the ratio of prisoners to prison staff. It is not only prisoners who do not feel safe, but hard-working staff who brave the frontline every day, aware that there might simply not be anyone there to back them up if an incident becomes unmanageable.

A couple of weeks ago, BBC’s “Panorama” aired an undercover investigation that was filmed inside HMP Northumberland. I am sure anyone who watched it was, like me, appalled to see the truth about prison life laid bare: pervasive violence; widespread drug use; security systems not fit for purpose—put simply, chaos.

During this debate, it is important to remember that part of the reason this dire situation has arisen is that far too many people have been inappropriately put in prison, when they should be receiving mental health treatment in a secure inpatient unit. There is a need to address how the courts treat people with mental health problems, particularly in respect of community sentences and the inclusion of mental health treatment requirements within those.

I have been raising questions about suicide and self-harm in our prisons for many years, but I was compelled to request this debate because of one particular case, the tragic case of Dean Saunders. He was just 25 years old when he died by his own hand at Chelmsford prison in Essex last year. I had the privilege of meeting Dean’s parents, Mark and Donna, to hear about this tragic case in their own words. Dean was suffering from severe mental illness and had harmed himself and his brother and father as they tried to help him during a paranoid episode. He was charged with attempted murder and sent to prison. His family were told that there he would be safe.

The inquest jury unanimously concluded that Care UK, the private company that ran healthcare at the prison, treated “financial considerations” as a significant reason behind the decision to downgrade him from constant watch to half-hourly observations, despite several warnings that he might harm himself. It said that there were “multiple failings”, including a “complacent” approach to Dean’s mental health. The jury found an assessment of his mental health needs was “not adequately conducted” and concluded that the cause of death was “contributed to by neglect”.

The system failed because of financial cuts in the prison budget, and Mr Saunders paid for it with his life. Despite that damning verdict, Care UK continues to provide healthcare, including mental health services, to more than 22,000 prisoners in many prisons across the UK.

I note that the Justice Secretary has met Mr Saunders’ family, and I welcome that, but Mr Saunders presented a high risk of suicide—he should never have been in a prison in the first place. He needed specialist treatment in a secure mental health facility to protect him, but none was made available.

Does the hon. Lady agree that one of the problems may well be that people are siloed into being under either the care of forensic psychiatry or that of the prison system? There is very little and very poor interaction between the general mental health system and what goes on in prison, particularly in terms of helping people to receive the adequate care in the community that they need when they leave prison on discharge.

There have been many reports, inquiries and recommendations that highlight the very point the hon. Gentleman made—reports dating back to 10 years ago. I hope the Minister will reflect in his response on the reports, inquiries and recommendations that have already been put forward and outline what he will do to ensure that that current separation is adequately addressed to prevent situations like this case. What are Ministers going to do to ensure that similar situations to what happened to Dean never happen again?

The shocking and shameful rise in suicide and self-harm is happening on this Government’s watch and the Minister must outline his plan of action today. These are not statistics; they are real human beings—somebody’s father, somebody’s mother, somebody’s daughter or somebody’s son. The Government cannot get away with sweeping this issue under the carpet for a second longer. I note that the Joint Committee on Human Rights is also conducting an inquiry on this issue and I hope that today’s debate might be a precursor to the outcomes of that inquiry.

Last month, in Justice questions, I raised Mr Saunders’ case. The Under-Secretary of State for Justice, the hon. Member for Bracknell (Dr Lee) told me that he was

“seeking the details of all those cases to see whether there is a pattern in why they are happening. I hope to come forward later in the year with suggestions for policy change relating to mental health assessments in prisons.”—[Official Report, 24 January 2017; Vol. 620, c. 156.]

An assessment is not, in and of itself, enough. However, when I sought more details in a written parliamentary question, the Secretary of State’s answer exposed a U-turn on any plans for such an investigation. Although another exploration of data would have been wholly inadequate, it would at least have been something. Now it seems that the Government have no plans in place to confront this crisis.

If the Minister thinks that a further review of the evidence is needed, I am here to disabuse him. If he thinks we need more consultation, I am afraid he is mistaken. Countless inquiries and reports have been conducted, which have a plethora of very practical recommendations to their name. There was the review carried out by Baroness Corston on women and, significantly, the Harris review on self-inflicted deaths of young people, which was the most comprehensive review of suicide in prison and heard directly from bereaved families. Many important recommendations on learning and accountability were put forward, which so far have been rejected.

Families tell us time and again that what they want after a tragedy like this is for no one else to go through a similar experience and for concrete changes to be made. Ultimately, we are seeing the same failings repeated time and again in this pattern of preventable deaths. There is currently a significant accountability gap. Deeds, not words, are what are needed now; a concrete plan of action is necessary, not yet another ministerial speech. I say that in memory of all those who have died by suicide in our prisons. It is unacceptable. We abolished the death penalty half a century ago for very good reason. Now we must ensure that in 2017, no prisoner pays the penalty of their life because of the failure in our prison system. I look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Mr Chope. I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on securing today’s debate, and I thank my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for his insightful interventions.

I extend my particular thanks and welcome to Mark Saunders, the father of Dean Saunders, who tragically died by his own hand in Chelmsford prison, for joining us for the debate. I reiterate the point that the Secretary of State and I made to him when we met: I very much look forward to working with him to bring in some real solutions to the challenge of suicides in our prisons.

Like the hon. Lady, I am concerned that the rates of suicide and self-harm in our prisons are too high. It is an issue that transcends political parties, despite our obviously different perspectives on the reforms needed in our prisons. My priority as prisons Minister is to provide leadership and to drive improvement across the system to bring those rates down.

As hon. Members will recognise, some of the problems in our prisons have long roots. It will take time to refocus the system on rehabilitation and reform but, as the last set of statistics for levels of suicide and self-harm reaffirm, we must also take urgent and decisive action to make prisons places of safety for those prisoners who are at risk.

The challenge of record levels of suicide and self-harm in prisons is a complex one and there is no simple solution. We know that prisoners are a high-risk population and that many of them come into the prison system with drug or alcohol problems, isolation, social disadvantage, experience of sexual or physical abuse, or mental health problems. All those factors increase the risk of self-harm or suicide among prisoners. We acknowledge that the nature of a custodial experience can further increase those risks, but that should not serve as an excuse.

I am encouraged by the Minister’s comments. Is he aware of figures from De Montfort University that show that 46% of women in custody have previously attempted suicide and that women in the criminal justice system on average die 16 years younger than their counterparts? Will he acknowledge that that issue should be part of the ongoing dialogue that is needed between the mental health and the criminal justice systems?

Order. I did say to the hon. Lady earlier that interventions from Opposition spokespersons are not allowed in a short Westminster Hall debate. I have re-confirmed that that is the ruling, so I am not going to allow the Minister to respond to that intervention. I apologise to the mover of the debate for the interruption.

Any loss of life, whether male or female, is tragic. I would hope that my comments will address the issues in female as well as male prisons.

Deaths in the early days and weeks of custody are highest after reception, sentencing, transfer or recall. There are also significant numbers of deaths among lifers and other prisoners late into long sentences. We are developing a package of reforms as part of the prison safety and reform programme, and we will consult with a range of external stakeholders to seek their views on the action that will be taken to address the complex issue of suicide and self-harm in prisons.

In a written question, the hon. Member for Liverpool, Wavertree asked about the internal review. I assure her that there is an inquiry under way to look at all deaths in custody in the past year and to further our understanding of why those events are happening. She will know what the results of that inquiry are as soon as they are available.

The early days and weeks in custody are particularly critical, and we are taking steps to ensure that when somebody enters a prison they are given the support they need at that important time. We are rolling out new training courses across the estate to help our staff to identify risks and triggers of suicide and self-harm and to understand what they can do to support prisoners at risk. That involves awareness training for prison staff on supporting prisoners with mental health issues. The new package consists of six sections that can be delivered to both new and existing staff either in succession or in a modular form.

I thank the Minister for his answers. To clarify, will that training for prison officers be compulsory or voluntary, and will it be carried out according to the amount of funding available?

We are making the training available to all prisons, and we expect prison governors to ensure that as many of their staff as possible can take it—particularly those who are operating on wings and have direct contact with prisoners. The full training package takes about 1.5 days to complete.

I would like to make some progress and develop these points. I will perhaps take an intervention later.

We are also making improvements to the assessment, care in custody and teamwork process—the case management process in place in our prisons to support and manage prisoners at risk—and identifying opportunities to make it more effective. That includes changes to relevant training and developing a new self-harm diagnostic tool for use by prison governors and staff, which brings together information for each prison about numbers and types of incident, and where and when in the prison they are happening.

We are also improving infrastructure and partnerships. To support governors and prison staff across the estate, we have put in place specialist roles—regional safer custody leads—in every region to provide advice to prisons and to spread good practice on identifying and supporting prisoners at risk. We are also committed to developing partnerships with others who can help us. In addition to the funding already provided to support the prisoner listener scheme, we will be providing extra funding for the Samaritans to provide targeted support for prison staff and to prisoners directly, including by piloting emotional resilience training for new prisoners, delivered by released ex-listeners.

In the immediate term, a national learning day will be held on 14 March for prison staff on suicide and self-harm. We also strive to continue to learn from others and from completed and ongoing reviews. It is critical that we respond to the independent advisory panel’s ongoing review of women’s self-inflicted deaths. We continue to benefit from individual reviews into deaths in custody by the prisons and probation ombudsman. As hon. Members will have seen, we have introduced the Prisons and Courts Bill, which contains measures to put the ombudsman on to a statutory footing, with powers of entry and requirements on the Secretary of State to publish responses to the ombudsman’s reports. It will give those reports real teeth and will introduce an imperative in the system to follow through the recommendations and ensure that they are implemented. The Bill gives effect to long-standing commitments by successive Governments to give the ombudsman permanent status. I hope that hon. Members will welcome and support the Bill as it progresses through the House.

We will also redouble our efforts to support protective and environmental factors, which evidence tells us reduce risk. We know that strengthening family ties and peer support can support prisoners’ wellbeing and make custody safer. Governors will be held to account for the family services in their prison, and from autumn 2017 the family service budgets will be devolved to governors so that they have flexibility over how they resource family services to best meet the needs of their prisoners. We are also supporting digital developments in prisons, including the roll-out of in-cell telephony, to enable prisoners to call their families more easily and at cheaper rates. We will learn from Lord Farmer’s review to investigate how helping prisoners to engage with their families can support their rehabilitation and provide encouragement.

I thank the Minister for very kindly giving way. I can see he is about to conclude, and we still have a few minutes left in the debate. Can I bring him back to two points? First, on the training that may or may not be available to prison staff, I urge him to reflect on the fact that there are people who have served in our Prison Service for decades but have never received any mental health training. It is important that every single one of them receives such training. Secondly, is the Minister’s Department looking at how to reduce risk in prisons, in the same way as we reduce the risks from ligature points in mental health settings?

On the hon. Lady’s second question, absolutely yes, we are reducing risk in prisons, in terms of the fabric in cells and so on. In addition to the training and opportunities for prison officers to become better skilled and better able to identify suicide risk and to deal with mental health issues, last week, as she will be aware, we announced a promotion for all band 3 officers—they can get promoted to band 4 and get an additional salary at band 4 if they specialise in certain roles in prison. One of them is specifically to do with safer custody. Therefore, a prison officer today can choose to specialise as a safer custody officer and get paid more to do so. Some 2,000 prison officers across the country could benefit from that increase in pay and from the training that I have outlined.

In the light of the disproportionate number of self-harm incidents among female prisoners, we are exploring ways of improving family links, including overnight visits, family days, child-centred visits, homework clubs and the delivery of relationship and parenting programmes. We are also taking account of evidence that shows that prison environments have a direct impact on prisoners’ wellbeing and rehabilitation, as the hon. Lady rightly pointed out. Our plans for estate transformation include ensuring that prison sites are configured to support prisoners’ access to fresh air, exercise and meaningful activity.

Fundamental to supporting that activity and improving the safety of all those living and working in our prisons will be the recruitment of the additional 2,500 frontline staff we are funding. Extra staff will enable prison officers to conduct new ways of working and transform the culture in our prisons, so that every prison officer is responsible for the supervision and support of about six prisoners. The 1:6 model is in part based on the work of Lord Toby Harris on self-inflicted deaths, which particularly focused on the youth estate. That is why we are introducing the important key worker role.

I thank the Minister for very kindly giving way again. Does he accept that those are not additional staff, but merely a replacement of the staff that have already been cut? We have lost more than 7,000 prison officers since 2010. We have only to look at the outcome of the inspection at Northumberland prison to see that there is a very significant issue of prisoners feeling so unsafe that they do not feel able to leave their cells.

The 2,500 staff are additional to what we have, so at the end of 2018 we will have 2,500 additional officers. The baseline—the comparison with 2010—is not accurate because, although we lost 7,000 prison officers, we closed down 18 prisons. We are looking at a completely new baseline. However, the most important thing is the one-to-one support from a dedicated officer, which is at the heart of our prison reforms, ensuring that prisoners first and foremost are safe to benefit from the help they need to quit drugs, participate in education and skills programmes and acquire the skills to prepare for life after release.

The hon. Lady asked about the 75% of prisoners—she alleged—who face delays in being transferred to NHS hospitals beyond the 14-day deadline. That is obviously a serious concern, and I will work closely with Department of Health partners to look into it. Health partners are obviously important in supporting prisoners and meeting their physical and mental health needs. In 2015, just to put the statistic out there, there were 1,010 transfer admissions to secure hospitals from prison, but I admit that a lot more needs to be done.

I read the inquest report into the incredibly tragic death of Dean Saunders. Like the hon. Lady, I agree that we are a long way short of where we should be in terms of preventing such self-inflicted deaths. The points I have enumerated today show what we are doing now, and we will come forward with even more detail and further reforms to ensure that we bring down the number of these deaths as much as we possibly can. I look forward to working with the hon. Lady—I will be willing to discuss these issues in detail with her—and with the Saunders family and a number of other families who have lost loved ones in this way.

Motion lapsed (Standing Order No. 10(6)).

Sitting suspended.