By Independent Monitoring Boards (IMBs)

Independent Monitoring Boards (IMBs) monitor and report on the conditions and treatment of those detained in every prison in England and Wales. They have specific powers and responsibilities in order to effectively monitor the conditions and treatment of those in CSUs. Boards are notified when a prisoner is segregated, can speak to prisoners in CSUs in private, are invited to attend segregation review boards (SRBs), and can access and review all records.

This report provides an overview of outcomes for men in closed adult prisons with mental health needs who are being held in CSUs. It is based on:

• A survey completed by IMBs at over 30 closed adult men’s prisons in England for four weeks during late Autumn 2022

• A follow-up survey six months later in Spring 2023 was completed by IMBs who had previously identified segregated prisoners waiting for transfers to more appropriate secure settings.

• Findings from IMBs’ most recent annual reports.

• Several IMBs’ recent correspondence to ministers, senior HMPPS officials, and healthcare bodies raising serious concerns over the care of prisoners with mental health needs in CSUs.

Key findings

• In recent years, almost all IMBs monitoring in prisons holding adult men have repeatedly raised concerns over CSUs not being a suitable or appropriate place for prisoners with mental health needs.

• Prisoners with mental health needs were often held for prolonged and long-term periods in CSUs. IMBs found that this was mostly due to:

  • Men struggling to cope or refusing to reintegrate back onto the residential wings (referred to as ‘normal location’)

  • Lack of capacity in prison healthcare units or prisons with specialist functions

  • Delays in referral, assessment, and transfer to a secure hospital

  • There being no alternative, often because of a lack of diagnosis or men not having met the threshold for admission to a secure hospital.

• Although most IMBs understood why CSUs were deemed the most appropriate place for these men to be held out of the limited locations available in prisons, there were still widespread concerns that CSUs were the only alternative for those who were acutely unwell and in need of specialist care.

• For men who were already struggling with their mental health, their well-being and behavior often deteriorated further while being segregated for prolonged periods.

• Prisoners with mental health needs were often moved between different CSUs, healthcare units, or were returned to wings for short periods which made it harder to track the cumulative time some prisoners spent segregated.

IMBs, 2024. 18p.