By NACRO (UK)

This briefing examines: the level and range of mental health problems in prison and how people in prison who have mental health problems are identified; the impact that the prison environment can have on people’s mental health; the support currently available in prison and the impact all this can have on people’s ability to turn their lives around on release. We propose solutions which aim to ensure that everyone has access to the right support whilst they are in prison and on release. Improving the mental health of people in contact with the criminal justice system is an essential step to reducing reoffending and ensuring people can rebuild their lives in the community when they are released. In addition to providing the right treatment and support, we must ensure that prisons are not the cause of mental health problems, nor should they contribute to a deterioration in someone’s mental health, either because of a poor prison environment or a lack of treatment and support when it’s needed. The quotes used throughout this briefing come from people with lived experience of the justice system that have been supported by Nacro. Summary of our main recommendations We set out recommendations at the end of this report which we believe will help people in the justice system get the support they need for good mental health. These are grouped as follows: The beginning of the criminal justice journey: Our recommendations focus on keeping people out of prison where they would be better supported and rehabilitated in the community. During a prison sentence: These recommendations concentrate on improved screening and training to identify mental health needs; improved support provision and improved relationships with staff; improving the prison regime to ensure purposeful activity and time out of cell and improve safety; and embedding a more trauma-informed approach. Transfer and transition into the community: Here we focus on the need to improve timely transfers to secure mental health facilities, and embed and evaluate the RECONNECT care after custody service.

London: NACRO, 2024. 28p.

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.

By The Independent Monitoring Boards

Independent Monitoring Boards (IMBs) monitor and report on the conditions and treatment of those detained in every prison in England and Wales. The government recently rejected the Justice Select Committee’s recommendation for a resentencing exercise to take place for anyone serving an IPP sentence. IMBs submitted current findings on the impact of this decision, and the sentence itself, on IPP prisoners’ wellbeing. This briefing summarises findings from 24 IMBs submitted between 17 February and 9 March 2023 and references two 2021-22 annual reports from IMBs at HMPs Hewell and Moorland, which conducted surveys with IPP prisoners. Key findings The findings indicated: • Serious safety implications were heightened by the recent announcement, with assessment, care in custody and teamwork (ACCT) documents being opened for several IPP prisoners. Three apparently self-inflicted deaths of IPP prisoners occurred in three prisons in the four weeks following the announcement. • IPP prisoners had increased feelings of hopelessness and frustration following the announcement, which IMBs noted could act as a catalyst for poor mental health, violence and disruptive behaviour. • Variable and often inadequate staff engagement both pre- and post-announcement, with some prisoners only learning of the decision through a letter. • Progression pathways were poor and unclear to prisoners, which meant many prisoners questioned whether they would ever be released following the announcement. Some prisoners were being held in inappropriate establishments, often without access to required courses. The increasing difficulty of transferring to open conditions has left some prisoners ‘institutionalised’. • Insufficient preparation for parole hearings and for release, with reports of inadequate care plans and ‘through the gate’ provision. This lack of provision contributed to recall: for example, some prisoners were recalled only because of issues arising from the loss of accommodation.

London: Independent Monitoring Boards, 2023. 6p.

By Coral Sirdifield, Charlie Brooker, Rebecca Marples

A narrative systematic review was undertaken of the literature concerning the health of people on probation. In this paper, we provide an up-to-date summary of what is known about the most effective ways of providing mental healthcare for people on probation, and what is known about the relationship between different systems and processes of mental healthcare provision, and good mental health outcomes for this population. A total of 5125 papers were identified in the initial electronic searches but after careful double-blind review only four papers related to mental health that met our criteria, although a further 24 background papers and 13 items of grey literature were identified which are reported. None of the included studies was a randomized controlled trial although one was quasi-experimental. Two of the other papers described mental health disorders in approved premises and the other described the impact and learning from an Offender Personality Disorder project. We conclude that the literature is bereft of evidence on how to effectively provide mental healthcare for people on probation.

Forensic Science International: Mind and Law Volume 1, (2020) 100003

By Coral Sirdifield, Charlie Brooker, Rebecca Marples

A narrative systematic review was undertaken of the literature concerning the health of people on probation. In this paper, we provide an up-to-date summary of what is known about suicide and suicidal ideation and probation. This includes estimates of prevalence and possible predictors of suicide and suicidal ideation. Searches were conducted on nine databases from January 2000 to May 2017, key journals from 2000 to September 2017, and the grey literature. A total of 5125 papers were identified in the initial electronic searches but after careful double-blind review only one research paper related to this topic met our criteria, although a further 12 background papers were identified which are reported. We conclude that people on probation are a very high risk group for completed suicide, and factors associated with this include drug overdose, mental health problems, and poor physical health. There is a clear need for high quality partnership working between probation and mental health services, and investment in services, to support appropriate responses to suicide risk.

Forensic Science International: Mind and Law, Volume 1, November 2020,

By Erving Goffman

“Asylums is an analysis of life in “total institutions”—closed worlds like prisons, army training camps, naval vessels, boarding schools, monasteries, and old folks’ homes—where the inmates are regimented, surrounded by other inmates, and unable to leave the premises. It describes what these institutions make of the inmate, and what he can make of life inside them. Special attention is focused on mental hos­pitals, drawing on the author’s year of field work in a large American institution. It is the thesis of this book that the most important facto." in forming a mental-hospital patient is his institution, not his illness, and that his reactions and adjustments are those of inmates in other types of total insti­tutions as well.”

NY. Anchor Books. 1961. 382p.

By Kelly Marie King

Extensive research exists documenting national trends in incarceration and the myriad “collateral consequences” individuals face upon returning home from prison or jail. Few studies to date, however, have examined men’s social conditions and lived experiences during periods of confinement, presenting a timely opportunity for qualitative inquiry. Such insight is of particular importance for Black men residing in urban neighborhoods, given the disproportionate burden of incarceration shared by this group. To better understand how incarceration affects men’s social networks and mental health, this dissertation analyzed secondary data from N=22 in-depth, qualitative interviews with N=20 formerly incarcerated Black men in Baltimore, Maryland (MD). Semi-structured interviews, conducted by a Black, female, doctoral student, took place at an academic, community-based research center between October 2014 and June 2015. Inductive analysis was used to uncover salient themes relevant to recently released men’s lives. Chapter 3 explores potential pathways underlying observed associations between incarceration and social network turnover. Losing loved ones to death or incarceration, perceived lack of support, desire to “do different," and social isolation all emerged as possible mechanisms through which imprisonment alters men’s relationships with friends and family. Results highlight the need for additional opportunities for men to foster prosocial connections. Chapter 4 investigates informal social network structures within correctional environments. Men

• More.....

  described four social subgroups within the correctional context: preexisting ties, gang membership, “staying to yourself,” and homosexuality. Findings may be used to shape existing correctional policies to support the development of meaningful, nonviolent connections, across subgroups. Chapter 5 assesses the impact of the correctional environment on men’s mental health during and following periods of confinement. High levels of institutional control and exposure to violence emerged as drivers of poor mental health, including hypervigilance, emotional withdrawal, distrust, institutionalization, and suicide. Results help clarify existing relationships between incarceration, depression, anxiety, and PTSD, and underscore the need for appropriate screening and treatment modalities, within and outside of correctional facilities. Finally, Chapter 6 describes the theoretical, programmatic, and policy implications relevant to this dissertation, offers an overview of the strengths and limitations associated with the chosen research design, and provides suggestions for future research.

Baltimore, MD: Johns Hopkins University, 2018. 184p.

By Mark Dow

American Gulag takes us inside prisons such as the Krome North Service Processing Center in Miami, the Corrections Corporation of Americas Houston Processing Center, and county jails around the country that profit from contracts to hold INS prisoners. It contains disturbing in-depth profiles of detainees, including Emmy Kutesa, a defector from the Ugandan army who was tortured and then escaped to the United States, where he was imprisoned in Queens, and then undertook a hunger strike in protest. To provide a framework for understanding stories like these, Dow gives a brief history of immigration laws and practices in the United States—including the repercussions of September 11 and present-day policies. His book reveals that current immigration detentions are best understood not as a well-intentioned response to terrorism but rather as part of the larger context of INS secrecy and excessive authority.

Berkeley and Los Angeles: University of California Press, 2004. 429p.

By Thailand Institute of Justice

Prison health is extremely important to public health, not only because of the high prevalence of serious and often life threatening conditions among prisoners, but also because of the continuous exchange between those in prison and the communities outside. Since December 2019, the world has been grappling with a new global health threat: the outbreak of COVID-19 caused by the novel coronavirus. Prisons have turned into potential hot spots of the disease. Despite chronic overpopulation, resource constraints and other challenges, prisons around the world have tried to contain the spread of the virus through various measures. This report aims to highlight challenges, promising practices, lessons learned and recommendations on how prisons have dealt with COVID-19, using examples from around the world.

Bangkok:Thailand Institute of Justice, 2022. 72p.

By Laura M. Maruschak and Marcus Berzofsky

In 2011–12, half of state and federal prisoners and local jail inmates reported ever having a chronic condition (figure 1). Chronic conditions include cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma, and cirrhosis of the liver. Twenty-one percent of prisoners and 14% of jail inmates reported ever having an infectious disease, including tuberculosis, hepatitis B and C, and other sexually transmitted diseases (STDs). About 1% of prisoners and jail inmates who had been tested for HIV reported being HIV positive.

Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics 2016. 23p.

Edited by Lars Møller, Heino Stöver, Ralf Jürgens, Alex Gatherer and Haik Nikogosian

Based on the experience of many countries in Europe and the advice of experts, this guide outlines some of the steps prison systems should take to reduce the public health risks from compulsory detention in often unhealthy situations, to care for prisoners in need and to promote the health of prisoners and staff. This especially requires that everyone working in prisons understand well how imprisonment affects health and the health needs of prisoners and that evidence-based prison health services can be provided for everyone needing treatment, care and prevention in prison. Other essential elements are being aware of and accepting internationally recommended standards for prison health; providing professional care with the same adherence to professional ethics as in other health services; and, while seeing individual needs as the central feature of the care provided, promoting a whole-prison approach to the care and promoting the health and well-being of those in custody.

Copenhagen: WHO Regional Office for Europe, 2007. 198p.

Edited by Adele D. Jones and Agnieszka E. Wainaina-Woźna

Estimates are that 125,000 children have a parent in prison in England and Wales. Indeed, on the international stage, over half of all prisoners worldwide are thought to have children under the age of 18 yet the impact of a parent’s incarceration on a child is rarely taken into account. COPING increases understanding of how the imprisonment of a parent really affects children. Working in different countries, with different social and cultural traditions, different incarceration levels and different policies and interventions, our research has produced evidence that can inform policy and programmes to better support and protect children from the effects of parental imprisonment right across Europe.”

Huddersfield, UK: University of Huddersfield, 2013. 670p.

By Alison Liebling

The suicide rate in prisons in England and Wales is 40 per 100,000—four times that of the general population. How can this rate be explained? Recent prison suicides have aroused much public concern and media attention, yet there has been very little research examining their true cause or nature. Previous studies have tended to rely exclusively on official statistics and prison records, and have had little effect on formulating policy and practice. Suicides in Prison is the first major study in this area to draw directly on the experiences of both prisoners and staff. The interviews conducted by the author help to cast new light on the circumstances which can lead to suicide or attempted suicide. The book provides further evidence to support the growing recognition that suicide is not an exclusively psychiatric problem. The coping mechanisms and social support given to the people involved can play a crucial role. Alison Liebling also shows how serious difficulties in the management of prisoners at risk of suicide may be exacerbated by problems of communication between departments, and that prison officers may lack the necessary training to play a potentially major role in suicide prevention. Most importantly, if staff perceptions and attitudes are not addressed, any attempt to improve procedures may well be ineffective. Suicides in Prison will be of interest to probation officers, social workers and prison staff and governors as well as those studying penology. It traces the recent history of the problem and provides the first major theoretical discussion of the nature and causes of suicide in prison.

London; New York: Routledge, 1998. 288p.

Institute of Medicine and National Research Council.

Over the past four decades, the rate of incarceration in the United States has skyrocketed to unprecedented heights, both historically and in comparison to that of other developed nations. At far higher rates than the general population, those in or entering U.S. jails and prisons are prone to many health problems. This is a problem not just for them, but also for the communities from which they come and to which, in nearly all cases, they will return.

Health and Incarceration is the summary of a workshop jointly sponsored by the National Academy of Sciences(NAS) Committee on Law and Justice and the Institute of Medicine(IOM) Board on Health and Select Populations in December 2012. Academics, practitioners, state officials, and nongovernmental organization representatives from the fields of healthcare, prisoner advocacy, and corrections reviewed what is known about these health issues and what appear to be the best opportunities to improve healthcare for those who are now or will be incarcerated. The workshop was designed as a roundtable with brief presentations from 16 experts and time for group discussion. Health and Incarceration reviews what is known about the health of incarcerated individuals, the healthcare they receive, and effects of incarceration on public health. This report identifies opportunities to improve healthcare for these populations and provides a platform for visions of how the world of incarceration health can be a better place.

Washington, DC: The National Academies Press. 2013. 67p.

By Karl Nitsche, and Paul & Wilmanns.

This work brings the reader to the present-day view-points with reference to the prison psychoses through the medium of a historical review of their development in the German literature. Such a work should be welcomed by all who are interested in the problems of psychopathology and particularly those who long for more rationalistic methods of dealing with the criminal and with all of the problems of criminology. Nervous and Mental Disease Monograph Series No. 13 .

Journal of Nervous and Mental Disease (1912) 104 pages.

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By Rev. R. H. Sanders.

Lights and Shades of Prison Life. Methods of reform considered from a Christian standpoint. Along with some opinions of distinguished men and women, who have made a study of criminal life.

S. B. Shaw. Chicago (1903) 322 pages.

Edited by Elisabeth Fransson, Francesca Giofrè and Berit Johnsen.

“My cell is as large as a student’s small room: I would say that roughly it measures three by four and a half meters and three and a half meters in height. The window looks out on the courtyard where we exercise: of course it is not a regular window; it is a so-called wolf’s maw with bars on the inside; only a slice of sky is visible and it is impossible to look into the courtyard or to the side.”

Creative Commons (2018) 349p.