Prisoners and Mental Health

More prisoners than ever are being diagnosed with mental health problems requiring hospital treatment, official figures have revealed.

The number of male prisoners being transferred to hospital under the 1983 Mental Health Act grew by more than 20% between 2011 and 2014 in England and Wales, said the Ministry of Justice (MoJ) in response to a freedom of information request.

In the period covered by the figures, the greatest increase in transfers to hospital under section 47/49 of the 1983 act was among men aged 21-39. In 2011, 442 people (398 men and 44 women) were transferred, which rose to 522 (483 men and 39 women) in 2014 according to the latest data currently available.

Campaigners for mental health have called for more people with mental health problems to be treated in hospital rather than sent to prison. Concerns were also raised regarding the use of hospital orders – court orders that allow defendants to be sent for medical care instead of receiving a prison sentence – has declined by more than 25% since 2011 for men and remains at a similar level among women. In these cases, people may be returned to prison if their mental health improves.

Levels of suicides and assaults in prisons are at record highs, and incidents of self-harm have increased sharply.

The information comes after the recent case of a mentally ill prisoner who blinded himself and injured his groin area whereby staff were present but failed to intervene.

Sean Lynch, 23, was held in Maghaberry Prison, a high security jail used his fingers and thumbs to damage his eyes, and claimed to have used a piece of broken glass to injure his groin over a three day period in 2014 whereby he self-harmed in his cell. He left permanently blind and suffered an 8cm cut to his testicles as a result. CCTV cameras showed the prisoner “crying in pain” and banging his cell door, the report said.

A report by the Prisoner Ombudsman for Northern Ireland, Tom McGonigle, said Lynch inflicted “extreme and shocking” self-harm over three days and that on the final day, two prison officers watched as he injured himself on more than 20 occasions in an “ordeal” that lasted for over an hour.

Prison officers “directly observed” the inmate for more than a quarter of the time, the report added but they did not step in because of security concerns as they also believed four staff members would be unable to manage him, and that there could be a risk to prison security if he were to obtain the keys they carried. Although the main reason they suggested for the delay was that they did not realise the seriousness of his injuries.

It was also noted that official guidelines said they only needed to intervene if a situation was life threatening. Under the Order “life threatening” is defined as “a prisoner with a ligature, with serious cuts, or unconscious, or any unexplained reason where there is no response from them.”

Additionally the report also condemned officers saying, “it seems remarkable that the officers felt it was neither necessary or appropriate” to enter his cell.

“Their duty of care was trumped by security concerns,” it stated, “that appear to have no basis in reality.”

Lynch was a promising footballer in his youth, but started to battle mental health issues and experiment with alcohol and drugs as a teenager. In November 2013, when he was 22-years-old, he was charged with assault and criminal damage. He was granted bail but breached the conditions. Subsequently he was remanded to Maghaberry Prison on April 22, 2014. This was his sixth time in custody since October 2010 – his previous stays ranged from two days to two months.

Although formal psychiatric assessment had been ordered by medical staff, he was treated as a routine referral from court as his mental health deteriorated significantly during his time in prison and he engaged in numerous episodes of self harm. The Ombudsman found his behaviour in prison had become “increasingly bizarre and violent” and previous episodes were dealt with by “short-term responses which included several moves of location and placements in observation cells with anti-ligature clothing”. Lynch had also faked symptoms on occasion, which led prison staff to believe he was trying to manipulate them into moving him to a different location.

“This belief, which was also partly caused by insufficient awareness of his mental illness, impacted negatively upon his management and care,” the report claimed.

He was supposed to receive six mental health reviews but only one took place and it took two weeks for him to see a psychiatrist. It was also mentioned that the problems may have been exacerbated  by an eight-day delay in administering an increased dosage of medication that was prescribed. Prison authorities had also initiated a prisoner at risk process but this was not designed to care for someone “as challenging as Mr Lynch” according to the highly critical report.

The Ombudsman has made some 63 recommendations to both the Prison Service and the South Eastern Health Trust over the incident. The Prisons Service, Department of Justice and South Eastern Health Trust have all responded to the report, saying lessons will be learned.

The justice minister and director general of the prison service have both said the report highlights the difficulties managing a prisoner with severe mental illness.

Lynch’s father, Damien Lynch said the recommendations in the report offered “no comfort” and that “everything had been taken” away from his son.

“His sight is completely gone, his life is completely gone,” he said.

“I have no faith, I don’t think anyone would have any faith if this had happened to their son,” he added.

“Why didn’t they just enter the cell and handcuff him?”

Damien Lynch also added that the Prison Service had not offered any apology to his son or family and has called for the officers in question to be sacked and said that the family have now become his son’s full time carers. He also confirmed that despite his son’s mental illness, authorities were proceeding with a case of assault relating to a attack on a prison warder at the time following which he had to be restrained and tranquillised.

The Ombudsman said: “This dreadful sequence of self-harming highlights the challenges of caring for severely mentally-ill people in prison. The key messages from this investigation are the need for someone to take prompt and effective control when a prisoner’s/patient’s mental health is deteriorating rapidly; and for improved assessment and information-sharing at the point when people go into prison.”

The Northern Ireland Prisons Service’s Director General, Sue McAllister, said it was the most extreme case of self harm she had witnessed in 30 years of working within the UK prison system. “I hope that the recommendations to be taken forward will provide some comfort for Mr Lynch and his family that lessons have been learned from this tragic case,” she said.

A contemporary, independent assessment by a priest is informative: he said on 1st June “He needs to be in a psychiatric hospital … his condition is beyond anything the officers can cope with.” This mentally ill prisoner needed urgent, specialist medical attention and it is questionable whether Maghaberry was the appropriate place for this vulnerable person.

The key issue arising from this distressing case is how the criminal justice system, and our prisons, care for prisoners with severe mental health problems. Concerns over the wellbeing of vulnerable people in our jails have been raised time and again and it is time to do something about it.

 

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Naina Bhardwaj

Naina Bhardwaj

Naina Bhardwaj

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