BMA calls for urgent reforms to protect the public from failing prison system
December 2007
Prison doctors’ leaders have issued an urgent call for the Government to implement a raft of initiatives aimed at repairing twelve months of political failure that have left the public potentially exposed to newly released offenders with untreated drug addiction and mental health problems.
2007 has been a year of continuous crisis for the English and Welsh prison system. Unprecedented overcrowding pressures forced the Government to introduce a range of emergency measures in June that included the early release of thousands of inmates. Temporary accommodation, such as police and court cells, were used throughout the year to provide additional capacity for frequently full prisons. Neither measure prevented the penal population reaching an historic high of 81,455 in December.
Despite the enormous and sustained strain placed on traditionally under funded prison healthcare services and rehabilitation programmes, the Government failed to provide prison doctors with additional funding or emergency plans to cope with this crisis. Lord Carter’s long term review of prisons, published in December, also neglected prison health and did not address the UK’s high rates of re-offending.
Dr Redmond Walsh, a prison doctor in London and member of the BMA’s Civil and Public Services Committee, said:
'Throughout the year many prison healthcare facilities, rehabilitation programmes and post-release monitoring services have been under enormous pressure from an influx of inmates with serious behavioural related conditions. An estimated two thirds of prisoners who enter custody are drug dependent and seven out of ten have one or more psychological disorders. It is clear that these conditions are in a large number of cases the primary cause of their criminal activity.'
'The priority for the prison system after custodial punishment should therefore be to treat individuals, where possible, so that when they are released they are no longer a threat to themselves or the community. However, this responsibility is being neglected in many areas of the country.'
'A large number of prison doctors do not have the time or resources to properly assess new inmates with drug or mental health problems when they first enter custody. If prisoners with serious conditions are identified then many will be let down by under funded and poorly staffed services that cannot cope with demand.'
'However, funding is not the only issue. Many prisons are currently swamped by illegal narcotics, a situation that makes it close to impossible to wean some prisoners off their habit or protect susceptible prisoners from becoming addicts. Medical records – the key tool for doctors – are poorly maintained and often not transferred properly between prisons or from the community. Post-release monitoring services, that should make sure offenders have accommodation and adequate supervision after release, are frequently disorganised and occasionally unavailable.'
'The combined result of these problems is that the prison system is releasing large numbers of individuals who are not fit to return to the community. The UK’s appalling re-offending rate, where two thirds of prisoners commit a crime within two years of release, is clear evidence of this terrible failure. Large parts of the prison system have become just a holding pen for criminals rather than a secure environment where their behaviour assessed and treated if possible.'
Dr Clare Jenkins, chairman of the BMA’s Civil and Public Services Committee, said:
'The BMA believes that the situation has reached a critical point and requires urgent action in the opening months of 2008 to prevent further innocent people’s lives being damaged by individuals who in some cases could have their criminal motivating conditions addressed.'
'2007 was a disaster for the prison system, 2008 must be the year when the prison system starts protecting the public again and where doctors can properly care for the health of prisoners'
Recommendations from the BMA:
New measures to combat escalating drugs problem in prisons
A formal Government enquiry into the drugs crisis in the prison system. Recommendations from the enquiry should include:
- A national strategy to reduce the availably of illegal substances in prison
- An evaluation and assessment of current drug rehabilitation practices within the prison system to ascertain their current effectiveness and whether alternative methods may be more successful.
- An examination of how post-monitoring services can be improved – with consideration of whether community orders could be used to ensure prisoners visit drug services once they have left prison.
National target for all prisoners to receive drug assessments within 24 hours of sentencing.
Urgent additional funding and staff so that all prisons have a team of dedicated health professionals that can run specialist rehabilitation services for all prisoners identified as having a drug dependent problem.
New ethical code of practice for prison accommodation to include
New Government charter to enshrine basic conditions for prison accommodation. To include:
- A ban on the use of temporary accommodation, such as police and courts cells, which do not have access to prison health care facilities or on call clinicians and therefore represent a substantial risk to prisoner’s immediate health and long term rehabilitation prospects.
- A long term target to reduce the number of inmates per cell to no more two people, following consultation regarding practicalities and funding.
Issuing of urgent new guidelines and funds for mental health services so that mentally ill prisoners receive immediate treatment from specialist facilities within NHS trusts if necessary. Accompanied by a clear statement that NHS trusts have an obligation to treat patients from the prison system.
Complete overhaul of post release procedures for newly released prisoners. Reforms to include mandatory assessments of all prisoners’ psychiatric condition prior to release and a cohesive strategy that involves community services in any recommended post-release care and/or monitoring of prisoners after release.
Overall prison health improvements
A well funded and nationwide survey to establish the health of the prison population, particularly with regards to poorly researched penal health areas, such as alcoholism and sexual health.
New code of practice that prohibits transferring of prisoners to different prisons while they are in the middle of treatment or awaiting surgery. Additional guidelines to ensure that if a prisoner is transferred their rehabilitation treatment continues without interruption at their new prison.
Implementation of a new medical records regime that allows prison clinicians to transfer records effectively and smoothly between institutions so that information is shared promptly.
Review of prison health organisation to examine whether the transfer of responsibility from the prison service to local PCTs is working effectively.