The Mental Welfare Commission (MWC) visited Scotland’s 15 prisons, ten years after making recommendations for changes to their mental health services in 2011.
A decade later, the report, released on Thursday, criticised services, saying they continue to fail staff and prisoners.
The research showed a significant majority – 77% – of the prison staff who were interviewed by the commission reported that they had concerns about mental health support within the prison they worked in.
This included concerns over waiting times, communication between Scottish Prison Service (SPS) and NHS, and the need for more therapeutic activity.
The report also spoke about how the pandemic “exposed the fragility of the mental health resources” in prisons and how under-served and under-resourced they are.
One of the most notable concerns noted were staff fears about their ability to keep prisoners safe from the effects of new psychoactive substances (NPS) entering prisons.
Out of the 223 prison staff interviewed for the report, a total of 69% said they were “extremely concerned” about the use of NPS in prisons.
One staff member was quoted saying: “There seems to be no way of stopping it coming into the prison.
“The worry is of people overdosing, especially where you have people who have never used drugs before being offered it … seems only a matter of time before there’s a fatality.”
The commission’s 2011 report called for improvements of healthcare responsibilities being transferred from SPS to NHS Scotland.
But its latest report said this has failed to materialise.
There were also reports of issues with delays in delivering medication to prisoners.
A number of psychiatrists who completed a survey said: “There is a problem in accessing medications in prison it can take several days or weeks to get supplies of medication.”
Some prisoners interviewed also said medication prescribed by their GP in the community, for example for anxiety or sleep, were rejected by the prison GP.
The commission said the current prescribing practices in prison were “not consistent with person-centred care and treatment”.
Out of the 107 prisoners who were interviewed, about 75% of respondents reported they have had, or currently experience problem substance use with alcohol (14%), drugs (20%) or both (41%).
Of those, 35% said they have not been offered addiction support in prison, the report said.
Other concerns were about staffing issues in prisons and the need for more mental health nurses.
Prison officers interviewed said screening assessments of a prisoner’s mental health on arrival “could be more interactive person-centred and not tick box”, and that assessment for other mental health issues should be “as robust as the suicide strategy.”
The commission said one prison officer summed up the main concerns over identifying prisoners’ mental health needs on arrival at prison by saying: “We would improve things if there were fewer admissions, more staff to do the assessments, more time to focus on new people and more training for staff.
“It would also be good if we had complete and immediate access to information held by different organisations on people arriving in prison, especially for the first time.”
The commission has previously said all prisoners who are acutely mentally unwell should be transferred to hospital care without delay but the latest report found this was not the case.
Ten of the prisoners visited were segregated; some were acutely mentally ill and unable to speak, with staff working in those units reporting that they felt “ill-equipped to manage severely mentally unwell prisoners”.
One prisoner who was considered acutely mentally unwell was found to have spent more than 45 weeks in a separation and reintegration unit (SRU) before being taken to a hospital, with staff reporting “extreme concern” for the person.
The report, however, went on to say there was evidence of supportive SRU prison staff teams and healthcare staff making every effort to support mentally unwell individuals in segregation and in very challenging conditions.
The need for more training of staff was also noted in the report.
The commission said only 43% of respondents had completed mental health first aid training and 89% felt there should be more bespoke mental health training offered.
The report made nine recommendations; these included the need for additional training of staff and urgent audits of their use of segregation for prisoners who are acutely mentally unwell.
It also called for the Scottish Government to monitor these recommendations and work with SPS and NHS to support prisoners with mental health problems.
Suzanne McGuinness, executive director of social work at MWC, said: “Scotland has one of the highest rates of imprisonment in western Europe and the majority of people arriving at prison reception have a history of mental ill health.
“Suicides in prison remain a serious concern in Scotland.
“While we found some good practice, our overwhelming impression was of a prison population which is under-served and under-resourced. Our key messages of 2011 have not been realised 10 years on and the anticipated improvements of health care responsibilities being transferred to NHS Scotland have not materialised.
“A joined-up, whole system, approach to managing and supporting prisoners and staff across Scotland’s prison estate is needed as a matter of urgency.”