Comment: Mental health needs in prison ignored

OFFENDERS needing mental health help must be sure of getting it, writes Azeem Ibrahim

80 per cent of all prisoners in Scotland have some kind of mental disorder. Picture: TSPL

Prisons are not a good place to be if you suffer from mental health issues. And often, a significant reason why an offence has been committed is down to those very mental health problems.

The statistics are telling. By some measures, 80 per cent of all prisoners in Scotland have some kind of mental disorder, 80 per cent of women prisoners certainly, and at least 4.5 per cent have very serious and enduring psychiatric problems. By comparison, only 1 to 1.5 per cent of the general population have serious and enduring mental health problems, and around 25 per cent have some kind of mental problem at any one time. These figures suggest that mental health is a significant determining factor for criminality.

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In our report published today, we argue that where criminal behaviour has been at least in part prompted by such issues, the best approach would be to tackle that first in a clinical environment, rather than immediately imprisoning these individuals. And for some categories of offenders, imprisonment should be the very last option. Instead, the justice system should focus on rehabilitating and reintegrating these people into society by tackling their mental health problems.

Scotland has already made some progress in this direction. Up to 2011 we had the highest rates of incarceration in the European Union. Since then, the Criminal Justice and Licensing (Scotland) Act 2010, which was aimed at reducing ineffective short-term sentences, has also reduced incarceration for the categories we are interested in, and produced much more positive outcomes. For example, by reducing the rates at which mentally vulnerable people have been sent to prison for minor misdemeanours such as substance abuse, we have reduced their contact with actual, hardened criminals who could exploit them and drag them further into criminality and thus aggravated re-

But more can be done, and we suggest concrete steps. There is an ongoing effort to create systematic sentencing guidelines in Scotland, which would create a clear and consistent framework for judges in applying the law. The committee in charge of this is due to start meeting in October, and they are expected to produce proposals for the sentencing framework by early next year. We wish to engage directly with this process. And we also urge the general public to engage with this issue based on the evidence about mental health, imprisonment and re-offending that we survey in our report.

We want them to be clear that where offenders have a history of mental illness which can be addressed before sending them to prison, that should always take priority – especially when it comes to sentencing women, where the evidence shows that imprisonment does not only affect the individual concerned, but also create problems for others around them, such as their children.

That is one side of what is required. The other side is providing the necessary mental health services to these individuals. The 2010 Act has moved the responsibility for the mental and physical health of prisoners away from the Scottish Prison Service, and has moved it to the NHS Health boards. But so far, very few NHS boards have engaged proactively with this new remit and the outcomes for prisoners show it. We suggest that the boards be required to report on an annual basis how they are discharging their duties under the 2010 Act – at the moment none s are doing this.

But finally, we must also recognise that much of the failure of NHS Scotland in this regard is down to having limited resources. Despite the requirements of the 2010 Act, there is no clear strategy in place on how to deliver the necessary mental health services to those offenders who need them, acknowledging the challenges of delivering such services to this particular group, and thus there is no clear understanding of what resources are required either. Consequently, resources allocated are inadequate.

To conclude, we urge the government to focus both on our approach to sentencing, and our approach to providing mental health services to those offenders who need them if we are to truly improve outcomes in our justice system.

• Dr Azeem Ibrahim is the executive chairman of the Scotland Institute