On the 5th June 2019, the Independant Monitoring Board (IMB) published their National Annual Report for the late 2017 to 2018 period.
The IMB findings reported on 10 key aspects of prison life:
- Equality and Diversity
- Health and Social Care
- Education, work and Purposeful Activity
- Preparation for Release
As part of the introduction to this report Dame Anne Owers sets the scene:
“…the visible decline in (prison) safety, control and the expectations of both prisoners and staff since I last visited them, as Chief Inspector of Prisons, in 2010. It is therefore welcome that additional resources have now been put into prisons, with an influx of staff, but it will take time before prisons can not only stabilise, but progress.”
Here are some of the more noteworthy takeaways from the report that impact on the general health and wellbeing of prisons and prisoners:
Staffing issues dominated annual reports in this period. The main theme from across the estate is the ongoing influx of new, and therefore inexperienced staff. This is further compounded by the churn as prisons struggle to retain those officers. This affects every kind of prison and every aspect of prison life: from security and safety to healthcare, activities and rehabilitation. A recognition from the IMB that cannot be understated.
Drugs in prison not only have a direct impact on health and on prisoners’ erratic and sometimes violent behaviour; they also undermine safety and stability by producing an alternative power structure, based on debt, bullying and intimidation of prisoners, their families and sometimes prison staff. This also impacts on already stretched healthcare services.
In general, incidents of violence and self-harm increased, often significantly, throughout 2018. Boards attributed this to a combination of the availability of drugs (and the associated debt and bullying), the inexperience or shortage of staff, and frustration due to inactivity.
Most boards reported an increase in the number of Assessment, Care in Custody and Teamwork (ACCT) documents opened for those at risk of suicide or self-harm during the period. It is recognised within the report that this may be in part a consequence of increased vigilance, following the steep rise in suicides in preceding years.
One board reported that they were concerned that an “overly risk-averse approach” had resulted in too many ACCTs being opened, making it more difficult properly to identify and support those at serious risk of harm. Whilst this may be very true, prisons could equally be criticised for doing the opposite. Such a practice of not opening too many ACCT’s could and is often recognised at Coroners Inquests as a failing in a duty of care. This feels very much like a case of damned if you do, damned if you don’t.
Another board noted that self-harm tended to coincide with canteen day and when the prison was in patrol state (i.e. prisoners being locked in their cells). Another, recognising the same phenomenon, had produced information and distraction programmes on in-cell television, with input from mental health. Commendable indeed.
Many boards welcomed the increased staff training in suicide and self-harm, and some reported improvements as a result. However, some also pointed to continuing concerns about the quality and consistency of ACCT documentation, observations and support, and in some cases the lack of involvement by healthcare staff in ACCT reviews, especially given the strong connection between mental health issues and self-harm.
Health and Social Care.
Boards reported the pressure on prison healthcare, reflecting the level of both physical and mental health need, as well as staff shortages and the impact on prisons of shortfalls in provision outside criminal justice.
It is well known that overall prisoners’ health, both physical and mental, is worse than among the general population. Physical health outcomes are affected by lifestyles, drug and alcohol misuse and disengagement with community healthcare, as well as the complex needs of an ageing prison population.
Prisons, like the rest of the criminal justice system, disproportionately contain individuals with mental health problems, which imprisonment can exacerbate – particularly as prisons, unlike mental hospitals, cannot compulsorily treat patients except in extreme circumstances.
Many boards reported the effects of staffing shortages, both of uniformed and healthcare staff. Sometimes there were not enough uniformed staff to escort prisoners to appointments, either within the prison or to external hospitals. Staff shortages also impacted on the supervision of medication queues.
Shortages of nursing staff, particularly mental health nurses, led to long waiting times, over-high caseloads and reliance on expensive agency staff with no continuity of care.
Shortages of uniformed prison staff and poor communication also affected the high number of prisoners not attending appointments made for them (DNA’s).
The IMB report states that the underlying problem was a disconnect between the level of need and the level of provision. The demand for healthcare services, especially mental health, was extremely high in many prisons, and many boards reported that need was increasing beyond current resource.
What the report doesn’t recognise, but is equally worth noting is the demands placed on staffing resources that are compounded further – for those in need of mental health services, our prisons are recognised by the courts as being places of safety. (Feel free to pause to reflect on this for a moment.)
The report provides a benchmark for the future, and it is with a sense of both hope and optimism that the array of promising intiatives already underway as part of the prison reform programme begin to reap results. Those initiatives include:
- the roll-out of offender management in custody (OMiC)
- the prison estate transformation programme
- lessons learnt from the then Prisons Minister’s ten priority prisons project, and responses to the Inspectorate of Prisons’ urgent notification process
- revised processes for supporting prisoners at risk of suicide and self-harm
- the new drug strategy
- embedding the CSIP (challenge, support and intervention) process for violence reduction
- new processes and contracts for dealing with prisoners’ property.
From now on, we can also look forward to a quarterly digest of published IMB Annual Reports, as the IMB undergoes further work with Boards to identify emerging themes and issues and to record progress against the hopes and expectations of the prison reform programme.
The prison night is very much at its darkest right before the dawn.
Read the full report here