Written evidence submitted by Women in Prison (MHB0029)
About Women in Prison
Women in Prison (WIP) is a national charity which provides independent, holistic, gender-specialist support to women facing multiple disadvantage, including women involved in (or at risk of being involved in) the criminal justice system. We work in prisons, the community and ‘through the gate’, supporting women leaving prison. We run Women’s Centres and ‘hubs’ for services in Manchester, London and Surrey. Our combined services provide women with support and advocacy, relating to domestic and sexual abuse, mental health, harmful substance use, debt, education, training, employment, and parenting.
Our campaigning is informed by our frontline support services for women, delivered at every stage of a woman’s journey through the criminal justice system. The experience and knowledge of staff working directly with women affected by the criminal justice system enable us to see first-hand the effects of policy in practice and strengthen our recommendations for change.
About this response to the call for evidence
Our response focuses on our expertise supporting women in contact with the criminal justice system. Women in Prison also support Prison Reform Trust’s full response to this call for evidence.
In this response, we consider Clauses 31, 41 and 42 of the draft Mental Health Bill and the following questions:
If effectively resourced and implemented, the measures introduced in this draft bill will be a positive step to ensuring people are not inappropriately remanded to prison due to concerns for their mental health or held in prison as a place of safety pending a mental health assessment or treatment. It will also put into statute a requirement for people with severe mental ill health to receive prompt transfers out of prison.
Clause 41 Removal of police stations and prisons as places of safety
Clause 42 Remand for a persons ‘own protection’
We welcome the inclusion of Clauses 41 and 42 which lay out that prison and police cells must not be used as a place of safety to hold people pending a mental health assessment or appropriate mental health provision and that people cannot be remanded to prison based on concern for their mental health.
There is an uneven distribution of mental ill health across society. People facing social and economic disadvantage and experiences of racism and discrimination are at a much higher risk of developing mental health conditions and are more likely to come into contact with the criminal justice as their conditions escalate to crisis point. There must be adequate treatment and support for people with mental ill health who come into contact with criminal justice agencies.
Prison is a harmful and traumatising environment which is unsafe and inhumane for people experiencing severe mental ill health. Imprisonment is intrusive, from the lack of privacy to being subject to invasive measures of pat downs, strip searches or restraint. It can be particularly distressing for people who have experienced domestic abuse, which accounts for around two thirds of the women’s prison population.[1] Recent statistics show that the rate of self-harm is seven times higher for women than it is for men. [2]
Despite this, prisons have identified women with acute mental ill health being remanded to prison by the courts because of the lack of appropriate provision in the community. A joint thematic inspection also identified that the use of prison as a place of safety appears to be more common in women’s prisons.[3]
Whilst some individual prisons have recently been monitoring occurrences, no centralised data is collected on the number of people admitted to prison whilst they await psychiatric assessment or treatment, or the number of people refused bail on grounds of their mental health. These figures provide an indication about the scale of the issue however it is not possible to extrapolate trends from this information given potential variation over time and across different geographies. This makes it challenging to determine the extent to which mental health services will see a change in the number of people referred for inpatient or community treatment and support.
In order for these Clauses 41 and 42 in the draft Mental Health Bill to be effectively implemented, there must be the capacity available within the mental health system to appropriately respond to people’s needs. This includes beds in mental health settings but also improved treatment and assessment in the community to enable some assessments to be completed without the need for detention.
Clause 31 Transfers from prison to hospital
Clause 31 introduces a 28-day statutory time limit within which individuals with severe mental ill health must be transferred from prison to hospital for treatment under the Mental Health Act. This statutory time limit begins from the point of an initial referral for assessment rather than once the assessment has taken place (Clause 31, Section (3)). This change should ensure swifter transfers by preventing assessments from being staggered or delayed until an appropriate bed has become available in order to avoid breaching the guidelines.
Section 47A (5) goes further, by providing that bed or staff shortages do not count as “exceptional circumstances” to not facilitate the transfer in the 28-day period. We welcome this explicit point to ensure that relevant bodies prioritise and expediate the transfer within the timeframe. However, there remains the question of whether there is an appropriate level of resources and capacity to ensure that there is no bed or staffing shortages. The Care and Quality Commission this year identified that the “forensic inpatient system is under stress due to capacity, leading to delays in inpatient transfers and discharge” and it is unclear how this is being addressed.[7]
Currently under Section 47 of the Mental Health Act, once two doctors have assessed the individual and decided that hospital is necessary, a request will be sent to the Ministry of Justice for permission for the individual to be transferred to hospital. In giving permission, the Ministry of Justice then writes a ‘transfer direction’. If a hospital bed is not found within 14 days, the direction expires, and the prison healthcare team has to restart the process from the beginning, prolonging the transfer period. The department must set out expectations for the number of beds that may be required as a result of the statutory time limit and guidance for what process is followed if the transfer does not take place during this period.
A prison inspectorates visit to HMP Bronzefield identified that between January 2021 and January 2022, of the 30 women referred for transfer, 17 were transferred within the 28-day guidance, but in 13 cases the transfer time exceeded this, and one patient had waited five months.[8] Specific consideration should be applied to the provision of secure mental health care for women. The charity Agenda has identified that women in prison are often disadvantaged when they are transferred into secure care, being held in forensic mental health settings far from home making family visits more difficult and costly and impacting family ties.[9]
The data relating to Clause 31 must be closely monitored to understand how this is functioning in practice. There must be transparency on the impact of the introduction of the new statutory 28-day time limit, with data collated and published on the length of time transfers take broken down by the gender and ethnicity of the person transferred and how any miles from home they are placed.
15 September 2022
[1] Ministry of Justice (2018) Table 4.3 Supporting Data Tables Female Offender Strategy
[2] Ministry of Justice (2022) Safety in custody: quarterly update: to March 2022
[3] HM Inspectorate of Probation, HM Crown Prosecution Service Inspectorate (HMCPSI), HM Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS), Care Quality Commission (CQC), Healthcare Inspectorate Wales (HIW) and HM Inspectorate of Prisons (HMIP) (2021) A joint thematic inspection of the criminal justice journey for individuals with mental health needs and disorders
[4] HM Chief Inspector of Prisons (2021) Report on an unannounced inspection of HMP and YOI Low Newton
[5] Criminal Justice Inspectorates (2021) A joint thematic inspection of the criminal justice journey for individuals with mental health needs and disorders
[6] HM Chief Inspector of Prisons (2022) Report on an unannounced inspection of HMP and YOI Bronzefield
[7] Care Quality Commission (2021) Monitoring the Mental Health Act in 2020/2021
[8] HM Chief Inspector of Prisons (2022) Report on an unannounced inspection of HMP and YOI Bronzefield
[9] Agenda (2018) Submission to the Independent Review of the Mental Health Act Call for Evidence