Independent Advisory Panel on Deaths in Custody submission to the Justice Select Committee call for evidence on Imprisonment for Public Protection (IPP) sentences – November 2021

What is the experience of people on IPP sentences in prison? What additional mental health challenges do people serving IPP sentences face because of the nature of their indeterminate sentence?

3. IPP prisoners should be seen as a particularly vulnerable group. The possibility of a perpetual cycle of imprisonment exacerbates feelings of hopelessness, therefore heightening risks of self-harm and suicide. The impact on the mental and physical health of people serving an IPP sentence is a key theme which emerges from the IAPDC’s consultations.
    
4. Concerns have been expressed by Coroners, the Prison and Probation Ombudsman (PPO) and HM Chief Inspector of Prisons (HMIP) about the impact of this sentence on self-harm and deaths in custody.

Hopelessness
 

5. Responses to the IAPDC’s 2017 consultation with prisoners[4], as well as further letters received via Inside Time, demonstrate how the indeterminacy of imprisonment leaves people on the IPP sentence feeling hopeless, helpless, and often afraid to seek support, which in turn could prolong their detention. IPP prisoners note that these feelings of hopelessness stem from both a frustration at serving life sentences for crimes that typically would have merited shorter determinate sentences, as well as a sense of unfairness about the disparity between their sentence and the crime[5]. 
    
6. Hopelessness is thought to be a relevant factor in terms of the relationship between IPP sentences and self-harm and is one of the most prominent cognitive factors associated with suicides more generally[6]. One meta-analysis study found hopelessness has a strong link with suicidal thoughts and attempts[7]. Hopelessness is also known to be associated with repeat suicide attempts[8].
    
7. Concerns about the health and wellbeing of IPP prisoners have been raised with the IAPDC by, among others, family members, senior NHS managers, Samaritan Listeners and Royal Colleges of medicine. Independent Monitoring Boards have repeatedly expressed concern for the welfare of IPP prisoners, remarking in their most recent annual report[9]:

"Several Boards, including Wakefield, Lindholme and Haverigg, continued to report the negative impact of the absence of a release date on the mental health of IPP prisoners.”
 

8. The IAPDC visited HMP Humber in 2018 and spoke to prisoners and staff at the Hope Unit. A Samaritan Listener confirmed that lost hope was “the most fatal thing”. The senior officer and team had built up good professional and supportive relationships with prisoners on the unit but remained concerned that continuing uncertainty, regular knockbacks and unsuccessful parole hearings mean IPP prisoners “lose complete hope and lose trust in the system”[10].
    
9. Although evidence suggests hopelessness increases suicidality, it is difficult to establish the independent effect of hopelessness without co-morbid depression or psychological distress. Studies have found that people given IPP sentences are disproportionately likely to have pre-existing mental health problems. Research also details the negative mental health implications of IPP imprisonment[11].

Self-harm

10. The psychological toll of having an unknown release date is well[12] documented[13]. The Prison Reform Trust’s 2019 report, No Life, No Freedom, No Future, which draws on government statistics, found that IPP prisoners were over two-and-a-half times more likely to harm themselves than others in the prison population[14].
     
11. Rates of self-harm amongst IPP prisoners are high. Table 1 shows that even as the IPP population reduced, the number of self-harm incidents increased between 2014 to 2017. Whilst self-harm incidents have reduced over the past two years, this mirrors an overall decline in the IPP population. Last year, a total of 2,066 self-harm incidents were recorded, meaning there were more such incidents recorded than the number of IPP prisoners[15].
    
    Table 1: Number of self-harm incidents among IPP prisoners from 2012 – 2020

Self-inflicted deaths

12. IPP prisoners have repeatedly been identified as at a higher risk of suicide or self-harm than those in the general prison population. For example, the Prison and Probation Ombudsman reported in 2014:

“This [an IPP sentence] is an uncertain situation and for some could lead to hopelessness, which is associated with increased risk of suicide.” [16]

13. As of May 2021, of the 250 IPP prisoners who have died since the sentence came into effect, 65 have taken their own lives whilst in custody[17]. Although this number is high, the figures involved are too small to draw any statistically significant conclusions and to understand whether IPP prisoners die disproportionately versus prisoners on other sentences. However, it may be that further analysis that considers the deaths of the IPP population with an appropriately comparable population, such as those serving sentences longer than four years within the wider prison population, would reveal relevant differences.

14. Investigations into individual deaths have drawn attention to the real impact of the IPP sentence on worsening mental health which can ultimately lead to suicide. Commenting on the inquest in 2018 into the self-inflicted death of IPP prisoner Tommy Nicol, Deborah Coles, Executive Director of INQUEST and an IAPDC panel member, noted:
     

“The inquest heard evidence of an abhorrent lack of care concerning Tommy’s deteriorating mental health. He was left alone and distressed in an unfurnished cell, already two years over his sentence. A forensic psychiatrist said he was almost certain that the IPP sentence more than minimally contributed to his death.[18]”

15. Donna Mooney, Tommy Nicol’s sister, has spoken of the unique challenges Tommy faced being on an IPP sentence, and has worked tirelessly to highlight the plight of those still serving an IPP sentence. Donna has stressed that Tommy felt his sentence was a ‘life sentence’ and described it as “psychological torture of a person who is doing 99 years”[19] which ultimately led to him taking his own life. She told the IAPDC:
     

“I just want his death to count for something. He had his whole life feeling that he didn’t count for anything.”
 

16. The IAPDC recommends a thorough review of the mental health needs of all individuals on an IPP sentence. This review should also consider the important and specific social care and physical health needs that, if unmet, might increase the risk of suicidality inside custody and on release for this vulnerable cohort.
     

Women, self-harm and suicide

17. The IAPDC’s analysis in 2019 – using an annual mean over six years – suggested that the rate of self-harm among the female population was as high as 4,520 per 1,000 prisoners[20]. Although women prisoners make up a small proportion of the IPP population (2% in 2017/18), their self-harm rate is at least double that of other women in prison and over ten times the national average within the general female population.

18. In March 2019, the Griffins Society published The Plight of Women on IPPs[21] which outlines findings from detailed interviews with nine women in prison who, at the time, had served at least twice and as many as 11 times their tariff. Six of these nine women had tried to take their own lives multiple times during their sentence. Other findings include anger and frustration at the indeterminate element of the sentence and that every woman said simply having a ‘having a date’ would make the most difference.

Coping with the loss of loved ones

19. The impact of losing loved ones whilst in prison compounds feelings of hopelessness and anger at the sentence, particularly when a loss occurs in the post-tariff period. Women on IPP sentences have also spoken of the impact of losing children to local authority care[22]. The loss of relationships with children have been identified as particularly traumatic for women[23].
     

“I never received any grief counselling following the deaths of my parents again as funding is not available for IPPs or so I was told. when I arrived here due to the self-harming I was referred to mental health who without seeing or speaking to me assessed me as unsuitable for support. I was seen by a GP around 10 weeks ago who referred me to mental health again for grief counselling and general support but still they have refused to go near me because of the IPP label.”
 

20. Due to the damaging nature of the sentence, families provide an important source of support. However, relationships with families often become fractured because of the uncertainty of release[24].
     

 

“If you support and strengthen visits properly. Deaths in prison will fall. I ‘ll say family wings and video link is key to stop death and drug taking in English prisons.”

 

21. In line with Lord Farmer’s review[25], which identified the family as the “golden thread” running through the prison journey, the IAPDC recommended in its 2019 report that the Government work to maintain and facilitate family links through detention close to home, family visits or video links, and that compassion should be shown to prisoners who have lost loved ones with bereavement or grief counselling offered.

“There’s an endless amount of hoops they’ve got you jumping through. And your families out there. My nan’s 82 now. You can see why some of the lads do desperate things.”(HMP Humber)

Deteriorating physical health

22. It is important to acknowledge the negative impact of the IPP sentence on physical health. In letters received from IPP prisoners, many speak of the impact of the sentence on both their mental and physical health, with the latter being affected by the specific issues that arise from lack of purposeful activity and chronic stress.
     
23. Some letters attest to the intertwined nature of mental and physical health, highlighting that some of the effects of anxiety, depression and other mental ill-health can lead to worsening physical health, for example, from an inability to engage in physical activity. IPP prisoners can also face challenges accessing appropriate healthcare specifically because of their sentence.
     
24. The IAPDC recommends a review of modifiable risk factors and physical health needs for those on IPP sentences, which should cover broader issues relevant to health and wellbeing, such as (but not limited to): physical and mental health needs; social care needs; daily/weekly activities/hours per week; work; education; library visits; gym and exercise; contact with family/friends; skills for everyday living; and sentence requirements and suitability for recategorization, release on temporary license and transfer to open conditions.
     

 

“I have been diagnosed with epilepsy which is triggered by stress. I have never once seen a member of any Mental Health team, and it is not for want of trying. I have been told over the years a variety of reasons why from that they have no funding to cover IPP’s to the assumption that I don’t meet the criteria to access the support of Mental Health. I was told in my last prison that I could only access mental Health as an IPP if I had had “a successful suicide attempt” (didn’t make sense to me) but if I need support to call the Samaritans”

 

What are the current barriers preventing release? What measures would need to be taken to overcome these barriers, and what would be the operational and resource implications for HMPPS?

25. Some studies explore the adverse effect of the IPP sentence on an individual’s ability to engage in regime and risk reduction work that would help prepare them for release[27]. In the Griffins Society report, interviews with women prisoners illustrated widespread feelings of compounded anger that the sentence had been abolished, but they were still in custody, which led to a lack of confidence in the system and affected their willingness to engage in programmes that may enable their release[28].
     
26. An IPP prisoner with learning difficulties in Wandsworth prison, noted that to be released, he had to attend specific offender behaviour courses, however, those courses were not available at his prison, and he was not able to move to a prison that did run the necessary programmes. He was essentially “stuck in a horrific limbo”[29] which severely impacted his mental health.
     

“Prison is MEANT to be about rehabilitation but it’s not. It’s about punishment and protecting the public. Yes, these are important, but as a prisoner, I need to see progress. I NEED to see light at the end of the tunnel. All I see right now is darkness. And THAT is why I am still a potential suicide risk.”

What options are available to reduce the size of the IPP prison population? What are the advantages and disadvantages of the different options?

27. The IAPDC recommends that the Government reviews the cases of all individuals still serving an IPP sentence and develops a sensible forward plan for each individual that would allow for some hope and sentence progression. This solution would have the most positive impact on physical and mental health.

How is release and resettlement planned and managed for IPP prisoners given their unpredictable release date?

28. The support that is typically in place for prisoners on release is not sufficient for IPP prisoners because of the additional risk factors and challenges they face. This is echoed by other organisations such as the Prison Reform Trust, who found that the:

“support available for people serving IPPs in the community after release did not match the depth of the challenge faced when rebuilding their lives after prison.[30]”

29. One prisoner wrote to the IAPDC:

How are people on IPP sentences managed within the community once released?

30. One of the challenges people on IPP sentences face is the fear of being recalled, which can leave them living in a never-ending cycle of anxiety, unable to socialise with others out of fear of breaching their probation rules. This fear is even felt before they are released, and some now fear life outside of prison more than life within.
     
31. People on IPP sentences need individual, tailored, and increased support as well as access to ongoing health and social care services because of the additional mental and physical challenges they face upon release. The IAPDC recommends a specific stream of social prescribing could be developed for this cohort.

What are the main reasons why people serving IPP sentences are recalled? Once recalled what support is given to prepare them for re-release?
 

32. Although the IPP population is decreasing, the proportion of those who are post-tariff, and the number of IPP recalls to custody, has increased in the past five years. Reports have found that people are often recalled into indefinite custody for behaviour that appears to fall short of the tests set in official guidance[31]. This is echoed by prisoners’ fears that on release, they may be recalled for minor incidents or false allegations[32].
     
33. The Prison Reform Trust’s analysis of recalled IPP prisoners highlights the impact of recall on wellbeing. One of the contributing factors is a lack of a clear plan for re-release; some participants felt unable to ask for help, many did not have a good understanding of what would be required of them, and some were not given any work that would secure their re-release[33].

The IAPDC is grateful for this opportunity to submit written evidence to the inquiry and would welcome the opportunity to provide further information or oral evidence if required by the Committee.