Mental health care and rising suicides in UK prisons

July 12, 2017

“He called me and said very calmly, ‘Dad, I have to kill myself'”: Why suicides in UK prisons are at an all-time high.

Milton Keynes, UK – Ralph Morris does not falter as he recounts the disturbing final phone conversation with his son. “He called me and said very calmly, ‘Dad, I have to kill myself.’ I said, ‘Thomas, please don’t think like that, son. I’m coming to see you on Tuesday, next week. You’ll be released in November and I’ll be there for you.'”

Thomas Morris ignored his father’s appeals. In June 2016, he hanged himself within the walls of his prison cell at Woodhill prison in the city of Milton Keynes, in southern England. He was 31 years old.

“They don’t get a lot of phone credit and the call was terminated,” his father remembers. “That was the Saturday and then on Sunday morning they visited us and gave us the news”.

Thomas was one of 119 inmates to have committed suicide inside prisons across England and Wales in the year 2016.

The figure is the highest since records began in 1978 and is equivalent to one suicide every three days, according to Britain’s Ministry of Justice.

Woodhill prison has documented the most self-inflicted deaths of any prison in the United Kingdom, with seven inmates committing suicide there in 2016.

Morris is convinced the staff at Woodhill could have intervened to prevent his son’s suicide.

“I saw him in prison in April and although he seemed fine physically, mentally, I had real concerns,” Morris says. “I wrote a letter to HMP Woodhill, expressing my concerns. They acknowledged receipt of the letter and they said they had spoken to Thomas who assured them that he was OK.”

Following his son’s death, Morris learned from another prisoner who had been released from Woodhill that Thomas had attempted to take his own life on a previous occasion just a month before his death. Despite this, Morris says his son Thomas was not put under observation by prison staff. An inquest into Thomas’ death found that Woodhill prison could and should have prevented him from committing suicide.

Morris believes his son should not have been sent to prison, but instead committed to a facility to deal with his apparently worsening mental health.

“He wrote to me and said that he felt that he was depressed. He heard something on the TV and felt it was talking to him. He felt he’d be blamed for crimes that were on the news. In plain terms, my son had lost his reasoning and rationality,” Morris says.

Mental health problems 

Alex Cavendish is a former prisoner, academic and campaigner for prison reforms. He argues that many of the people serving sentences should not be in prison at all.

“What we’re seeing increasingly, is the use of inappropriate imprisonment of people with serious mental health conditions, simply because there is nowhere else available at the time for the magistrate, or the judge to send them,” Cavendish says.

The London-based Centre for Mental Health estimates that 90 percent of the nearly 86,000 prisoners in England and Wales suffer from some kind of mental health problem, such as bipolar disorder, depression or personality disorders.

Cavendish thinks that many of the problems facing prisons, including the high suicide rate, are attributed to a lack of sufficient care for inmates with mental health conditions.

“A lot of the violence that we’re seeing reported in prisons, between prisoners, self-harm and attacks on staff, are related to mental health problems,” he says. “And because many prisons are short staffed and they just don’t have medically qualified professionals, there’s a massive disconnect.”

According to figures from the Prison Reform Trust, 70 percent of people that committed suicide in prisons in England and Wales last year were identified with mental health needs.

Adam Mac is currently serving a sentence at a prison in the northern English city of Wakefield. He told Al Jazeera that medical staff at Wakefield are not giving prisoners the proper attention they require.

“After doing a psychological course (assessment), there is very little support available and this is where the mental health team should be filling in,” Mac says. “In my experience, mental health teams are happy to pick up the pieces when someone has self-harmed or committed suicide, but they are invisible when someone is crying out for help before that point.” 

Mac is also critical of the officers. “The prison officers themselves don’t really know how to handle people with mental and or emotional issues,” he claims. “Some look down on them, some overly pander to them. Very few find the right balance.” 

Al Jazeera presented Mac’s allegations to the Ministry of Justice. A spokesperson said: “We take the mental health of prisoners extremely seriously, which is why we have increased the support available to vulnerable offenders – especially during the first 24 hours in custody – and invested more in specialist mental health training for prison officers.”

Andy Bell, from the Centre for Mental Health, an independent organisation, says that although prison officers are not medically trained professionals, they should have more awareness of how inmates are suffering from mental health conditions.

“The prison officers that have the most important caring role for someone that’s vulnerable,” Bell says. “Of course, if there are fewer to go round that means there’s fewer opportunities to talk to prisoners and identify their vulnerabilities. It also means prisoners are likely to spend time longer in their cell, which, of course, can increase vulnerability.”

Staffing crisis

Prisons in England and Wales are experiencing a crisis in staffing. This can be traced back to 2010, after the Conservative Party came to power and slashed funding to the Ministry of Justice, as part of wider austerity measures. As a consequence, there are 7,000 fewer prison officers today, compared with seven years ago.

The effect on inmates has been devastating and in some cases, fatal.

Cindy Woodings explains how her son, Luke, was found crying in his cell by a prison guard 11 days after his incarceration. She says in the notes recorded by the officer that Luke had told him: “You’ve let me down. I’m not supposed to be in a cell on my own.” Twenty minutes later, he was found hanging in his cell. 

The date was June 14, 2015 – Luke’s birthday. He died in a hospital three days later, aged 29. 

“The prison guard on duty was not from that wing,” recalls Woodings. “He was working overtime that day because they were so understaffed. He’d got four landings to look after on his own and didn’t know Luke’s case, didn’t know anything about him.”

Woodings explains how the prison officer was on the bottom floor supporting another inmate inside a cell, while Luke was on the highest level of the prison.

“He cannot see another prisoner, on all four landings, because he cannot leave that inmate unattended. During this time, he heard the chair go at the top landing and his instinct told him it was Luke,” she says.

Luke had struggled with depression and a heroin addiction, but thought being imprisoned would help him to reform and treat his dependency.

“He committed shop theft and went to Leicester prison,” Woodings says. “And whilst in prison, he saw a psychiatrist. He diagnosed Luke with having a mentally unstable personality disorder, which made him a high-risk of suicide.”

According to Woodings, Luke was improving as a result of the medication he was receiving. But after his sentence came to an end, so did the treatment.

Woodings says Luke panicked and was determined to return to prison. After his release, he threatened a police officer, was charged and later convicted and sentenced to six weeks in jail.

“But they sent him to Lincoln, instead of back to Leicester,” Woodings explains. “So when he arrived at Lincoln, he told them that he has a personality disorder and he needed to see someone from the mental health team immediately. That didn’t happen.”

At that point, Woodings says, Luke began harming himself and was taken to a hospital, where doctors said he urgently needed a mental health assessment. Yet Woodings alleges he did not receive this from the psychiatrists at the prison.

‘Prison officers are not nurses’ 

Woodings is adamant that Lincoln prison staff had failed to protect her son. “You have an inmate that had been under a psychiatrist that was high-risk of suicide, who self-harmed twice, quite seriously and he’d informed you of his mental state. The hospital has informed you twice about his mental state. Surely, you neglected his basic needs.”

The issues of staff shortages and poorly trained officers resonate with Kim Lennon. She worked for 10 years as a prison officer at HMP Lewes, in southern England.In 2014, she reported to local and national media about security failings at the prison and the effects the staffing crisis was having on inmates.

“We used to have time where you knew your prisoners. They would talk to you and let you know stuff,” Lennon says. “Prisoners are locked up a lot more because of the shortage of staff. They’ve got to sit behind a door, with four walls and so they get frustrated and they get angry.”

Lennon also reveals how prison officers are not equipped to care for inmates with mental health problems.

“We had half a day of training in a year. And I didn’t learn anything really. It’s difficult because people with mental health issues shouldn’t be in prison anyway. Prison officers are not nurses. And we’re not trained for that.”

In November, the Ministry of Justice announced an initiative to hire 2,500 new prison officers in response to warnings about dangerous prison conditions, caused in large part by a lack of staff. But Cavendish believes this has not been successful.

“They had a recruitment drive last year that failed miserably,” Cavendish claims. “More people left the prison service than joined it. So in all the prisons, even if they have low staff ratios, cannot even fill the vacancies, because the salaries are so low and the conditions now so violent, the prisons have such bad reputations that no one really wants to work in a prison.”

Overcrowded prisons

As staffing levels in prisons have declined over the years, the number of people being incarcerated has increased. In 1993, the prison population in England and Wales was around 40,000. Since then it has more than doubled, to almost 86,000, making it the highest prison population in Western Europe.

But the prison system cannot take any more. According to statistics from the Ministry of Justice, 77 of the 117 prisons last year were beyond capacity, holding 9,762 people more than they were intended. Combined with the severe staff shortage, overcrowding has had a destructive effect on the lives of prisoners.

Al Jazeera contacted a Category A prisoner (inmates in this group are considered to pose the highest threat to the public, police and national security, if they were to escape) who is serving a life sentence and who did not want to be identified.

He thinks that these “changing conditions” are among the reasons behind the rise in suicides among prisoners. “More bang up, fewer activities, less time on the phone, less association with other inmates; a feeling of never ending isolation,” he said.

This confirms research from the charity The Howard League for Penal Reform which says there is less time for rehabilitation because of overcrowding and a lack of available supervision. It says prisoners are instead spending up to 23 hours a day in their cells, severely limiting their activity.

Prison reform campaigners say it is these conditions that are fostering a record rise in violence, self-harm and suicide.

Bullied inmates

Cavendish believes another major cause of suicide among prisoners is bullying. He says most instances of bullying are related to drugs and debt.

Referring to inmates, he says, “they’re quite happy to buy drugs on credit, but then the interest rates are, of course, appalling. It can double over a week. So if the prisoner isn’t able to pay the supplier, in front of other prisoners, he’ll beat him up. Or, pressure is put on the prisoner’s family, to come up with the debt. So for the prisoner unable to repay the debt, or whose family has been threatened, they’d rather commit suicide, than face the consequences.”

“I knew one lad, who was 21, he was heavily in debt,” Cavendish recounts. “It was mainly tobacco and he owes a lot of money. The drug dealer summons him to his cell and threatens the boy. The boy couldn’t face it any more and he hung himself. That’s not unusual in prison.”

Woodings alleges that her son, Luke, was also bullied while in prison.

“You could see bruises on both knees, you could see a bruise in the middle of his back, and you could see bruising to his fingers,” Woodings insists. “And he’d got an ulceration in his rectum that was caused by trauma. The coroner told me in his professional opinion that the ulceration in Luke’s rectum was caused by trauma.”

“The evidence was all there,” Woodings says. “I reported it to the police, but they didn’t investigate that because they couldn’t find out who the inmates were, because nobody knew anything.”

Mac told Al Jazeera that it is not just the prisoners that are engaged in the bullying.

“Bullying does happen and it is on the increase at Wakefield,” Mac says. “At times, the staff are actually part of the problem. They often turn a blind eye unless it is actually reported (which often makes it worse) and at times it is the staff themselves who are the perpetrators. In the course of my sentence, I have been blackmailed, verbally abused, even threatened and assaulted by no less than a dozen officers.”

In response to these allegations, a Ministry of Justice spokesperson told Al Jazeera: “We expect the highest standards of professional conduct from our prison staff. The vast majority are hard-working and honest, but any allegations are investigated thoroughly and we always seek to prosecute those involved.”

IPP: Forgotten inmates languishing in jail

Cavendish says longer prison sentences across England and Wales must also be considered when trying to understand why more prisoners are committing suicide.

The Prison Reform Trust says there are 3,528 prisoners serving an Indeterminate Sentence for Public Protection, or IPP.

Prisoners that are serving an IPP have been convicted of serious crimes such as sexual assault or manslaughter. They must serve a minimum sentence, or tariff, before going before a parole board that will determine if they are suitably reformed for release.

But it does not end there. An individual serving an IPP is released on licence, for at least 10 years and could be recalled to jail, if the parole board determines there is a risk to public safety.

The intention behind the IPP was to reduce the number of life sentences while remaining tough on violent criminals.

Cavendish says many of the prisoners serving an IPP have gone way past their tariff and are left languishing, with little hope of being released.

“We’ve then seen the situation where people that were initially sentenced for a minimum tariff of 18 months or two years, have served 10 years, or longer,” he explains. “People in this position have described it as a form of mental torture. When it gets to the point that prisoners have served three or four times their minimum tariff, they give up hope. And their view is that there is no point in continuing to live, because there’s nothing to look forward to.” 

The Prison Reform Trust says 83 percent of inmates serving an IPP have gone beyond their minimum tariff.

The IPP was abolished in 2012, after it was discovered that judges were using it for more minor offences. But the elimination of the sentence was not applied retrospectively, leaving thousands behind bars.

Alex Hewson from the Prison Reform Trust substantiates the traumatic effect IPPs have on prisoners.

“Our own research shows the growing toll of despair the IPP sentence is having on prisoners and their families, years after its abolition,” Hewson told Al Jazeera. “People on IPPs have one of the highest rates of self-harm in the prison system and many remain stuck in prison not for what they have done, but for what they might do.”

The record rise in suicides among prisoners in England and Wales seems to be just one symptom of a failing prison system, as Cavendish explains.

“There’s no doubt that there’s a crisis in the prisons. There’s violence at every level. And it gets worse every year. And now we’re throwing into the mix, riots. Last year, there were six major riots in a period of weeks. I think we will end up with a major prison riot, where staff may be taken hostage, where parts of prisons will be burned, where there may be prisoner-on-prisoner violence that leads to people being killed,” he warns.