A lack of secure mental health beds in the community means that many prisoners in England are spending long periods in isolation, during which their health and wellbeing deteriorate, a damning report from the Independent Monitoring Boards has found.1
Of 31 prisons surveyed over four weeks in autumn 2022, more than a quarter (26%) included prisoners who were held in isolation while waiting to be assessed or transferred to more appropriate secure settings because of their mental health needs.
One prisoner spent over 800 days in care and separation units (previously called segregation units), where prisoners are isolated to “maintain good order and discipline” or for their own safety if they are at risk from other prisoners.
Another man with autism, schizophrenia, and severe symptoms of attention-deficit/hyperactivity disorder spent over nine months in isolation and experienced a dramatic deterioration in his mental health, said the boards, which monitor and report on the conditions and treatment of prisoners in England and Wales. In another case a prisoner with complex mental health needs spent over 550 days in isolation while awaiting assessment for transfer to a secure mental health hospital.
The target to transfer severely unwell men from prison to secure hospital is 28 days, but many boards reported severe delays throughout the process—in referral, assessment, and transfer. A proposed reform of the Mental Health Act would have written the 28 day target into law, but the bill is no longer being progressed.
The monitoring boards said that prisoners were often moved back and forth between care segregation units and prison healthcare units and wings, making it harder to track the cumulative time they spent segregated. Several boards had specific concerns about prisoners serving indeterminate sentences of imprisonment for public protection (IPP), which have no limit set on the time to be served, because many displayed serious mental health conditions and were regularly put into care and separation units.
One board raised concerns about an IPP prisoner with a serious mental illness and physical and learning disabilities who was held in isolation for over 250 days. It reported his deterioration, describing him as confused, tearful, unpredictable, and volatile.
Stopgap measure
Elisabeth Davies, national chair of the Independent Monitoring Boards, described the use of segregation as “the wrong tool to manage the mental health crisis in prisons.” Without appropriate mental health provision in the community and tighter monitoring of transfer timelines from prison to hospital, the report said it was likely that care and separation units would continue to be used as a stopgap for mentally unwell men and that transfer targets would continue to be regularly exceeded.
Davies said that, although a statutory 28 day transfer target would not have solved the problem entirely, it would have brought this a step closer.
“Segregating any prisoner, especially those with mental health needs, is not a decision taken lightly by prison managers,” she said. “While they clearly feel that they have no other option, CSUs [care and separation units] should not be used as holding bays for these vulnerable individuals.
“While local independent monitoring boards found that overall staff worked hard to support prisoners in the best way that they could, collectively they have reported a disturbing picture of mentally unwell men spending lengthy periods in isolation, which often results in a deterioration of their mental health. If anything is to change, the solution is, and has always been, providing appropriate mental health provision in the community and tighter controls around the transfer times from prison to hospital.”
A spokesperson for the Ministry of Justice said, “Segregation is an absolute last resort for those deemed a danger to themselves or others. Prisoners are entitled to the same care as they would receive in the community, which is why we guarantee the most vulnerable individuals are able to access mental health support tailored to their needs.”