This is the background and evidence from our current CrowdJustice campaign.
Further Information Expert Opinions and Findings
Mr Graham Rogers, a leading consultant psychologist
Mr Rogers strongly disputes the Ministry of Justice's claims that adequate mental health services are available in the prison system. Based on his own experience and publicly available information on the level of mental health services accessible by most prisoners, he casts serious doubt on a body of evidence provided to a High Court in another jurisdiction by the Ministry of Justice concerning Ms L.
"The woman's case is complex; the National Crime Agency (2021), in their letter to the High Court referred to, "treatment for Mental Health Issues." However, they then focused on the role of a GP and a nurse who assess individuals entering prison and recommend, if necessary, specialist services. Crucially, GPs are not experts in mental health or the assessment of complex mental health needs.
Within Ms L’s specific case, the prison system historically evidenced significant disagreement between its own professionals. They were unable to identify an agreed diagnosis and, as a result, failed to find an agreed, suitable treatment.
The most common misdiagnosis within the prison system, without any doubt in my mind, is 'personality disorder' (PD). According to the Prisons and Probation Ombudsman (2016), 60% of those in prison with 'mental illness' receive a PD diagnosis. Misdiagnosis in the UK prison system is common, according to Mokros et al. (2018). They estimate 1-in-3 cases are misdiagnosed.
Where one relies on psychiatry, the rate of misdiagnosis can be significantly higher and diagnosis less reliable, Aboraya et al. (2006), Aboraya (2007), Baca-Garcia et al. (2007). One specifically notes that 'agreement' between psychiatrists is often poor, Ash (1949), Meehl (1954), Large et al. (2009), Gowensmith et al. (2013).
I would respectfully argue that if you do not assign the correct diagnosis, you are unlikely to offer the proper treatment; see Meyer et al. (2001)."
A study by Bipolar UK, along with The Royal College of Psychiatrists and Bipolar Scotland (2012), using a survey of 706 people, found that on average, it took more than 13 years to receive an accurate diagnosis, with 85% of individuals receiving the wrong diagnosis. Of these, 85% who received the wrong diagnosis, 71% stated their conditions got worse due to inappropriate treatment (the use of medication).
It is noteworthy that under the new International Classification of Disease, version 11 (ICD-11), (2018), PD has been radically reduced, from ten (10) disorders, down to five (5), where ‘borderline PD,’ no longer exists; replaced by a lesser, ‘borderline pattern.’
With a distinct shortage of available professionals, accessing regular mental health treatment by NHS professionals is problematic, both within the community and the prison system. The scale of mental health needs within prisons is significant. These startling figures reflect the difficulty, shown via the Prison Reform Trust (2021):
Duty of Care
It is not enough to ask what constitutes ‘appropriate care’ or even ‘good enough care’ for those with mental illness. We also need to consider reasonable access to any form of care – getting an appointment with a mental care professional is difficult but getting to that appointment is virtually impossible.
The PPO has identified the shortage of any form of health care within the UK prison. Unbelievably, it has become even more problematic since the privatisation of the healthcare system within prisons, with healthcare wings reducing opening hours. I refer to HMP Bronzefield, having directly observed the change at the time of privatisation. Under the NHS, health services were available five days a week, from 8am to 4pm, though often closing closer to 5:30pm when needed. After privatisation, service access appointments reduced to 10am to 3pm for only four days a week - a significant reduction in service levels.
These difficulties were acknowledged by the CQC, as reported in The Guardian by Denis Campbell, Health Policy Editor, October 2018:
“Almost half of England’s jails are providing inadequate medical care to inmates, whose health is being damaged by widespread failings, the NHS watchdog has told MPs in a scathing briefing leaked to The Observer."
“Healthcare behind bars is so poor in some prisons that offenders die because staff do not respond properly to medical emergencies, the Care Quality Commission (CQC) says.”
“Mental health services for the 40% of inmates who have psychological or psychiatric problems are particularly weak (emphasis added), which contributes to self-harming and suicides among prisoners, according to the care regulator’s confidential briefing to the Commons health and social care select committee.
"It blames chronic understaffing, problems getting to medical appointments and guards knowing too little about ill health to recognise problems. The mixture of NHS and private companies that provide healthcare in England’s 113 adult jails and young offender institutions “frequently struggle to deliver safe and effective services”, the commission tells MPs.”
In responding to this, I would note, if we assume a prison population of 80,000, then based on the above (40%), 32,000 have mental health problems, and "guards knowing too little about ill health to recognise problems."
The prison population is extremely complex but dominated by those with mental health needs and those with learning, language and communication difficulties and disorders. Yet the prison system appears to be unable or unwilling to identify their needs or meet them.
Thank you for making a difference and saving lives.
*Eight Report of Session 2017-19(1)
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