Locked up and locked down: Covid-19 and the dire state of mental health in prisons

According to the Prison Reform Trust, prisoners have a disproportionately high rate of poor mental health, with the problem apparently acute amongst female prisoners. Published figures demonstrate that the rate of self-harm and suicide in prisons is appallingly high, and treatment for mental health conditions in prisons remains limited and often inadequate, despite the efforts of dedicated staff. Prisoners going into custody with mental health problems often experience a worsening of their condition; mentally healthy people often develop mental illness as a result of imprisonment. Sadly, these trends correspond with my own personal experiences in over 25 years of criminal practice.

But as public and official awareness of mental health issues increases, and as mental health is now, in theory at least, considered as essential to overall wellbeing as physical health, will attitudes and policies change?

A trigger for reform may be the fact that the majority of people are themselves experiencing enforced isolation and inactivity, which could precipitate a change in public attitude as to how we punish offenders and what we hope to achieve by imprisoning them.

Coronavirus has caused prisons particular problems, exacerbated by overcrowding and already stretched healthcare facilities. As a result, prisons appear to be responding by restricting the time prisoners spend out of their cells, which in many prisons was already limited to only an hour or so a day because of overcrowding and staff shortages. Meanwhile, prison visits have been suspended and trials have been postponed. Taken together, there seems little doubt that prisoners’ mental health is likely to worsen during the current crisis.

The Court of Appeal in R v Manning has been forced to acknowledge the current situation in prisons and has accepted that this may be a factor in deciding whether or not to suspend a prison sentence. However, sentencing policy to date has almost entirely ignored the effect of imprisonment on mental health, and there has been little political inclination to address the problem.

Will the current crisis lead the Government and judiciary to address the underlying problems in our prisons, or will we see the usual "sticking plaster" approach? Past experience is discouraging, but it is just possible that, as in other parts of the justice system, a radical response may be unavoidable even if politically unpalatable. There is no easy solution to mental health problems in prison (or anywhere) but a wholesale re-think of sentencing policy and philosophy is the essential first step.

This would mean a drastic reduction in the use of custodial sentences for non-dangerous offenders and increased recruitment and investment in prison staff. The former could free up resources for the latter so, unusually, this is a policy that could ultimately pay for itself. But ministers and judges have been given the clearest warnings about prison overcrowding and underfunding for many years. It may take an even greater crisis than the current one to lead to lasting change.