Report finds young custodial deaths ‘failure of the state’

Radical changes in the prison system are needed to prevent deaths of vulnerable young people in custody, a year-long review has concluded.

Each of the 87 self-inflicted deaths examined represents a failure of the state to protect those prisoners, Lord Harris’ report said.

Without decisive action from the Government more young lives will be wasted, the chair of the Independent Advisory Panel on deaths in custody warned.

More than 100 recommendations are set out in the report, which runs to more than 200 pages and looked at deaths of adults aged 18 to 24 as well as four teenagers, the youngest two of whom were aged 15.

The majority of deaths were white males, with only two females among the cases of young adults examined.

Those who died between April 2007 and the end of 2013 had had troubled lives, some having suffered child abuse or spent time in foster care.

There have been an estimated further 22 self-inflicted deaths in custody since the beginning of 2014.

The review, thought to be the most comprehensive analysis of penal policy in many years, states: “Lessons have not been learned and not enough has been done to bring about substantive change.”

Understaffing could be a contributory factor in deaths, Lord Harris said, citing evidence of medical and mental health appointments being missed because there are not enough staff to accompany the patient.

“It stands to reason that current staffing levels impose an additional serious strain on the system,” he said.

He was critical of the attitudes of some staff members, saying he was struck by the “callousness” in some instances.

He recalled one incident where a prisoner had tried to hang themselves and was taken to hospital.

As they lay dying prison officers “insisted” on remaining at the foot of the bed while the offender’s parents stood with their child.

He stressed that the reasons a young person has ended up in custody should not alter the duty of care towards them.

There must be a major re-think on the purpose of prisons, Lord Harris warned, ensuring the primary philosophy is rehabilitation.

The review questions benefits of prison as a form of intervention, calling for a reinvestment and redirection of resources to the welfare system and community alternatives.

A new role, namely a custody and rehabilitation officer, is recommended to take responsibility for the care of a small number of prisoners, replacing the existing personal officer scheme, the report said.

A specific policy to deal with bullying, an issue raised frequently during the review team’s research, is also recommended.

Lord Harris said: “While there is no simple and easy solution, it is clear that the prison service needs to make radical changes to protect the most vulnerable people in custody more effectively. Young adults in prison are not sufficiently engaged in purposeful activity and the prison environment is grim, bleak and demoralising to the spirit.”

Juliet Lyon, director of the Prison Reform Trust, said a recommendation that the Minister for Prisons should call the family of a prisoner who has died to both express their sympathy and promise an investigation into the death is particularly welcome.

“Too many vulnerable young people are slipping through the net of mental health and welfare services and ending up behind bars,” said Ms Lyon.

“Very many of the tragic deaths described in this sobering report could have been prevented by thorough assessment and intervention at an earlier stage in these young peoples’ lives.

“Time and again this is what bereaved families say after struggling for years to get the help they need.

“The stark recommendation for the Minister to telephone families when a loved one has died in custody will come as a shock but it may well be that that only when this conversation takes place that change will result and true accountability be achieved.
“The report raises the fundamental question of why we lock up our most vulnerable young people in our bleakest and most short-staffed institutions.

“Prison should be a place of last resort and far more needs to be done to divert young people out of the criminal justice system into proper treatment and support.”

The report is a “devastating indictment of a flawed system that is systematically failing”, according to the co-director of Inquest, a charity which provided evidence to the review.

Deborah Coles, who was part of the review team, said: “That its findings echo what has been said repeatedly and that so many deaths could have been avoided if already-known lessons had been acted upon is all the more shocking.

“Government can either ignore this report at its peril or do something radically different that could be a lasting legacy. Already this year eight young people have taken their own lives in prison.

“This should be a watershed moment and provides the basis for a complete transformation in policy. Justice Minister Michael Gove should take the opportunity to make a clear and clean break from the lamentable failures of the past.”

Ms Coles said prison fails to rehabilitate or protect inmates, and said Inquest supports the review’s call for a re-think on the purpose of the institutions.

“Unless as a society we reconsider dramatically why so many young people in conflict with the law end up in prison, the deaths will continue along with the on-going trauma for grieving families,” she said.

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