Female prison using segregation to ‘manage’ inmates with complex mental health problems, report

Scotland’s only all female prison appears to be using segregation as a way to manage “high levels of distress” experienced by inmates with complex mental health problems, a new report has claimed.

The Mental Welfare Commission for Scotland looked at the treatment of prisoners with complex mental health problems, and found some were experiencing up to 82 days in segregation.

This could see women spending some 22 hours a day in cells in Cornton Vale Prison, which were described as “sparse and lacking in comfort”.

However the Commission noted that the women “seemed more disturbed in the SRU (Separation and Reintegration Unit) environment and accounts of their stress and distressed behaviours more pronounced”.

The report added: “For women who were floridly unwell with acute psychosis or manic psychosis, the severity of their symptoms and level of disturbance significantly worsened in the SRU.”

The Commission went on to say it was “concerning to see how little mental health staff were sometimes able to engage with and support women who were acutely mentally ill or distressed”.

A total of 23 women prisoners were kept under Rule 41 – where a health professional requests they are either confined to their cell or put into segregation – for mental health reasons during 2020.

A total of 25 of these episodes were recorded, with these lasting from one day to 82 days, with an average length of just over a month (32 days).

In 17 cases, women were in the SRU for at least part of the time they were subject to this rule – with the length of time this applied ranging from one to 70 days.

The Commission said: “For those women with more complex mental health problems and vulnerabilities, for whom hospital care was often not an option, segregation appeared to be used as a way to manage their high levels of distress and behavioural disturbance in the custody environment, though it appeared to only lead to escalation.”

With a contract awarded last year to replace the existing Cornton Vale women’s prison with a new facility on the same site outside Stirling, the Commission noted that it was “planned that women with mental health needs will no longer be cared for in the SRU”.

Instead, the report told how the segregation unit in the new building would be “used solely for women requiring segregation for disciplinary issues” and that women with “high care needs due to mental health” should be cared for in what was described as an “enhanced needs area”.

The Commission said it has also been told by the Scottish Prison Service that it had updated training for new prison officers in autumn of 2020, to include “a more prominent focus on mental health and trauma-informed care”.

The report was produced in the wake of work by the European Committee for the Prevention of Torture (CPT), which visited prisons and police facilities in Scotland in 2018.

And while the Commission reviewed the records of nine women, who all received mental health care while in prison between 2017 and 2020, it said its report posed questions for the wider prison system.

It found cases of delays in transferring mentally unwell prisoners to hospital, saying that the records showed “patterns of escalating symptoms, indicating that each woman’s acute illness was evolving whilst they were not receiving the inpatient care and treatment they urgently required”.

It also highlighted “repeated inequalities” of women in prison being unable to readily access intensive psychiatric care unit (IPCU) beds or secure forensic female beds, due to a lack of facilities and pressure on local services.

Claire Lamza, senior manager at the Mental Welfare Commission, said: “This document opens a window on the lives of some of the most marginalised women in society.

“It gives some insight into the irreparable damage that is being done to those individuals, and we can only imagine the wider impact on their families and communities.

“We hope this detailed review will be read and acted upon by those who are examining Scotland’s future approach to the best ways to care for mentally unwell people in prison.

“While changes are being made at Cornton Vale, the wider situation needs to be addressed, and Scotland as a society needs to do more.”

Mental Wellbeing Minister Kevin Stewart said: “This is an important report that contains a number of recommendations which will be given careful consideration.

“Our Mental Health Transition & Recovery Plan published in October last year made clear our commitment to continue to work with partners to seek better support for those with mental ill health within the criminal justice system.

“The plan is supported with £120 million from a Recovery & Renewal Fund and focuses on the specific mental health needs of women and girls to support better outcomes across a range of settings.

“In addition we continue to work with the Scottish Prison Service and other partners to ensure that frontline staff are properly supported. This includes the development of a new custodial estate for women in Scotland, scheduled to open in 2022 and filling over 41 whole time equivalent mental health roles located across the prison estate including the female estate.”

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