The health of prisoners

Editor—I read the article by the former chief inspector of prisons with interest,¹ mainly because my father is a prison officer who has worked in all types of establishment from top security prisons to open prisons. He and most of his colleagues are committed to the welfare of their charges, some of whom have mental illnesses.

My father, while agreeing with the good intentions in Ramsbotham's article, highlighted some omissions. Future doctors who may be considering working in the criminal or mental health services should appreciate the enormity of the task and the confines on employees and patients.

Closure of most mental health hospitals has led to greater risk of assault on prison staff and inmates. Most British prisons were designed for housing criminals deemed unsuitable for society. Cutbacks mean that prisons have changed little, and so they are not equipped to deal with prisoners having mental illness. Strip cells and padded cells have been outlawed, as it was claimed they were an infringement of civil liberties. The consensus among inmates and officers is that these cells were a humane way of caring for prisoners until a more suitable placement was found. The incidence of self harm among mentally ill prisoners has increased since these cells were removed.

Even in open prisons, problems are becoming more widespread, with increasing assaults on staff and inmates, contrary to the holiday camp image portrayed by the media. One factor is the cutbacks to prison staff—for example, on a night shift, the time when the risk for self harm is greatest, a typical prison will have only five officers patrolling the entire establishment. As in the current NHS crisis, the loss of members of staff at all grades increases the demands on those remaining. Being left on your own in a cell for hours would drive even the sanest of us crazy, let alone those who are more vulnerable to start with. The situation, again comparable to that of the NHS hierarchy, is that management is focused on saving money. To be director general of the prison service, a “qualification” is not to have been a serving officer. Training relies on textbooks, not on getting hands-on experience.

Those with the greatest insight into the day to day running of public services—the prison officers, doctors, or teachers—are not consulted when decisions are made. Until higher management loses the “we know best” attitude, the public services that the nation prides itself on will continue to spiral downwards.

1. Ramsbotham D. The health of prisoners. studentBMJ 002;10:2-3. (February.)