Ramsbotham D. (2003) Prisongate. Free Press (Simon and Schuster inc.). London. ISBN 0-7432-3884-2. 267 pagesExposing the near meltdown in Britain's prison system, Prisongate contains much of interest to those with an interest in the state of Britains' prisons. The author, Sir David Ramsbotham, as Chief Inspector of HM Prisons - had unparalleled access for over 6 years to every prison in England, Wales and Northern Ireland. Chapters on local prisons, the treatment of sexual offenders, resettlement prisons and women in prison all identify inadequate regimes, scarce resources and management failures; but the most shocking of his revelations involve mentally ill prisoners.
"All day long they lay down or sat beside their beds with nothing to do ... Other than medication, however, they received no day-care or any other kind of treatment programme."
p.110/111
The author suggests a figure of 500 prisoners requiring detention under the 1983 Mental Health Act. He cites 70 per cent of male and 50 per cent of all female prisoners as suffering from a personality disorder. These individuals were often young, unmarried, and charged with acquisitive offences (burglary, robbery or theft). Many had drug problems, were poor, and a significant number had experience of trauma often physical or sexual abuse. Many were 'short-term repeat offenders', serving serial sentences, whose coping skills were poor.
Throughout the book, prison health services appear under-staffed and ill equipped to deal with the scale or complexity of the apparent mental health. "Few, if any, mentally disordered prisoners anywhere in the prison system were cared for to normal NHS standards..." p.121. To compound the problem, transfer to NHS facilities was often slow or even impossible. Consequently prisoners' mental state often deteriorated. Containment rather than care was the norm. Prison evidently cannot "deliver beneficial programmes such as education, drug and mental health treatments...to anything like the number who need them." p.147
The author proposes specialist assessment, identified prisons working with particular disorders and care plans which 'outreach' into the community. Greater provision, he argues, must also be made for individuals fulfilling the criteria for Dangerous and Severe Personality Disorder. Special criticism is reserved for the widespread practice of seclusion"...seclusion was ...generally detrimental to mental health and ...was likely to make violent people more violent..." p.123
Another locus of special concern was the Close Supervision Centres, where some of the most violent and disruptive prisoners are held securely. These centres were often unable to meet the needs og the prisoners held within them. "Only two prisoners had no recorded mental disorder. Eight prisoners had already spent time in a special hospital. Two prisoners were waiting special hospital admission." p.124
The roles of healthcare professionals often appeared compromised by the surroundings and regimes within which they worked. The author recounts the words of a psychiatrist, 'Confinement in so dreadful a place was actually a form of torture which could drive people mad... '. p. 203. Whilst the struggle for mental health nurses to have their role recognised by security staff is highlighted, with therapeutic concerns losing out to security considerations. "Almost invariably the nurses - and appropriate treatment - lost." p.204
Although only one element of a failing system portrayed in Prisongate, the plight of mentally disordered prisoners is stark. Political inertia and a failure to reform are firmly identified as culpable factors. David Ramsbotham throws his weight behind current policy initiatives to bring prison mental healthcare into the NHS fold, and to increase rehabilitation opportunities. The author's concept of a 'healthy prison' continues to be a benchmark against which prisons are assessed.
Authoritative and impassioned, Prisongate locates a scandal stretching into the 21st century - the failure to give prisoners, especially those with mental health problems, humane care and treatment.
