Women who challenge - Nacro

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CHAPTER 3health problems have been identified during thecourse of criminal proceedings but are,nevertheless, sentenced to custody and othercases where an individual’s mental disturbancehas not become apparent prior to sentence andwill not have been taken into account indecisions about a custodial sentence. Thus, inaddition to any issues of gender bias, we havetwo major factors: the first, a major mismatchbetween the need for mental health services atvarying levels of security and the availability ofresources; and the second, a lack of informationabout individuals’ mental health problems;these obviously have repercussions in terms ofthe number of offenders with mental healthproblems who find their way into prison.Mental health care for womenprisonersAs we have seen, all the sources indicate thatthe prevalence of mental disturbance within theprison population is high, especially within thefemale prison population. So a particular issuefor women prisoners is what kind of care theyreceive in prison in terms of mental healthservices. We examine separately below the usein women’s prisons of prescribed medicationacting on the central nervous system. Here welook at the care available in more general terms.We consider the proposals for the futureprovision of health care for prisoners in Chapter4. At present, the bulk of prison health carecontinues to be provided by the Prison Servicewith some services contracted from NHS andindependent providers. Theoretically, healthcare in prisons is to be provided at anequivalent standard to that provided in the NHS,in accordance with health care standardsproduced by the Prison Service forimplementation by 1997 13 . In his 1997 ThematicReview 14 , the then Chief Inspector, Sir DavidRamsbotham, noted that the health carestandards, which apply to both men and women,contained very few specific references towomen, in spite of their very different needs inhealth terms. He recommended that a specificstandard for women’s health should be added tothe health care standards.This lack of care in relation to addressing thespecific needs of women was plainly revealed inan incident quoted by Devlin 15 , in which CaroleRigby of WISH showed conference delegates achart of a male body, which had been suppliedfor use in the preparation of medical reports onnew prisoners at Holloway. Such an ill-thoughtout act speaks volumes about the lack of astrategic approach to dealing with the needs ofwomen prisoners. Although some progress hadbeen made by the time of the Chief Inspector’sfollow-up report 16 , he still found it necessary torecommend the appointment of an OperationalHead of Women’s Health to have overallresponsibility for health care in women’sprisons.The overarching need for this becomes clearwhen the specific issue of mental health care isconsidered. In his 1997 Thematic Review, theChief Inspector recommended that the healthcare standards on mental health should beimplemented to improve services for prisonerswith a mental disorder. By the time of hisfollow-up report in 2001, this still had not beenachieved.The dearth of adequate mental health care inprisons is amply demonstrated by a re c e n ts u rvey by Reed and Ly n e 1 7 of 13 prisons within-patient beds, visited as part of HMInspectorate of Prisons’ programme ofinspection. Their findings showed that theprisons failed to meet the re q u i rements of thehealth care standards on mental health careand fell far short of standards in the NHS.S t a ffing levels in the health care centres wereinadequate both in terms of numbers and withre g a rd to staff training and qualifications. Thes u rvey revealed that, although the health cares t a n d a rds re q u i re that staff should re c e i v etraining in mental health care, most of thenursing staff in the prisons surveyed hadreceived no mental health training. Some of thedoctors with clinical responsibility for mentallyd i s o rd e red in-patients had some specialistpsychiatric training, but none was re g i s t e re d13 HM Prison Service (1999) Health care standards for prisons in Englandand Wales London: Prison Service14 HM Chief Inspector of Prisons (1997) op cit15 Devlin A (1998) op cit16 HM Chief Inspector of Prisons (2001) Follow-up to Women in PrisonLondon: Home Office17 Reed JL and Lyne M (2000) ‘Inpatient care of mentally ill people inprison: results of a year’s programme of semistructured inspections’British Medical Journal 320: 1031-34page 18
Women who challenge: women offenders and mental health issueson the relevant specialist register for thosewho are psychiatrically qualified.Reed and Lyne’s findings also showed that therewas a lack of therapeutic activity for patients,with most only spending 3.5 hours a dayunlocked as against the health care standardrequirement that those who are well enoughshould be unlocked for 12 hours a day, with atleast six hours of planned activity a day.Arrangements for the assessment of patients byvisiting psychiatrists, with a view to transfer tothe NHS or treatment in prison, were found towork reasonably well. However, prisonersassessed as suitable for transfer to hospitalwere waiting long periods before beds becameavailable.There is a dilemma about the level of mentalhealth care that should be provided in prisonsin the sense that we are saying that those whoare mentally disturbed should not be in prisonin the first place. The dismal picture revealed byReed and Lyne’s survey underlines the reasonswhy. Specialist services do not in our view havea place in prison and, indeed, as Reed and Lyneshow, it is in-patient care in prison that is themajor problem. It is, of course, whollyunacceptable that mentally disturbed offendersshould remain in prison for lengthy periodswithout specialist services. To match NHSstandards and ensure that prisoners are notdisadvantaged, prison health care should beable to provide much higher quality efficientand effective primary care, coupled withadequate arrangements for prompt referral andtransfer to secondary health care settings asrequired.Dr Reed has confirmed 18 that of the 13 prisonsincluded in the survey, two were women’sprisons and pointed out that, given the higherprevalence of mental disturbance found inwomen prisoners, it could be argued that thecriticisms made in the light of the survey applyeven more strongly in relation to the care ofwomen prisoners. With such poor standards ofcare in prison, there is no prospect of thosewith mental health problems coming out in abetter state than they went in. In fact, given theimpact of imprisonment itself, the reverse islikely, with all the implications that has forreoffending.The impact of imprisonment onwomen and their familiesThere is evidence to suggest that the experienceof imprisonment has a more detrimental effecton women than on men and a number ofreasons why this should be. First, the size of thefemale prison population itself has a bearing onthe matter. Since it is, compared with the maleprison population, so small, the female prisonestate is correspondingly small with only some18 female prison establishments currently (seeAppendix 1). This means that women prisoners,more often than men, are held far from theirhomes. To compound the problem, most ofthese establishments are in rural areas far fromurban centres, making it difficult and expensivefor families to visit and consequently makingthe maintenance of family ties even harder thanit is for most prisoners. The survey conductedat the end of 1996 for the Chief Inspector ofPrisons 19 found that for over 25% of womenprisoners, lack of contact with their childrenwas their greatest concern.The National Prison Survey 1991 20 found that47% of women prisoners had dependentchildren living with them prior to their beingimprisoned, compared to 32% of male prisoners.A survey conducted in 1994 21 , which definedmothers as women with children aged under 18and/or who were pregnant, found that 61% ofwomen prisoners were mothers. The ChiefInspector of Prisons’ survey found that twothirdsof women prisoners were mothers with anaverage of three children each and 55% had atleast one child under 16 years. More than onethirdof the mothers had one child or moreunder five years.However, whereas in the majority of cases thechildren of male prisoners are looked after bythe prisoner’s spouse or partner, this does notapply in the case of female prisoners. The 1991survey found that, in the case of 91% of themale prisoners with children, the children werebeing looked after by a current or formerspouse or partner. Only 7% said their childrenwere being looked after by other relatives and18 Personal communication with the author 15.08.0119 HM Chief Inspector of Prisons (1997) op cit20 Home Office (1992) The National Prison Survey 1991 London: HMSO21 Caddle D and Crisp D (1997) Mothers in Prison. Home Office ResearchFindings No. 38 London: Home Officepage 19
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Page 10 and 11: CHAPTER 2Table 1 Offenders found gu
Page 12 and 13: CHAPTER 2study by Dell et al (1993)
Page 14 and 15: CHAPTER 2indicated above, it is dif
Page 16 and 17: CHAPTER 2Table 4 Patients admitted
Page 18 and 19: CHAPTER 3‘typically male’ (viol
Page 22 and 23: CHAPTER 32% had a child with foster
Page 24 and 25: CHAPTER 3the frustrations of female
Page 26 and 27: CHAPTER 3women shown by the statist
Page 28 and 29: CHAPTER 3remand and 41% of female s
Page 30 and 31: CHAPTER 3seclusion was used primari
Page 32 and 33: CHAPTER 4What are Government strate
Page 34 and 35: CHAPTER 4schemes - uses drug worker
Page 36 and 37: CHAPTER 4• alternatives to custod
Page 38 and 39: CHAPTER 4In the case of women espec
Page 40 and 41: CHAPTER 4distributed throughout hea
Page 42 and 43: CHAPTER 5Where do we go from here?I
Page 44 and 45: CHAPTER 5Accessing a job and/or tra
Page 46 and 47: CHAPTER 5Evidence from the CARAT pr
Page 48 and 49: BibliographyAllen H (1987) Justice
Page 50 and 51: APPENDIX 2Service modelsForensic me
Page 52 and 53: APPENDIX 2Community-based servicesB
Page 54 and 55: APPENDIX 2The SamaritansThe Upper M

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