Mental health nurses working in prisons are facing a series of problems including insufficient training to help people who are considering killing themselves, and too little experience of working in acute settings, according to a new charity report on suicide prevention in prisons.
The report, by the Centre for Mental Health and the Howard League for Penal Reform, looked at challenges that needed to be addressed to put a stop to increasing suicide rates among prisoners.
“It was really surprising to me that nurses don’t get properly trained in suicidal ideation”
The number of suicides in prisons in England and Wales has nearly doubled in the past five years, from 57 in 2011 to 119 in 2016, said the report. In particular, there was an “unprecedented” 34% rise in suicides from 2015 to 2016.
At the same time, self-injury among prisoners has risen by around a quarter in the past year, with 36,440 incidents in the 12 months up to June 2016.
The charities spoke to staff working in eight prisons and six healthcare providers, including NHS trusts, to find out what could be done to improve the situation.
Healthcare professionals reported that training was less able to prepare staff for prison working now, with one saying there was a “significant problem in the training of mental health nurses” because education had shifted to being more community-based.
“Staff were concerned… unless somebody had an ‘obvious’ mental health or substance misuse need, vulnerabilities were vastly undetected”
Centre for Mental Health report
“They’re not seeing people in an acute environment like a hospital which is more akin to a prison environment,” said one clinical reviewer.
Meanwhile, a clinical psychologist said it “was really surprising to me that nurses don’t get properly trained in suicidal ideation”.
In addition to training issues, the report found nurse assessments were being made difficult due to crucial records that contained a person’s risk of self-harm “rarely” being transferred from courts to prisons.
The “huge time constraints” on nurses to complete assessments when prisoners arrived also often meant they had to use a “template driven” system instead of their clinical judgement, said the report, called Preventing prison suicide: Staff perspectives.
“Staff were concerned that it meant that unless somebody had an ‘obvious’ mental health or substance misuse need, vulnerabilities were vastly undetected,” it said.
One interviewee, a clinical reviewer, noted these assessments were sometimes carried out by healthcare assistants, but with seemingly no professional judgement behind the decision.
“The assessment is done by luck of the draw… I’ve seen it done by healthcare assistants to incredibly experienced nurses with no rhyme or reason… more of a taxi rank principle – ‘first up, I’ll take you’…,” they said.
Other problems identified included staff shortages and poor mental health in the prison workforce itself, as well as a need for improved mental health training for all staff, including officers. Varying thresholds for mental health service referrals were also noted.
“We need to bring about a culture change in prisons…that understands the traumas both prisoners and staff too often live with”
The charities said a series of improvement were required. Continuous opportunities to upskill mental health practitioners, such as to develop clinical questioning skills relating to suicidal thoughts, were needed.
“Robust” initial assessments of prisoners must also be a priority due to the increased risk of suicide during early custody, said the report.
Centre for Mental Health chief executive Sarah Hughes said: “Every loss of life in prison is a tragedy for everyone involved. Our research shows that we need a new approach to suicide prevention in prisons by putting safety and wellbeing at the heart of our criminal justice system.”
“We need to bring about a culture change in prisons that puts safety top of the agenda, that understands the traumas both prisoners and staff too often live with, and that means people get the right help when they need it,” she said.
“Making the changes set out in our report will save lives and enhance the rehabilitation of all prisoners,” she added.