Prison Mental Health

Using professionals and former prisoners to present and talk about their personal mental health challenges, to raise awareness about mental health and encourage the audience that it's okay to talk.

What you will find on this page

Understanding mental health in prisons

Mental Health Terminology

Common symptoms of mental ill-health

Understanding causes of mental health problems among prisoners

Understanding mental health in prisons

Dear Reader

Over 10.35 million people are in prison globally, and prisoners have a disproportionately high

rate of mental ill-health; research suggests that around one in seven prisoners has a serious mental health condition.

The figures over the past five years relating to deaths, self harm and violence within the UK prison system is greatly concerning yet still on the increase. Its widely evidenced prisoners are more likely to suffer mental health problems than those in the community and note between up to 90% of prisoners are thought to have mental health issues.

According to The Mental Health Foundation, good mental health is characterised by a person’s ability to fulfil a number of key functions and activities, including:

the ability to learn
the ability to feel, express and manage a range of positive and negative emotions
the ability to form and maintain good relationships with others
the ability to cope with and manage change and uncertainty.2

Whilst those with poor mental health may find life difficult to cope with and may find it hard to constructively interact with others.

It can be particularly difficult for those with poor mental health to participate in, or contribute to, daily prison life. Poor mental health can also reduce engagement in rehabilitation activities and it is therefore associated with reoffending.

Mental health Terminology

The WHO constitution states: mental health as ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’.

Mental ill-health

A mental illness is a disorder diagnosed by a medical professional that significantly interferes with an individual’s cognitive, emotional or social abilities. There are different types of mental illness and they occur with varying degrees of severity. Examples include mood disorders (such as depression, anxiety and bipolar disorder), psychotic disorders (such as schizophrenia), eating disorders and personality disorders.

Mental health problems

A mental health problem also interferes with a person’s cognitive, emotional or social abilities, but may not meet the criteria for a diagnosed mental illness. Mental health problems often occur as a result of life stressors, and are usually less severe and of shorter duration than mental illnesses. These often resolve with time or when the individual’s situation changes. However, if mental health problems persist or increase in severity, they may develop into a mental illness.

Cultural perspectives on mental health

Attitudes toward mental illness may vary amongst individuals, families, ethnicities, cultures, and countries. Cultural and religious teachings often influence beliefs about the origins and nature of mental illness, and shape attitudes towards the mentally ill. In addition to influencing whether mentally ill individuals experience social stigma, beliefs about mental illness can affect patients’ readiness and willingness to seek and adhere to treatment.

Common symptoms of mental ill-health

There are many types of different mental health disorders, with a wide range of symptoms that may change throughout the life course, with some people experiencing more than one mental health problem. The coexistence of two or more disorders is called co-occurring disorders or comorbidity.

Signs of mental ill-health listed below can also be common responses to imprisonment. Many prisoners will display such signs during their imprisonment, but this does not mean they have a specific mental health condition or that they require a medical or clinical response. However, families and loved ones supporting a prisoner should be aware that low-level symptoms of mental ill-health may develop into more serious, longer-term conditions.

Confused thinking and speech
Experiencing extreme moods
Sudden mood/behaviour changes
Erratic behaviour
Not looking after oneself
Being quiet, sad or withdrawn
Disruptive, impulsive or aggressive behaviour
Drug and alcohol use
Not being able to recognise and communicate
problems and needs

Disconnectedness
Bound to regime/rigidity
Irritability
Apathy
Fear and anxiety
Inability to copy with daily tasks
Difficulty concentrating
Sleep problems
Eating problems
Demanding of staff time and attention
Suicidal thoughts and self-harm

Understanding causes of mental health problems among prisoners

Over the past decades reports on UK prisons have provided yearly statistics in areas of prison life that highlight challenges for prisoners and prison staff. Such challenges are recognised as leading risk factors that impact the health and the mental health of those residing and working within the prison setting.

Imported' (pre-prison) factors

Prisoners with mental health problems will often also have several other vulnerabilities, including substance dependencies, poor life skills, histories of trauma, unstable housing and limited experience of employment.

Imported factors describe what aspects prisoners bring with them into prison such as pre existing trauma, mental health issues, gang violence, homelessness or drug and alcohol misuse; these aspects influence their behaviour in prison.

A 2018 study to explore the relationship between 'imported factors and prisoner mental health status, revealed from just two UK prisons the prevalence of mental health difficulties was high, with 40.3% of prisoners reaching the clinical case threshold for depression and anxiety. Difficult childhoods contribute to both criminality and mental ill-health. It is also common for people with mental health disorders to have received no treatment before arriving at prison.

Imported' (pre-prison) factors

“Men tend to keep so much bottled up inside. This includes all the traumas and heart-breaking moments. Eventually there has to be a release. And too often that is in an explosive way” The social activist, Ron Blake

The toxic masculinity that tends to pervade the male prison system encourages individuals to disguise their true emotional state for fear of being seen as weak and vulnerable. Sadly, the mentality that ‘big boys don’t cry’ brings particular characteristics to the fore including:

being headstrong
displaying impulsive behaviour
exhibiting a ‘take it on the chin’ attitude

Individuals often choose to adopt these characteristics in order to fit in and avoid drawing attention to themselves. Men are more likely than women to underutilize mental health services or be open to admit they have a mental health problem. However, by dismissing or deliberately suppressing emotions, the likelihood of suffering mental health issues is considerably increased.

Safety within the prison environment

Safety in prisons has rapidly deteriorated during the last decade. Deaths and assaults both remain close to record highs.

Self harm incidents are now at a record high and a real concern up from 23,952 in 2014 to 61,153 in the year 2020.8 In the year to September 2020, 282 people died in prison a quarter of this number (70) were recorded as self inflicted8. A decrease of 23% from 91 self inflicted deaths in the previous 12 months and over the past five years 23% of all self inflicted deaths occurred in the first 30 days of arrival in prison over half (51%) of these deaths were in the first week.

Violence

Prisoner on prisoner assaults.

Assaults are on the decrease. There were 27,742 assault incidents in the 12 months to June

2020, down 19% from the 12 months to June 2019. In the most recent quarter, assaults decreased by 37% to 4,550 incidents10. Although figures suggest declines in violence the number of assaults show prison to still be a dangerous and scary place to reside.

Prisoner on staff assaults

Again on the decrease, There were 9,056 assaults on staff in the 12 months to June 2020,

down 13% from the previous 12 months. In the latest quarter the number of assaults on staff decreased by 17% to 1,896 incidents but over the decade the figures show a huge increase in officers being assaulted.

Serious assaults

Serious assaults are recorded as Inflicting grievous bodily harm,(GBH), a victim of GBH is left with serious injuries, which can sometimes be life-changing. They could also be left with long-term injuries or scarring.

Prisoner on prisoner- 2,370 recorded in the 12 months to June 2020

Prisoner on staff- 849 serious assaults recorded

Purposeful activity

Purposeful activity includes education, work and other activities to aid rehabilitation whilst in prison.

Just over a third of prisons (36%) received a positive rating from inspectors in 2019–20 for purposeful activity work

Covid-19

The Covid-19 pandemic has created major disruption in the normal running of the prison system. Severely impeding the courts’ capacity to process cases and administer justice. Inspectors found all people in prison were confined to their cell for 23 hours or longer a day following the introduction of regime restrictions

Drugs and alcohol

Drugs seem to be a growing problem for the declines in prisoner mental health. The government has planned to install x-ray body scanners in the prisons known to have the biggest drug problems, which will surely help to reduce the growing problem as the number of drug seizures continues to rise. There were 21,575 incidents where drugs were found in 2020, over twice the number just three years ago. There were 117 deaths in prison between June 2013 and September 2018, where the person was known, or strongly suspected, to have used or possessed psychoactive substances before their death13. Almost 53,000 people in prison received drug and alcohol treatment during 2018–19. Over half (52%)were for support with opiate use14.