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The forgotten population – making sure vulnerable persons in prison don’t slip through the net

As we adjust to the new restrictions on movement following the national lockdown, it is worth remembering that many vulnerable people remain in long term confinement and are reliant on the state for their care and well-being needs.

Hodge Jones & Allen recently represented the family of a very vulnerable young man, Mr B, who died by suicide whilst in prison. He had been diagnosed with Emotionally Unstable Personality Disorder (EUPD) and autism. His mental health needs were extremely complex, and he was prone to feeling low or depressed.

Although he had a loving and supportive family, he was particularly vulnerable. He had spent much of his youth isolated from his peer group as a result of his mental health difficulties, and received no formal support through local authorities. It became easy, then, for Mr B to feel welcomed by people who exploited his vulnerabilities for their own criminal gain. Mr B was manipulated to carry out an offence for which he was willing to die by suicide; a measure of how vulnerable he was. Whilst no other person was injured in the course of Mr B’s act, he himself suffered several injuries.

Recommendations were made by several psychologists that Mr B be placed in a mental health hospital, so that he could receive the appropriate support for his needs. The sentencing judge did not agree, and Mr B was sent to prison. Shortly after his arrival, after concerns that he was being bullied and the impact of this on his mental health, he was transferred to a mental health hospital where he stayed for a number of years. Mr B carried out a number of episodes of self-harm in this time.

Mr B was then returned to prison, where after a short stint of support, all input into his mental health stopped. Mr B was placed in a small specialist unit, whilst multi-disciplinary discussions took place about where within the prison estate he should be placed. He received some psychological support that related to his offending behaviour, but nothing to help him cope with the impact of returning to prison or to manage his EUPD. It was in this unit that he took his life.

Coroner’s inquest

At an inquest into Mr B’s death, admissions were made by the prison that he had been overlooked and not taken into the case load of a dedicated psychologist, as he should have been. Mr B continued to carry out episodes of self-harm in prison, including an incident in which he refused medication and then expressed suicidal thoughts. Prison staff had no training in managing prisoners with autism; a diagnosis which meant that Mr B’s way of communicating was different to other people’s and made his EUPD more acute. This put him at heightened risk of signs of self-harm or suicide not being recognised.

Multi-disciplinary meetings failed to recognise signs that Mr B was becoming increasingly anxious and depressed, instead focussed solely on the risk he posed to others. Meetings were also poorly attended by people who were familiar with Mr B, or who had responsibility for him on a day to day basis. The prison and mental health facilities operated separately from one another, with significant lapses of communication leaving Mr B without a cohesive plan for support.

He became stressed about the lack of psychological support or therapeutic input, and his low mood likely became a depressive episode that often precedes suicide. In the days immediately before his death, he refused medication. This was not flagged urgently to the psychiatrist, nor was he placed under constant observation. A few days later Mr B died by suicide.

It is a long established legal principle that people in prison are entitled to equivalent healthcare to people in the community. It is often forgotten, however, how vulnerable people can be upon entering the prison system. As in the case of Mr B, many have conditions that make it difficult to speak to their own needs. It is also no secret that the number of self -inflicted deaths in prisons is high, with no signs of abating. Recent statistics from the Ministry of Justice show that in the 12 months to June 2020, 76 of 294 deaths in prison were self-inflicted. Self- harm incidents had increased by 11% in the 12 months to March 2020 from the previous year.

‘Lessons have been learned’ but have they?

Although the prison and mental health services involved in Mr B’s death have taken steps to remedy the defects in their systems, it is unacceptable that such changes are introduced only in response to self-inflicted deaths. The hollow phrase ‘lessons have been learned’ has been used too many times to feel confident that further tragedies will be avoided.

The state owes a duty of care to protect people in prison, and protect their right to life. It is incumbent on the government to ensure that prisons are adequately resourced and staffed and have proper access to primary healthcare services to comply with their obligations under the Human Rights Act. The shocking statistics of suicide and self-harm, and the very sad case of Mr B, show that we are still some way from delivering a prison system that is safe for all.