In this guest blog, Joy Hibbins from Suicide Crisis explains that much more is needed to help people with mental illness avoid ending up in prison – especially preventative work by local mental health services.

The number of prisoners who die by suicide in England and Wales has reached record levels. The Ministry of Justice revealed that 119 prisoners died by suicide last year, the highest number since records began in 1978. In addition, the government’s updated strategy on preventing suicide, published in January, states that 9 out of 10 people in prison have a mental health or substance misuse problem.    

We need to look at why so many people with a mental illness are going to prison, and what we can do to prevent it from happening. I run a Suicide Crisis Centre in Gloucestershire and a small percentage of our clients have received prison sentences in the past year. In every case, if they had been able to receive the right mental health care in the community, I believe they would not have gone on to commit the crimes that resulted in prison sentences.

Calum* is just one example. When he came to his first appointment at our Suicide Crisis Centre, he was describing delusions. He told me that he believed that God was talking to him via the television. This was the start of my 18-month contact with Calum as he and I tried to access psychiatric help for him. The response was always the same: he was using substances and told that he could only be seen by addiction services. Once he was no longer using substances, he would be able to access psychiatric input.  

I repeatedly contacted mental health services to express my concerns about the delusions he was describing. In late summer 2016, Calum phoned to ask if I would accompany him to A&E. He was desperate to be admitted to psychiatric hospital, he told me. He was having suicidal thoughts and feeling very unwell. I met him there an hour later and he asked me if I would explain his symptoms to the hospital staff. He said it was difficult for him to do so. I already knew from having spoken to a clinician within addiction services that day that he had not disclosed that he felt he had the devil living inside him, nor that he believed that the devil had left his body in order to gather other evil spirits who also inhabited his body now. 

Although the triage nurse listened to Calum, she said that she had no time to hear me as well, so the information about his delusions was never recorded that day. Calum tired of waiting to see a doctor, walked out of A&E and I called the police with concerns about his safety. He was taken by the police under a section 136 to a psychiatric unit for assessment but was discharged within hours, as soon as the assessment was over. This was a significant missed opportunity to intervene and help Calum. 

I do not know if Calum disclosed information about his delusional thoughts during the assessment. If he did, the psychiatric team may have put it down to the effects of substances rather than mental illness.

In the weeks that followed Calum disappeared off the radar. I heard he was now homeless. Every time I saw a person sitting on the pavement asking for money, I hoped it might be Calum so that we could try to get help for him. Eventually a member of his family contacted me to tell me he had gone to see a family friend and collapsed at the friend’s home. He had made a suicide attempt a few hours earlier. 

The next day his mum contacted me. He was in police custody, having committed a burglary.  

Calum is now in prison. Significantly, he has been diagnosed with schizophrenia by prison psychiatrists, a diagnosis totally missed by clinicians in the community even though he had a number of psychiatric assessments and despite my flagging up his apparent delusional thoughts to them on several occasions. 

If he had been able to access psychiatric input in the community, I think it unlikely that he would have committed the offence that led to his imprisonment. He had attempted suicide in the 24 hours before the offence and was clearly in mental health crisis and emotional turmoil.

He had asked for help so many times. I had done the same on his behalf.

In almost every case where one of our clients has been imprisoned, I have seen a similar pattern. They describe having experienced something extremely traumatic in their lives, and having started to use alcohol or substances to try to block out flashbacks and intrusive memories of the event. They had often been exposed to repeated trauma over a prolonged period, for example within military combat, domestic violence, or childhood abuse. The trauma is almost always related to having experienced or witnessed violence. In some cases, they had witnessed a violent death. In every case, they had had no or insufficient treatment to address the trauma. They all had a dual diagnosis – often including post-traumatic stress disorder or personality disorder. 

If they could have accessed psychological input and psychiatric treatment for the effects of trauma, and for their mental health conditions, it is likely that they would be living very different lives today, outside the walls of a prison. We need to do much more at an early stage to ensure they receive the mental health care they need.

 

Joy Hibbins runs a Suicide Crisis Centre in Gloucestershire. For information click here.

*Not his real name.