In September of this year, the parliamentary Justice Committee ‘Mental health in prison’ report found that a disjointed and incoherent approach to care has left prisoners suffering from undiagnosed mental health conditions and unable to access services.

The Committee estimated that roughly 10% of the prison population are currently receiving treatment for their mental illness. However, as many as 70% are thought to require professional help. This is not only a problem in terms of not meeting prisoners’ immediate psychological needs, but it can also have long-lasting adverse social consequences as, unsurprisingly, studies suggest ex-prisoners with untreated mental health conditions are more likely to re-offend.

Consequently, if not only from a hard-headed, unemotional, rational perspective, improving prisoner access to mental health treatment is a crucial component in reducing crime – particularly violent crime.

Predicatively, therefore, acting on the link between timely access to treatment and criminal rehabilitation has been rising up in the political agenda, demonstrated earlier this year by NHS England guidelines and the Government who in their white paper reform of the Mental Health Act committed to introducing a 28-day statutory time limit from assessment for transfers from prison to mental health facilities.

On the other hand, as the Justice Committee’s report detailed, a potential political obstacle to providing better access to treatment is ‘some sections of the public fear that prisoners whose mental health needs require treatment get a ‘soft option’’. While the Committee report added these ‘fears’ are not backed up evidence, the consideration speaks volumes to the two, sometimes contradictory, purposes of prisons – punishment and rehabilitation.

Gate sectioning: rehabilitation or punishment?

Currently, despite NHS targets and the prospective Mental Health Act reforms, the majority of acutely mentally unwell prisoners are not able to be transferred to a secure hospital setting for treatment. The reason for this, the Justice Committee heard from prison services, is that there is a shortage of secure mental health beds. However, due to this shortage, mentally unwell prisoners are often kept in segregation due to the risk they pose to others and are held, sometimes for many months, without medical treatment.

Another implication is the practice known as ‘gate sectioning’, where newly released ex-prisoners are stopped at the gates and are subsequently held for treatment under the Mental Health Act. This Juliet Lyon, chair of the Independent Advisory Panel on Deaths in Custody, told the Justice Committee in October, mainly affects women and is “occurring more readily”.

Ms Lyon said: “There have been a number of incidents, particularly in relation to women, where they thought they were leaving—they were literally at the gate—and they have to be through that gate before it can happen, they are [then] sectioned, taken away and put in secure care.”

“That simply cannot be right. It is a very cruel thing to do, and it indicates that prison has been allowed to hold on to someone whose behaviour and health have been very poor, and they have been very damaged by it. Gate sectioning is occurring more readily.”

According to an analysis published by the Royal College of Psychiatrists during 2020 at the prison HMP Thameside, there were sixty-one secure transfers to mental health hospitals and eight instances of gate sectioning. The reason given by prison officials for the practice is that a rise in short prison sentences is putting services under strain, leading to these last-minute mental health interventions.

Although campaigners for prison reform have argued that gate section represents a lack of care, an overemphasis on punishment rather than rehabilitation, and exemplifies a continuing policy disparity between physical and mental health. The governor of Low Newton prison highlighted this point, commenting: “We wouldn’t ask someone with a broken leg to hobble around waiting until release for treatment.”

Organisations like the Prison Reform Trust have reasoned that rehabilitation, including addressing any mental health condition, should occur whilst they are serving their sentence. Peter Dawson, director of the Prison Reform Trust, commented in response to a recent prison inspectorate report on mental health:

“The Government repeatedly celebrates the fact that it expects to send more people to custody and is spending £4bn to build new prisons as a result. But this hugely important joint report from six different inspectorates shows that many of the people who will fill those cells will be mentally ill. Twelve years on from being given a road map to solve these problems, the Government's progress is exposed as inadequate. Austerity provides no excuse. Much of what the inspectors describe stems from a failure to work efficiently across departments rather than a lack of resources. But where resources are an issue, Governments still choose to spend on punishment rather than treatment.”