GPC lead on prison medical services Dr Mark Sanford-Wood said he believed the numbers of people who are already significantly mentally ill being sent to prison was on the rise and was putting additional pressure on the system.
The HMP Exeter GP told GPonline that prison doctors were having to care for more patients with serious mental health problems because it had become more difficult to access specialist psychiatric support services.
Dr Sanford-Wood’s comments came as the Ministry of Justice last week revealed there had been a 32% increase in suicides in prisons in England and Wales, with a record 119 people taking their own lives last year. Rates of self harm and violence against prisoners and staff also increased.
The government has agreed to fund an extra 2,500 prison officers to ease staff shortages in England and Wales after the Prison Officers Association warned of ‘bloodbaths’ because of declining staff levels and rising prisoner numbers.
The Prison Ombudsman last week criticised the criminal justice system after a man with serious mental health problems killed himself in HMP Chelmsford despite having been recommended by a psychiatrist for transfer to a secure hospital. The ombudsman said Dean Saunders should have been in a hospital and had been ‘let down’ by prison and health services. The prison had ‘insufficient’ psychiatric cover to meet the population’s needs, it said.
Dr Sanford-Wood, speaking before the latest suicide figures were published, said the increase in self-inflicted deaths was caused partly by resource pressures in prisons. ‘When you have a system under so much resource strain, strain on finances, strain on staffing, then inevitably it is going to make things more difficult, and you may get more suicides,' he said.
In the last year, the GP said, ‘the courts appear to be sending us increasing numbers of people who are already quite significantly mentally ill’.
‘We we are seeing increasing numbers coming through reception direct from court where the crime they are accused of appears to be the result of mental illness, rather than anything else. There does seem to be an increasing number of people who clinically, you would question whether they are in the right system.’
If more patients who should be treated in secure psychiatric settings are being sent to jail, Dr Sanford-Wood said, ‘inevitably, the prison system is going to be more challenged in providing them the care they need’.
The Devon GP leader said that increasing difficulty in accessing specialist psychiatric support services in hospitals also meant prison GPs were having to care for more patients with more serious mental health conditions.
‘Most GPs would recognise the amount of availability and support of specialist psychiatric services in hospitals can be quite patchy. That may be a funding issue, or it may be shortages in the psychiatric workforce,' he said.
‘There has been an increase in the number of psychiatric cases we are having to deal with ourselves. More challenging access to specialist psychiatric input for cases. GPs, in my experience, are now picking up more complex cases that previously probably would have seen a consultant psychiatrist.’
He added: ‘I'm not not saying those cases are being unsafely dealt with, but there is certainly a more challenging environment. Because the people we are dealing with are inevitably more unwell.’
The doctors’ leader was speaking on the eve of last Friday’s BMA conference for prison GPs to exchange ideas and experience of the fragmented service.