Melanie Jordan ~ Care and custody for those with mental health needs in prison

Care and Custody

Recently, the Prison Reform Trust published an article entitled: Ministers outline steps to keeping ‘care not custody’ promise ( This article commences:

‘The Health Secretary, Andrew Lansley, and the Justice Minister, Crispin Blunt, have outlined the progress made towards diverting people with mental health needs from the justice system into treatment and care, at a Westminster reception on April 23rd – hosted jointly by the Prison Reform Trust and the National Federation of Women’s Institutes on behalf of the Care not Custody coalition’.

Accordingly, Prison Reform Trust director, Juliet Lyon, argues ‘a bleak cell in a dark, noisy prison is the worst place for someone with mental health needs’. Furthermore, Lord Bradley highlights ‘while public protection remains the priority, there is a growing consensus that prison may not always be an appropriate environment for those with severe mental illness and that custody can exacerbate mental ill health, heighten vulnerability and increase the risk of self-harm and suicide’ (DH 2009:7)(

Thus, discussions regarding the prison environment, the care of offenders, and the nature of custody have contemporary worth.

This care not custody debate is also currently discussed in the National Newspaper for Prisoners InsideTime (

In January of this year a BBC Radio 4 three-part series, The Bishop & The Prisoner, from the Bishop Rt Rev. James Jones aired prisoners’ voices and narratives verbatim on radio ( Bishop Jones debates the purpose of imprisonment and the transformation from offender to useful citizen. Overall, the series focuses on reducing reoffending via the central argument that containment alone is neither effective nor sufficient. Here, the care versus custody debate also arises, yet is extended to the whole prisoner population.

This discussion could be further extended to include prison staff. Tait (2008) suggests that a reassessment of the role of the prison officer is required ( For example, the idea of prison officers as mere ‘turnkeys’ (p. 3) could be supplanted. Instead, ‘the care of and contact with the inmates in his or her charge’ (p. 3, emphasis added) are important. Empathetic care and contact are arguably crucial in the prison environment. Poignantly, Tait (2008) suggests that developing caring inmate–officer relationships often helps inmates manage their period of imprisonment, increases prison officer job satisfaction, and develops prison officer career aspirations. Such relations require prison officers to listen, understand, and respond to inmates’ needs. Tait’s (2008) caring interactions are ‘founded on relationships characterised by respect, fairness and sociability’ (p. 5). Beneficial ramifications for both prisoners and staff appear possible here. For those in prison with mental health needs, care alongside custody is arguably necessary. Factors associated with imprisonment itself appear to predispose prisoners to mental health problems and these mental health determinants in the prison setting require further research.

Regarding a whole prison approach to mental healthcare, the WHO’s healthy prison concept is a recognition that the health of prisoners is not the responsibility of healthcare clinicians alone. Rather, it is also dependent on the ethos and regime created in the penal setting. The WHO’s Health in Prisons Project acknowledges that prisoners’ individual healthcare needs are essential; however, the promotion of a whole prison approach to health is considered vital for apt development of healthy prisons that provide appropriate care for those in custody. Importantly, Ramluggun et al. (2010) report ‘the conflation of knowledge and experience of staff working in prison places them in a favourable position to contribute to the current reform of offender health’ (p. 70) ( Certainly, the experiential knowledge of wing staff is remarkably valuable. Indeed, the involvement of HM Prison Service staff in the development of both prison mental health policy/practice and HM Prison Service’s overall approach to prison mental health is to be supported.


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