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My Lords, we are all indebted to the noble Lord, Lord Ramsbotham, for initiating the debate and for his powerful opening contribution. In a recent article in the New Statesman, Rory Stewart, recently a Minister with responsibility for prisons, said that we should rediscover a sense of anger and shame at the state of our prisons, which should, in turn, be the spur to action and reform. He was right on both counts. We should be angry—a lot of that has been demonstrated today in the House—and we should be committed to reforming the system.
Leaving aside for the moment the unacceptable conditions in too many prisons, we have designed a system which could hardly do more to prevent rehabilitation. Prisoners often serve their sentences far away from family and friends who could provide the support they need. Many informed observers feel that, when prisoners receive education, it does little to improve their employment prospects or reduce reoffending. They are often discharged back into the community with inadequate continuing support, or indeed basic accommodation. The constant fear of politicians seems to be not whether they will be held accountable for those failings, but that they will be attacked if they address them for being soft on crime.
Putting all that aside, today I want to concentrate on just one aspect of the problem: mental health in prisons. In doing so, I draw on the report which the National Audit Office produced in 2017. I should declare that I am chairman of the National Audit Office. That report concluded that the Government did not even know how many people in prison had a mental illness, although such estimates as there were suggested that somewhere between 37%—the estimate of Her Majesty’s inspector—and 90% were mentally unwell, with only 10% receiving treatment. The NAO report also concluded that the Government did not know how much they were spending on mental health in prisons, whether they were achieving their objectives or whether they were delivering value for money.
What was clear, as other noble Lords have mentioned, was that self-inflicted deaths and self-harm were rising at an alarming rate, such that the number of self-harm incidents had risen in the four years before the report was published by 73% to 41,000 and that self-inflicted deaths had doubled to 120. Speaking when the report was published, the then Comptroller and Auditor-General, not known for overstating his case, said:
“Improving the mental health of those in prison will require a step change in effort and resource”.
The question is whether we have seen that step change since 2017. There have certainly been attempts to address the issue. Staff numbers have increased by 3,200 since March 2017. That is really important, because fewer staff means that prisoners spend more time in their cells and are less likely to access mental health services and to have personal, one-to-one support. However, of course, that increase follows a reduction of 26% in the total workforce in the previous years.
In addition, improvements have been made to mental health training for prison staff. That is to be welcomed, because in the three years to 2016, 40% of prisons did not provide any mental health refresher training. Data-sharing arrangements have been introduced and will hopefully ensure that when prisoners are screened on arrival, staff will have access to previous GP records, without which they will not even know whether a prisoner has been diagnosed with a previous mental illness. That has not been the case hitherto. There is now in place a partnership agreement between the Prison Service, NHS England and Public Health England that focuses on mental health.
It is far too early to say whether any of these good intentions will be delivered and will deliver improvements. As other noble Lords have said, the worry is that much else is threatening to make the situation even worse, not least because of the increased numbers of prisoners now promised by the current Administration and because although self-inflicted deaths have reduced from 120 to 86 last year, cases of self-harm have increased from that record 41,000 to a staggering 58,000. The number of attacks on prison staff has tripled since 2010, and prisoner-on-prisoner assaults have doubled too.
This really cannot be allowed to continue. Yes, we need to see a strategy, but it needs to be followed by action rather than promises. I suggest that the Government publish a comprehensive strategy with measurable targets to improve mental health in prisons, and that it is then independently monitored every year. Frankly, the failure to take seriously the issue of mental health in prisons should shame us all.