This site is intended for health professionals only

NICE pushes for justice and health system integration on mental health

Some 39% of offenders supervised by probation services and 90% of people residing in prison have some form of mental health problem

Criminal justice and healthcare services should collaborate to better manage mental health issues in adult offenders, the National Institute for Health and Care Excellence (NICE) has said.

In new draft guidelines published today, NICE recommends all staff working in the criminal justice system receive training to better recognise and respond to mental health problems.

This should include training on the prevalence of mental health issues in their working environment, the guidance says.

An estimated 39% of offenders supervised by probation services and 90% of people residing in prison have some form of mental health problem.

Furthermore, when entering prison, everyone thought to be at risk of a mental health problem should be referred to the prison’s mental health in-reach team immediately, before they are allocated to a cell, the guidance adds.

Nearly 199 people committed suicide in prison between 2012 and 2014 and 70% of these cases involved a person who was identified as having a mental health problem.

Meanwhile, close to 26,000 incidents of self-harm were reported by prisons in England and Wales during 2014 – an increase of 11% compared with 2013.

More than a third of the 2014 incidents occurred within the first month of the person arriving in prison, while one in 10 happened within the first week.

Professor Mark Baker, director of the centre for guidelines at NICE, said: “Mental health problems such as schizophrenia, psychosis, anxiety and depression are more common in people who are in prison than they are in the general population.

“We need to ensure these people are properly supported, particularly if they are to be released back into the community.

“Delivering care in such a restrictive environment is difficult, but it cannot become a barrier or excuse. People in prison must receive the same level of care as offered to those outside.”

Ian Hulatt, Royal College of Nursing professional lead for mental health nursing, said nursing staff are “perfectly placed” to form the bridge between criminal justice services and the NHS.

However, he said more nurses and further investment are required to effect this change.

He said: “It is clear from the rising number of mental health problems in the criminal justice system that these conditions are not being managed effectively.

“Mental health is a unique area of health care and it’s critical that all staff can access specific training to ensure those with mental health problems receive the care they need.

“These problems aren’t left behind in prison; criminal justice services need to work in collaboration with the NHS to make sure no one falls through the cracks. Patients need one line of care that transcends their contact with the criminal justice system.”

When finalised, the NICE guideline will apply to anyone who comes into contact with the English criminal justice system, including time spent serving a community or prison sentence, and any probationary periods.

Currently, the NHS is not responsible for healthcare provision (including mental healthcare) for people in police and court custody.