Late last month, a Prison Officers’ Association official claimed that prison had become so comfortable that prisoners were no longer trying to escape.

Glyn Travis told the BBC that even when drug dealers broke into a prison nobody attempted to escape because “life is so cushy within the prison system”.

The idea that prison is becoming more comfortable has been a fixture of popular culture for many decades. Newspapers revel in tales of prisoners enjoying the perks of modern life such as televisions and board games. Politicians gain easy approval from the media by calling for prison to get harder and harsher.

However, the reality of prison life is quite different. The prison environment, coupled with the complex social and health problems prisoners bring with them, makes providing healthcare that can actually make a difference a huge challenge for the NHS.

Harsh environment

Prisons may not all be the dark Victorian buildings with stark regimes and harsh discipline they once were. But they still incarcerate people, deprive them of responsibility for their own lives and put them at high risk of bullying and abuse. They can be chaotic and noisy places, where frequent lock-downs lead to prisoners spending hours in their cells, disrupting any routine they develop through work or education.

Prison can be particularly damaging for women. The average woman prisoner is held some 60 miles from home. Many are primary carers for children and live with constant anxiety about what will happen to them. Some 18,000 children are separated from their mothers every year while they spend time in prison, sometimes permanently.

A prisoner’s life is characterised by uncertainty, insecurity and anxiety. Many get transferred between establishments several times during a spell inside. Others face fears about what will happen to them on release: will they go back to the lives of chaos and exclusion most of them came from? Most prisoners get little help to prepare to change their lives when they get out.

It is not surprising, then, that rates of mental distress in prison are so high. Nine out of 10 prisoners have some kind of mental health condition, including substance use and personality disorders. Over half have depression or anxiety and about one in 10 has a severe mental health problem.

Support system

The challenge for the NHS is to find a way of supporting prisoners with mental health problems in an environment that makes that extremely difficult. There is now an inreach team for people with severe and enduring mental health problems in each prison in England. Inreach is the first systematic attempt to provide mental healthcare to prisoners across the country. Yet the average team has only four staff members, compared with the 11 that would be needed to support all the prisoners they should be helping.

For prisoners whose mental health problems are less severe (in medical terms) but whose lives are chaotic and who have many other health and social problems, there remains little or no service. Primary mental healthcare barely exists in many English prisons. Until it does, the notion of equivalence of care in prisons will remain an aspiration, not a reality.

In addition to caring for people who go to prison, the NHS has a critical role, in partnership with other agencies, in keeping others out. Opportunities for diversion from custody need to be available at every stage of a person’s journey through the criminal justice system. From a young person’s early contact with the police through to sentencing in court, the NHS needs to be there to offer alternatives to people with mental health problems to prevent them from going deeper into life in the penal system.

Too often, we hear that opportunities to divert people from custody are missed because assessments cannot be provided on time or community services are not available to support those who are in trouble with the police. People with complex problems are especially likely to miss out on community services, despite having the greatest need for support.

That prison officers are frustrated by the growing number of prisoners, many of whom they do not feel qualified to manage, is not surprising. Claiming that their lives are too comfortable is clearly wide of the mark.

But the Prison Officers’ Association’s comments do highlight that all public services, not least the NHS, need to get into gear to offer a better standard of support to some of society’s most disadvantaged people.