Published: 17/11/2005 Volume 115 No. 5982 Page 22

Dr Kimmett Edgar, head of research, Prison Reform Trust

The number of prisoners whose mental illness is so severe that they need acute psychiatric treatment is estimated at 3,000-3,700, but far too often prisons are serving as an impoverished back-up mental health service.

Prisons are being used to warehouse people whose mental health cannot be adequately treated in a prison setting. This is a consequence of a long-standing underinvestment in community mental health services, combined with an enduring failure to identify serious mental health problems at an early stage in the criminal justice process.

Mental health in-reach workers have been established in over 100 prisons, and primary care trusts have expanded roles in providing mental healthcare in prisons.

Increasingly, prison healthcare aspires to apply the principle of equivalence - that people in prison should have access to an equal standard of healthcare as the community.

However, the gap between prison and community health service is, if anything, widening.

The vast majority of prisoners, who do not have severe and acute mental illness, nonetheless suffer from anxiety, depression, or other mental health problems.

As long as the mental health in-reach teams are preoccupied with the needs of the severely mentally ill, these less urgent problems will not be addressed.

The mental health needs of specific groups are particularly acute. These include mentally ill offenders, who also have learning disabilities, or rely on sign language, are elderly, or hold a foreign nationality.

These offenders may face exclusion, discrimination, misdiagnosis and neglect.

Black and minority ethnic people also face difficulties in a prison system not geared to respond to their needs.

Our new report (due for publication 23 November), Troubled Inside: responding to the mental health needs of men in prison, proposes a framework for future developments needed to redress the failures of prison mental healthcare.

See feature, pages 28-30