Shine A Light

He’d take his medicine if only they’d bring it: mental health care in a British prison

Prison is failing those incarcerated who suffer from mental health problems. This personal story is one harrowing example.

Lydia Smith
3 November 2011

'Lydia Smith' and 'David' are pseudonyms.

"My blood was boiling and the adrenaline sky-high. I had to wait over an hour before my teatime meds were brought.  At 4pm I know the meds are due. I know this both mentally and physically.  4.15 I made enquiries asking where they were. I was told that the nurses were not in the office so must be on their way.  4.30 still no sign of them so I begin pacing in my cell, cursing them, getting all worked up and anxious.  5pm I get unlocked for my tea and I begin my rant, this carries on all the way down to the serving hatch where I state yet again how important the medication is. I tell whoever is there that I don't enjoy feeling like this, knowing that one wrong word or gesture would tip me over the edge. I am sweating and shaking with the adrenaline and barely keeping control.  Go back to my cell, throw my food away and wait.  5.15 my door is unlocked and the nurses are there all happy and totally oblivious to how I am feeling. It was a little scary knowing what was hiding just below the surface." 

That is from a letter my partner David sent to me last month.

David is in prison and his medication is the antipsychotic drug Quetiapine. It is due every day at 8am, 11am, 4pm, and 7pm.  But 8am often becomes 10.30; the 11am can be so late that it is lost because of the lunchtime lock-up from 12 to 2;  4pm is frequently so late that it becomes the 7pm dose;  and the 7pm  may either be the late 4pm dose or it may not arrive till 8.30.  Sometimes he gets only half the dose (one pill instead of two) and sometimes they forget the pill he needs to mitigate the side-effects. 

When the nurses don't come, David asks the officers where his medication is and the officers ring the health unit. The nurses say no, nothing for you, no drug charts, nothing. David asks again, the officers ring back. On and on it goes, for hours.   Then they arrive.  "I didn't realise!"  "The other nurse didn't leave the charts out!"  This happens several times a week.

These are not aspirins for a mild headache but antipsychotic medication for a category A prisoner with serious mental problems.

On average the Close Supervision Centre at HMP Woodhill  houses 25 inmates — not a huge crowd of prisoners to remember and not all of them are on medication. It should not be too difficult for nurses to familiarise themselves with their client base.  Do these nurses really believe his medication is suddenly just going to stop?  Suddenly he's cured?

The mental health care in the Close Supervison Centre has been managed by Oxford Health NHS since 2004.  It was at this prison in August 2005 that a man was found hanged in his cell in the Healthcare unit (just two weeks into a sentence for relatively minor offences).  He was known to be suicidal, had in fact told staff that he wanted to hang himself. His step-father had written a letter to the prison asking for him to be put on a watch and complaining that he wasn't getting the medication he'd been prescribed.
Staff communication skills are part of the problem. Strict EU laws forbid testing Eastern European nurses on their communication skills in case it restricts "free movement of labour". The number of European nurses registering to work in Britain has doubled since strict checks on their competence and language skills was scrapped in October 2010 — in the first five months alone 1500 nurses arrived from the continent.

Carelessness in the provision of vital drugs has a devastating effect on David. The stress, distress and agitation it causes are overwhelming, as is the agony of the superhuman effort required to control this.  I have urged David to keep a record of these failures in his care, but he allows it to pass without complaint because he is determined not to let it undermine all the hard work he is doing with his psychiatrist.

It has taken months of careful monitoring by prison psychiatrists to find the pill, the dosage, and a way of spreading the doses throughout the day that best suits David, and to find further medication that counteracts one of the physical side-effects.

These pills leave him with an unpleasant sense of emptiness which he has struggled to adapt to, there is memory loss and his normal thought processes are suffering too because, as well as stopping intrusive thoughts taking hold, the drugs make it harder to maintain any other train of thought from start to finish.

But still he willingly takes the pills as an indication of both his commitment to progress through the prison system and his sense of responsibility to others: David poses less risk to himself and to others when he’s calm.

There is, understandably, little public sympathy for prisoners considered dangerous — these are the people we all fear and we tend not to care what happens to them.  Public sympathy is rightly with innocent victims of violent crime. But many of these offenders have serious mental disorders and if we want these people to stop offending, the system must properly treat them. It is, after all, in all of our interests: most of them will eventually be up for parole and released.

Prisoners have a much higher rate of mental health problems than the general population.  Estimates suggest 72% of male and 70% of female sentenced prisoners have two or more mental health disorders. Some prison reformers put these figures even higher.  Self-harm is more common in prison and the suicide rate is an alarming 91 per 100,000 compared with 8.5 per 100,000 in the general population.  A Sainsbury Centre report says that at every stage the system fails prisoners in mental distress, and poor mental health, if not addressed, can be a factor in reoffending.

David alerted his mental health key worker to the problems he was having with getting his medication on time and this nurse then reminded the medical nurses how important his medication is (they seem unable to work it out for themselves). I wrote to the director of High Security Prisons, Danny McAllister on 5th September (still no reply) and copied the letter to two governors at the prison itself, who have given assurances that the matter would be looked into. David brought it up at his Care and Management meeting where he was told the Healthcare manager would be reminded of the importance of punctuality.  

But still the problems continue. Two days ago he was given his night-time dose at 4pm — and 150m instead of the 100m he was due.  Now David's distress is changing to flatness, depression and paranoia:  he feels it can't possibly be a coincidence and they are just trying to test him, to provoke him into doing something that will wreck all the progress he has made on the unit and give them another excuse to hold him back.  Because if he does lose control, who will be punished? Not the negligent medical staff - he will. 

Danny McAllister acknowledged my letter and passed it on to Nick Hardwick, the Chief Inspector of Prisons (in the same building).  Mr Hardwick writes: "I am afraid I have no powers to intervene in individual cases . . . I will make sure your letter is made available to inspectors when we next inspect HMP Woodhill.” He gives no indication when this might be.

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