Here’s a story about just how hard it is for a bad system to mend its ways, even when a lot of people are trying to do the right thing. It’s about a young man from Birmingham, which is important in itself, because the local prison at Winson Green is now the showcase for the prison service’s drive to improve life for its mentally-disordered inmates.
This man has had a bad drug habit for years as well as a severe personality disorder and, when he was released from jail a few years ago, his mother was so terrified of him that she made him live in the garage, which was just four walls and a concrete floor. The immediate result was that the community mental health team said they would not deal with him, he was a job for the homeless unit; and the homeless unit said the garage counted as a home, so he was not their responsibility either. He committed more offences and went back to Winson Green.
The prison wanted him transferred to hospital and called in a community consultant but, by the time he found the time to visit the prison to make an assessment, the prison had discovered that they had miscalculated the young man’s release date, and he was out in the commmunity again – where the community mental health team said he was a job for the forensic health team, and the forensic team said he should be dealt with by the community team. He committed more offences, including a threat to stab and burn his family, and he went back to Winson Green again.
He spent months waiting for a trial date and, when he got to court, the judge said he wanted a report on his mental health. The judge then got tied up on another case and months passed; the prison realised that whatever sentence the judge eventually gave would already have been served, so they decided to try to arrange for the young man to be released on a community rehabilitation order with a condition that he accept psychiatric treatment. The young man agreed to comply, the probation service agreed to supervise him, and, the day before he was due back in court, a community consultant came in and agreed to provide the treatment.
On the next day, the young man went to court. The judge accepted the plan and declared himself pleased. On the following day, however, the community consultant wrote an irritable letter to the prison explaining that he had felt pressurised to go along with the plan and that he could not, after all, agree to provide the treatment. Back on the streets again, the young man started to deteriorate.
Even though he was not in their custody, the prison knew he would be back soon, so they arranged a case conference for everybody who had an interest in him. The forensic and community health teams agreed to work together and the police agreed to help. The next day, knowing that he had been committing more offences, the police picked him up, put him in a cell and deliberately did not charge him so that a psychiatrist could come in and transfer him to hospital as a place of safety, where he could then be assessed for 72 hours and given a longer-term plan. But the psychiatrist who turned up to the cells had not been at the case conference, and he decided that the young man was not really mentally ill. So the police had to charge him and put him before the magistrates who declined to use any of their powers to assist.
In the background, with the young man back in custody yet again, the prison finally persuaded the forensic service to provide him with a secure bed for six months of treatment. It had taken them just over two years to get him treated.
Winson Green Prison has gone through a £28 million revolution in health care. It used to have five mental health nurses, it now has twenty six; it used to provide no mental-health care at all for prisoners on the wings, it now has an ‘Inreach team’ with four community pyschiatric nurses, four visiting psychiatrists, two senior social workers and a probation officer; and they have a brand-new purpose-built health care unit with 34 in-patient cells, supported by 20 prison officers who are being trained in health care to NVQ level. It has dramatically cut its use of major tranquilisers, and it segregation unit is frequently empty.
And yet it remains a prison, limited in what it can do within its walls, limited even more by the lack of a genuine network of care beyond those walls.
