Brooker, Charlie, Duggan, Sean, Fox, Clare, Mills, Alice and Parsonage, Michael
Short-changed: spending on prison mental health care,
London, UK, Sainsbury Centre for Mental Health, 16pp.
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Last year, £20.8 million was spent on mental health care in prisons through inreach teams.
This is 11% of total prison health care spending or just over £300 for each member of the prison
Prison inreach teams aim to provide the specialist mental health services to people in prison that
are provided by community-based mental health teams for the population at large. But inreach
teams have been hindered by limited resourcing, constraints imposed by the prison environment,
difficulties in ensuring continuity of care and wide variations in local practice.
Government policy for prison health care is based on the principle of equivalence. This means that
standards of care for people in prison should be the same as those available in the community at
large, relative to need.
The level of need for mental health care in prisons is particularly high, because of the much greater
prevalence of mental illness, especially severe mental illness, among prisoners than among people
of working age in the general population.
While more is spent per head on mental health care in prisons than in the wider community, this is
not nearly enough to accommodate this much higher level of need.
The resources currently available for mental health care in prisons are only about a third of the
amount required to deliver the policy objective of equivalence.
Spending on prison mental health care also varies widely across the country. In London and in the
North East, Yorkshire and Humber, the NHS spends more than twice as much per prisoner than it
does in the East Midlands and the South West. This variation cannot be explained by different levels
of need or costs: it amounts to a postcode lottery in prison mental health care.
Major investment is needed in the overall level of provision for mental health care in prisons and in
its geographical allocation if equivalence is ever to be achieved
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