Crisis and Controversy: Prison Mental Healthcare in the Late Twentieth Century in England and Wales
Speaking at the policy workshop, ‘The Prison and Mental Health: From Confinement to Diversion’, London, 12 February 2016
Nicholas’s paper dealt with the issue of prisoner health care in the 1970s and 1980s. In part due to severe overcrowding, maintaining the health of prisoners during this period proved to be a major challenge for prison authorities. The mental health of prisoners was also a serious concern, with prison medical officers often struggling to deliver appropriate care and treatment to such detainees.
This problem was compounded by the difficulty in locating suitable hospital places for mentally disturbed prisoners. From the 1960s onwards, the movement towards a ‘care in the community’ model had resulted in the the closure of many psychiatric hospitals leading to the decreasing availability of beds for mentally disordered prisoners in need of transfer to specialist facilities.
While the general medical consensus was that the mentally ill should be removed from prison, some among the prison medical service argued otherwise. For example, Dr Mary Ellis, editor of the Prison Medical Journal, asserted that prison doctors were possessed of specialised and necessary expertise in dealing with disturbed prisoners whose behaviour posed significant management problems.
The medical treatment of mentally ill prisoners in the 1970s and 1980s was a significant source of controversy, not least because their treatment fell outside the remit of the Mental Health Act and questions of capacity and consent were invariably elided on the basis of medical necessity. The psychotropic regime was also a focus of concern for critics who alleged that psychiatric medication was used to help maintain prison order rather than to alleviate medical conditions.
Nicholas finished his presentation by drawing historical parallels with the present as there are still extensive delays in locating appropriate hospital care for prisoners. As was the case in the 1970s and 1980s, the question of capacity and informed consent to treatment is complicated by the exigencies of the prison environment.