Mental health in UK prisons – the human rights perspective

As concern about the state of mental health in UK prisons grows, particularly regarding the dramatic increase in prisoner suicide and self-harm, so too does the relevance of human rights.

This concern is not a small one. Ministry of Justice Deaths in Prison Custody figures reveal a steady increase in self-inflicted deaths from 58 in 2010 to 119 in 2016, the highest since records began in 1978. Likewise, statistics provided by HM Chief Inspector of Prisons for England and Wales reveal that there were 32,000 incidences of self-harm in 2015, signifying a 25% increase from the previous year. 

A human rights framework for prisons

It is because of these disturbing trends that the Joint Committee on Human Rights (JCHR) conducted an inquiry into mental health and deaths in prisons. Published in May earlier this year, the report prefaces its review on a framework of human rights legislation with which to view prisoners and mental health issues. The report uses the framework of Professor Philip Leach, a human rights law professor at Middlesex University and director of the European Human Rights Advocacy Centre, who divides the pertinent human rights legislation into three areas: the international human rights framework (including both legally binding treaties and non-binding but “legally relevant” standards); European regional standards; and national human rights legislation.

First, under the international human rights framework, Professor Leach highlights the International Covenant on Civil and Political Rights (ICCPR), which insists that prisoners be treated with humanity and respect for their inherent dignity, and the UN Convention on the Rights of Persons with Disabilities (CRPD), which states that disabled persons must be respected their “physical and mental integrity on an equal basis with others” and that they are entitled to guarantees and treatment in compliance with the Convention “including by provision of reasonable accommodation”.

Compounding these legally binding international treaties are non-binding standards. Most notable among them are the UN standard minimum rules for the treatment of prisoners, or the ‘Nelson Mandela Rules’, which expect prisons to facilitate: remedial, social and health-based assistance; provision of healthcare services to protect the physical and mental health of prisoners; at least one hour of suitable exercise in open air daily; and only a limited use of solitary confinement measures, restricted to exceptional circumstances. Furthermore, as Penal Reform International points out, the unanimously adopted revision of the rules in 2015 clarified that prisoner health is a state responsibility and that prison health services should be of equal standard to those in the community.

Second, with regards to European regional standards, there are the expectations outlined in the European Prison Rules, many of which affirm the UN standards, such as the rule that “every prisoner shall be provided with the opportunity of at least one hour of exercise every day in the open air”. The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT Standards) likewise stresses that prisoners should spend “a reasonable part of the day” outside of their cells and should be “offered the possibility to take outdoor exercise daily”. The CPT also references suicide prevention, insisting that there should be “adequate awareness” and “appropriate procedures” in place to prevent self-inflicted deaths.

Finally, on the matter of national legally-binding legislation, there is the European Convention on Human Rights (ECHR), which the Human Rights Act enshrines in UK law. Article 2 stipulates a right to life, placing a positive obligation on the state to protect those in its care, including prisoners, for whom a safe environment must be provided through risk assessments, health services provisions, and permitting regular family contact.

The 2015 Harris Review, an independent report into young offender suicide in custody, clarifies that this article constitutes a positive obligation on the state, arguing that the article is in breach “if the authorities knew, or ought to have known, that there was a real and immediate risk of self-inflicted death” and failed to do “all that could reasonably have been [done]”, citing Keenan v. UK as an example of this. This ECHR case awarded Susan Keenan, mother of Mark Keenan who suffered from psychiatric disorders and committed suicide in custody, compensation for damages because the prison had failed to fulfil their positive duty of care by failing to note the immediate risk of suicide.

UK prisons’ performance on human rights

Considering these standards, is clear that current practices in UK prisons merit improvement from a human rights perspective. Indeed, the CPT themselves issued a report about UK prisons last year, and determined that urgent measures were needed to reverse the recent trends of escalating violence, self-harm and self-inflicted deaths.

A 2016 report on prison suicides by the Howard League for Penal Reform and the Centre for Mental Health illustrates how the state is not taking sufficient, positive steps to protect prisoners in its care. It identifies the underperformance of the Assessment, Care in Custody and Teamwork (ACCT) programme in flagging those at risk of self-harm: less than half of prisoners who committed suicide in 2015 were on the ACCT at the time of their death. The report also criticises certain disciplinary measures constituting a so-called ‘basic regime’ which “contravenes international human rights standards”. Eight percent of investigated prisoners who committed suicide between 2007 and 2012 were on this regime, despite the regime prisoners accounting for just 2% of the prison population.

A 2015 Prison Reform Trust study on segregation units similarly criticises the prison services’ shortcomings on human rights issues. These units facilitate just 20 to 30 minutes of daily outdoor exercise for prisoners, well short of the 60 minutes stipulated in the Nelson Mandela Rules and the European Prison Rules. This is in part attributable to a 2011 Public Service Instruction (PSI), which reduced the minimum requirement to just 30 minutes for prisoners on restricted regimes. The Trust adds that they “are unaware of any other European jurisdiction where the official requirement is for a period of less than an hour.” Likewise, restrictions on contacting helplines such as the Samaritans or Listeners are raised as highly problematic for mental health and human rights reasons.

While it may be easy to neglect what, quite literally, goes on behind closed doors (and firmly locked and bolted ones at that), it is important to remember that human rights extend to everyone, including those whose liberties we have rightly curtailed. It seems that with regards to its prisons, the UK needs to remember better and act more forcefully to make adequate provisions for human rights.

Joel Collick is a research assistant at Bright Blue