By Sundar Thavapalasundaram
In Britain today mental illness significantly increases one’s chances of imprisonment and impacts disproportionately on the most vulnerable.
A paradigm shift in Labour justice policy is needed, moving away from policies of containment to preventing the mentally unwell citizen drifting into this lifestyle to begin with.
With the mentally ill currently constituting over 90% of the UK prison population is justice best served within the current judicial framework or does it inadvertently discriminate?
Citizens expect criminals to serve their sentence and return seamlessly to society. This is predicated on the assumption that incarceration causes desirable changes in behavior and is not supported by high re- offender or re-imprisonment rates.
The prisons, police and judiciary lack the resources and skills needed to care for people with mental health problems. Furthermore, navigating the legal maze is complex and places the mentally ill at a disadvantage.
Politically, labeling criminal behavior as ‘illness’, risks being seen as ‘soft’ on crime. Labour must challenge preconceived ideas and champion reform in this area. The fact that most offenders with mental health problems are not dangerous and better treated outside the prison system must be highlighted and supported by strong moral and fiscal arguments.
It is morally wrong to incarcerate persons suffering with mental illness, particularly when competence is in doubt. Illness requires medical treatment and protection from the arduous nature of prison life. Placing vulnerable persons in this environment is an abdication of the state’s duty to protect its citizens.
Fiscally, the successful identification and treatment of mental illness, reduces re-offender rates and ensures convicts receive good mental health care. This may reduce the £11bn currently squandered on re- offenders, while alleviating the growing challenge of prison overcrowding.
Systems for identifying and diverting the mentally ill out of prison and into secure community treatment programs are needed. Reviewing sentencing and encouraging hospital and secure community care orders to be considered routinely is called for. As is mandatory mental health training for the judiciary, legal, police and prison services.
The judicial process needs to be supported by enhanced mental health services, with better coordination between prisons, secure units, NHS Mental Health Trusts, commissioning groups and community care providers. This would allow greater flexibility and individually tailored care solutions.
Re-examining the legal test for fitness to stand trial is important to ensure defendants facing prosecution are competent and therefore accountable for their actions. Used in conjunction with early psychiatric screening, this would allow ‘at risk’ defendants (facing possible custodial sentences), to be identified early. Judicial process might then be ‘reasonably adjusted’, to ensure fairness.
Conservative austerity measures are fermenting inequality, breeding criminality and eroding mental health services. Labour must respond to this if it is to build a truly fair society. Incarceration is an expensive, failed approach to justice and a progressive prison reform agenda is needed. What form this takes in fiscally challenging times will be the acid test for Labour policy makers engineering victory in 2015.
Dr Sundar Thavapalasundaram is a General Medical Practitioner & Member of the RCGP Health Inequalities Standing Group