When Carl* tried to kill himself in prison, he says he was angling for a quick escape – he thought about spending years with a rock hammer digging a tunnel, Shawshank-style, but ultimately decided that he couldn't face the commitment. He waited for his 9AM check, and knew from six years of prison experience that no one would be back again until 10AM. His cellmate had an English class on a Wednesday morning, so he had an hour to himself.
At 9.15AM, he took a mix of prescription pills that he'd been buying and trading with other inmates in the weeks before.
Carl tells his story now calmly and with humour. He didn't take enough of the medication to kill himself, but he did spend a night in healthcare where he woke up later that evening, knowing that he would be serving the remainder of his long sentence.
"I'd been to see the prison doctor a few times and told him how I'd been feeling," says Carl. "He'd give me a form to fill in – you know the kind, tick boxes, rate your own mental fragility on a scale of one to ten, that kind of thing – then he'd hand it back, and tell me I wasn't depressed or psychotic or anxious enough for medication. Even after the overdose, there was no counselling, no group therapy, no medication. No nothing. It takes a lot for a reasonable man to consider suicide a viable option."
Released in June, after serving 12 years for GBH, Carl says he's "not fucking surprised" by the findings of a report released on Monday by charity the Howard League for Penal Reform. The report claimed that the number of people dying by suicide in prison had reached an "epidemic proportion". With 102 deaths recorded by the charity in 2016 alone, the suicide rate in prisons is currently more than 10 times higher than that in the general population, the charity says, and is the highest it has ever been since recording began in 1978. Official figures in April also showed an annual rise in the number of suicides.
So in a system in which so many vulnerable adults are in state care, what more can be done to prevent mental health problems going undetected, and more importantly, to stop those in need of intervention from slipping through the cracks and possibly harming themselves? Josefien Breedvelt, a research manager at the Mental Health Foundation, says that support offered in prisons should be "of the same quality as that provided in the community", and that on top of increasing staff levels in prisons, the mental health of staff must become a priority for them to effectively work with inmates.
Training to be a prison officer takes 10 weeks, and while procedure for inmate suicides and self-harm is touched upon, a prison officer I speak to says trainees are offered little to no guidance on how to deal with some of the more severe, but nonetheless common, mental illnesses that inmates experience.
Lauren* qualified as a prison officer a few months ago and works at a Category B men's jail. She feels that more should be done during entry-level training to prepare officers for the mental health issues that inmates are living with. "You just have to use your common sense and stay alert to the little triggers," she says. "For instance, if a man on a life sentence starts giving out their possessions – their toiletries and personal items – you know that something is going on. But that's just your average Joe Bloggs stuff – as prison officers we should know more."
On Lauren's wing, she says two prisoners should be in a hospital for mental health-related illnesses, but there isn't the space or resource for them to be moved. And it's not just the prison staff that are feeling the side effects of having someone with such advanced psychological issues on the same ward as standard prisoners.
Josh*, 30, was released in April after serving five and a half years in seven different prisons. He says that the staff shortages, combined with the huge spike in the use of legal highs like Spice and Mamba, have made prisons "100 times more violent than they were a few years ago".
"You're sharing a wing with people who are deeply, deeply mentally ill," he continues. "I knew a bloke who used to cut himself and draw pictures of the devil all over his cell in his own blood, and he was in fucking prison. He was totally off the wall. But there were only two staff working on mental health – this is in a prison of around 650 people."
Alex* is another prison officer, working at HMP Rye Hill, who says they're all too familiar with the kind of inmate Josh describes. Like Josefien, Alex thinks that more needs to be done to protect the mental health of staff if a healthy and sustainable environment is to be achieved.
"I work in a sex offender's prison, where serious self-harm is particularly prevalent," Alex says. "Some prisoners press their cell call buzzer and then slice into their skin when you answer. I've cut down hanging prisoners. It's a cry for help, they want to prove their distress and pain is real."
When asked to respond to allegations of inmates engaging in self-harm at HMP Rye Hill, G4S – who manage the prison – said that there had not been a suicide at the facility during the period covered by the Howard League report. G4S directed us towards specific parts of a December 2015 report, written after an unannounced inspection of the facility in August of last year, pulling out quotes including:
"Those who were struggling to cope and those at risk of suicide and self-harm felt well supported and the management of complex cases was impressive; the weekly complex case review meeting was effective and focused on prisoners struggling to cope and those involved in violence and self-harm; with the change in population, levels of self-harm had increased, and were relatively high. The quality of assessment, care in custody and teamwork case management documents for prisoners at risk of suicide or self-harm was too variable but was good for the more complex cases and demonstrated high levels of care and support; and the prison had managed some extremely prolific self-harmers with high degrees of success."
"In terms of our support for staff," a spokesperson wrote, "we also have a team of counsellors on hand to support people in a whole range of circumstances."
A government spokesperson, speaking more broadly about the prison system, said: "Mental health in custody is taken extremely seriously and there are a range of measures already in place to help support prisoners. Providing the right intervention and treatment is vital to improving the outcomes for people who are suffering and all prisons have established procedures in place to identify, manage and support people with mental health issues.
But we recognise that more can be done. That is why have invested in specialist mental health training for prison officers, allocated more funding for prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons."
Alex speaks of a different experience. "Those images will never leave my mind, but I still have to finish my shifts and come in the next day. No one asks if I'm OK. It's my job, I'm expected to cope and provide the same service again and again. But something has to change, and it has to come from the top. If we carry on the way we are, this astonishing suicide rate will just continue to rise."
*Names have been changed to protect people's identities.
If you or someone you know have been struggling with thoughts of self-harm or suicide, you can call Samaritans seven days a week, at any time on 116 123.
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