Thousands of people with a mental disorder sent to prison when they need treatment

Press release
07 June 2021
  • Up to 8,000 prisoners in England and Wales could have been sentenced more safely under a community order with a Mental Health Treatment Requirement (MHTR).
  • Community orders with an MHTR have been shown to save lives, reduce reoffending and save taxpayers tens of millions of pounds a year.
  • New guidance from the Royal College of Psychiatrists encourages mental health services to help deliver MHTRs.
  • The Royal College of Psychiatrists is calling for £12m Government investment to ensure that the option is available to the courts for everyone who would benefit from an MHTR.

Thousands of people with a mental health disorder are in prison because no safer alternatives were available when a court had to pass sentence, according to a new report by the Royal College of Psychiatrists.

Up to 8,000 prisoners — around 10% of the current prison population in England and Wales — could have missed out on a community sentence or a suspended prison sentence with a Mental Health Treatment Requirement (MHTR) because specialist mental health services do not have the resources they need to deliver them.

Community alternatives could not only be better for offenders but also for wider society, disrupting the illness-offending cycle.

The cost of sending someone to prison for a year is £35,000, meaning the savings would be at least £56 million and likely to be much higher, depending on the number of people who could benefit from an MHTR.

To improve uptake of MHTRs the Royal College of Psychiatrists has produced guidance to encourage psychiatrists regardless of specialty to deliver them.

The Royal College of Psychiatrists is also calling on the Government for £12 million funding for mental health services so that no one who could benefit from an MHTR is denied one because of a lack of availability within mental health services to deliver them.

Professor Pamela Taylor, lead author of the Royal College of Psychiatrists’ report, said:

“Too many people with mental disorders who get involved with criminal justice are being failed by a system that overlooks the use of Mental Health Treatment Requirements. Sending them to prison for quite minor offences may be dangerous for the offender-patients and may harm the wider community too. Re-offending rates are high when people are locked away for a short period while their problems remain unsolved or increase.
“Thousands of people could benefit from structured, formally supervised care and treatment in the community, but mental health services don’t have the resources they need to deliver mental health treatment requirements at scale.
“With this guidance psychiatrists are committing themselves to working more and more effectively with this group of people but the Government must also play its part and give mental health services the funding they need.”

The funding should be used to set up leaders, consultant psychiatrists and other specialists in each large mental health trust to deliver treatment within this framework.

The Royal College of Psychiatrists estimates that 1,600 people with a mental health disorder serving a prison sentence of under one year are eligible and would have better outcomes under a MHTR, while a further 6,400 serving sentences between one and four years might also fit the criteria.

Short prison sentences are the most likely alternative to a community sentence with a requirement, but two-thirds of people sentenced this way reoffend within a year, compared with a third of men and 15% of women given a community sentence with a requirement.

The Government has funded a successful pilot programme ensuring that as many people as possible who only need mental health care through a GP can access these orders. Over-stretched hospital services have not yet been able to take on many of the more serious cases.

The latest figures show that just 278 out of 72,274 suspended sentences included a MHTR, while only 391 out of 130,761 community orders did so.

England and Wales currently have the highest imprisonment rate in Western Europe and above average for all Council of Europe countries.

According to the Ministry of Justice, the current prison population is 78,618, a number that is expected to rise to 98,700 by September 2026.

The Chair of the Royal College of Psychiatrists Forensic Faculty, Dr Josanne Holloway is appearing in Parliament today (8 June) before the Justice Select Committee inquiry into prison mental health care. Dr Holloway will talk about the need to both divert more people with a mental illness from prisons and give better mental health support for people who are in prison.

Read the position statement Mental Health Treatment Requirements (MHTRs) - A Royal College of Psychiatrists Position Statement on customising community sentencing for offenders with mental disorder.

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