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December 07, 2004

Mental health and British prisoners: The Guardian has identified the wrong scandal

Posted by Anthony Daniels

A major investigation by The Guardian claims that up to 70% of inmates in British prisons have mental health disorders. Anthony Daniels - who works as a prison doctor - argues that this is simply not the case. The number of prisoners who have genuine recognised mental health disorders - rather than ill-defined 'personality disorders' - are small. The real scandal is that the prison system cannot cope with even these small numbers.

The Guardian newspaper for Monday, 6 December, had a prominent story with the headline: Scandal of society's misfits dumped in jail. For The Guardian, apparently, it would be less of scandal if society's finest flower were in jail: but let us continue. A second headline on this story stated: "Up to 70% of inmates in Britain's jails have mental health disorders".

This is patent nonsense, although it is a figure often bandied about. It is reached by including those with so-called 'personality disorders', but personality disorder is only a descriptive term for persistently bad or maladaptive behaviour. In a sense, then, the news is reassuring: the criminal justice system is not sending people with persistently good or highly adaptive behaviour to jail. That would most certainly be a scandal.

There is little doubt what lies behind The Guardian's outrage: it would like further leniency towards those who make the life of the poorest in society a kind of hell on earth. But in fact there is a genuine scandal with respect to psychiatrically ill people in prison, and it is far, far more sinister than the one that The Guardian thinks it has uncovered.

In every large prison there are, at any one time, a small number of severely psychotic prisoners who cannot be treated in the prison. This is because, as the law now stands, it is illegal for prisoners to be treated without their consent while they are in prison: if they need such treatment, they must be sent to hospital outside the prison.

One can see why the law was framed thus. It is certainly possible that abuses might occur in prison: that prisoners might be treated not because they were ill, but because they were a nuisance and the administration would prefer that they were drugged up to the eyeballs.

This would be very well provided that, when psychotic, prisoners could be transferred easily to hospitals where they could be treated. But the hospitals have been closed, there are no beds in which to place them. And this means that they must remain in prison untreated, sometimes for many months.

The result, not surprisingly, is a return for some prisoners to the conditions of 18th Century Bedlam. Prisoners smear their walls with faeces for days on end, and industrial cleaners have to be brought in to clean them; they smash their cells and urinate on the floor; they spit at whoever approaches them and half-starve themselves; they bang incessantly on their doors and scream and shout into the ether at their imaginary tormentors.

In the name of human rights, both other prisoners and the prison officers, who in my experience are remarkably forbearing, have to put up with this for months on end. They have no human rights, only the person smearing his walls with faeces. The faeculent atmosphere is for them, apparently, the price of liberty.

What is extremely frustrating for medical and other staff alike is that the prisoners who behave like this can, almost without exception, be helped very considerably by modern treatment: it is merely a matter of administering the appropriate medicine. Indeed, a single injection often brings about a near-miraculous transformation of a person behaving in an extremely bizarre and self-destructive way. But this treatment cannot be given, and staff have to watch as the person deteriorates in front of their eyes.

This is clearly all a scandal, though it affects relatively few people. It is not a question of 50,000 people in prison with 'personality disorders', as The Guardian alleges, for whom medicine can do nothing. (The state, needless to say, subsidises the very kind of family arrangements that is to say, irresponsibly child-producing sexual liaisons that result in inadequate and antisocial people.) The scandal affects a relative handful of people, and indeed it is the smallness of the number that is one of the reasons the scandal is so scandalous.

Why is that, you ask? Surely, a scandal is scandalous in proportion to the number of people affected? But this situation is scandalous apart from its inherent cruelty precisely because the numbers affected are so small, and the apparatus set up to deal with problems of this nature is so vast. In other words, the system of care that we have is so inadequate, despite the funds spent on it, that it is beyond its capacity to help even a small handful of people in the most vulnerable of all situations.

Oddly enough, I have met few people who work in the giant apparatus (apart from a few doctors) who understand the disgrace of this. Huge amounts of money, and vast expenditure of time, go into efforts to help people who cannot or ought not to be helped, but nothing is done to help those whose lives would be transformed by a little medication which (alas) they are too confused to take willingly. The result is that they have to live in vile, pre-modern conditions.

The figure of 70 per cent with 'mental health disorders' is in my opinion a smokescreen for the manifest incompetence of the apparatus of 'care' in this country, an apparatus that in my opinion is corruptly self-seeking and self-aggrandising, a mere client group of the government. The figure of 70 per cent is a disguised plea for yet more resources, for the appointment of more managers, co-ordinators, facilitators and the like, all at comparatively high salaries, for more away-days in country hotels to discuss the situation, more meetings with free lunches and so forth. Moreover, the figure of 70 per cent is so high that no one could be blamed for failing to produce an effect: always the cry will be for more resources.

But the real scandal I have described requires very little in the way of resources. Moreover, its existence exposes the false pretences of the bureaucracy of care in this country, which is careerist rather than caring, to use for once a word that would have made even Little Nell wince. The shamelessness of the bureaucracy, which is proportional to its size, is startling.

I propose a law of bureaucracy: the ability of a bureaucracy to carry out its ostensible purpose is inversely proportional to the square of its size.

Anthony Daniels is a doctor and writer.

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