National Preventive Mechanism Eighth Annual Report 2016–17 Issues identified by NPM members Appropriate location International human rights standards set out the requirement that ‘Prisoners who require specialized treatment […] shall be transferred to specialized institutions or to civil hospitals’.112 NPM members have frequently raised concerns in their inspection reports about the appropriateness of the prison environment for detainees with serious mental health problems. It is of particular concern that prisoners awaiting transfer to hospital are often found in segregation units.113 During its 2016 visit, the European Committee for the Prevention of Torture (CPT) noted that the inpatient health care unit at HMP Pentonville was primarily being used to hold psychiatric patients, and concluded that such units should ‘not become a substitute for the transfer of a patient to a dedicated facility’.114 Similar concerns were identified by HMI Prisons, which reported that prisoners awaiting transfer were being managed either in the inpatient unit, the segregation unit or on open landings on the wings, and that in all three environments their mental disorders were not being assessed or treated as would occur in a hospital facility. In segregation and on the wings their vulnerabilities would have been exposed, leading to a potential deterioration in their mental states.115 The Prisons and Probation Ombudsman (PPO) reported that prisons had tried to arrange transfers to hospital for one in 10 of the 139 prisoners who died from suicide between 2012 and 2014 and had identified mental health problems at the time.116 The PPO found further cases where prisoners had not received appropriate support for their mental health problems, while waiting for a transfer or waiting to be assessed for a transfer to a secure hospital. Case study – Dean Saunders On 4 January 2016, a 25-year-old prisoner held at HMP Chelmsford, Dean Saunders, committed suicide. The independent investigation into his death, conducted by the PPO, noted that on 21 December 2015 a prison psychiatrist had assessed Mr Saunders as suitable for transfer to a secure hospital, but did not complete the first recommendation required for a transfer under the Mental Health Act because the local secure hospital did not have a bed available. The first recommendation was completed several days later on 31 December. Though the local hospital had a place for Mr Saunders, prison health care staff believed they needed a second recommendation from the prison psychiatrist, who was on leave until 5 January, when in fact a signature from any other doctor would have 112. United Nations Office on Drugs and Crime, 2015, The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), Rule 27. 113. See, for example, Criminal Justice Inspectorate Northern Ireland, HM Inspectorate of Prisons, Education and Training Inspectorate, Regulation and Quality Improvement Authority, 2016, Report on an unannounced inspection of Ash House Women’s Prison, Hydebank Wood 9–19 May 2016; HM Inspectorate of Prisons, 2017, Report on an announced inspection of HMP Pentonville, 9–13 January 2017. 114. Committee for the Prevention of Torture, Report to the Government of the United Kingdom on the visit to the United Kingdom carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 30 March to 12 April 2016, CPT/Inf (2017) 9, paragraph 66. 115. HM Inspectorate of Prisons, 2017, Report on an announced inspection of HMP Pentonville, 9–13 January 2017. 116. Prisons and Probation Ombudsman, 2016, Learning from PPO Investigations: Prisoner mental health. It is not known whether the deaths would have occurred had the prisoners been in hospital rather than prison. 42