HMP Kilmarnock struggling with dwindling mental health nurses
The East Ayrshire prison is facing a rising number of inmates, but is struggling to keep up with mental health care demand
Health chiefs have warned that HMP Kilmarnock faces an ongoing challenge to meet its duty of care to prisoners and staff unless improvements are made.
An in-depth report on the progress of healthcare at the prison will be considered by East Ayrshire Integration Joint Board’s Audit and Performance Committee this week.
Last year, a health needs assessment criticised the healthcare facilities at the prison.
It also highlighted the difficulty recruiting healthcare staff and the raised concerns over the impact of the handover from the private contractors Serco to the Scottish Prison Service in March this year.
Challenges to duty of care
Out of it came 27 recommendations ranging from direct interventions in the service provided by the prison based healthcare team to work with partners.
The report to the committee states: “The aim of the recommendations are to improve the delivery of health care services and the wider health and wellbeing outcomes of those in the care of the prison.”
The recommendations include specific efforts to change the skill mix of the mental health team to provide more appropriate health care as well as alterations to shift patterns.
Mental health care is seen as vital in prisons where there are a higher proportion of people who face serious mental health issues.
"Exceptionally important"
CEO of charity Families Outside, Nancy Loucks stressed it was "exceptionally important" for there to be access to proper mental health care in prisons.
She said: "Prisons, for a whole variety of reasons, hold quite a high proportion of people with mental health issues.
"That can be because the services that people need aren't available in the community, or just the reality that mental health services can turn people away if they don't have the beds with capacity, whereas prisons can't turn anyone away, they have to take whoever is sent tot them.
"We're talking about people who have most often quite severe backgrounds of trauma, they might be engaging in substance misuse to mask some of that trauma, and people who simply haven't had access to the care and the treatment they need.
"Simply don't have the resources"
"Prisons end up dealing with people in that situation, and simply don't have the resources to provide the support that they need."
The report states: “It is well acknowledged that people in custody are one of the most vulnerable and disadvantaged groups in society.
“It is often their life experiences and multiple trauma that leads them into the problematic, challenging and sometimes very harmful behaviour to others.
“An approach that supports and mitigates these adversities will also support people move away from their criminal behaviour and become more positive and active member and contributors to society.
Mental health nurse shortage
“Recruitment of mental health nurses has been very challenging which reflect both local and national shortages of mental health nurses and the particular difficulties recruiting to prison health care.
“This situation in unlikely to change in the near term and the reduced capacity has impacted on service delivery.
“The service has needed to focus on those most at risk and need and has not been able to provide lower level and preventative care to those that could benefit from these.”
Other recommendations are for partner agencies and include delivery of education, self-help groups and other wellbeing interventions to support those in the care of the prison.
Reoffending rates
Ms Loucks also expressed concern for life after prison for some people, as unaddressed mental health issues can lead to a higher likelihood of reoffending.
She said: Mental ill health and trauma are often core underlying reasons for why people are offending in the first place, so if we're not addressing the reasons that they're offending, then the offending will continue, I think that's just the reality.
"Certainly the families that we work with often express concerns about people not receiving the support that they need.
"Interestingly what we've seen before is that some people in prison might be willing to engage with mental health support and services when they're in prison, but haven't been engaging with community based support outside, so that can be a problem as once they get out.
Lack of support will "perpetuate the problem"
"If they haven't had that support while they're in prison, they simply don't access it when they're outside either, and that's obviously just going to perpetuate the problem.
While recruitment has been described as ‘challenging’ the report does note progress on securing some key healthcare staff.
The report adds: “The development of more trauma informed services will be essential to meeting the needs and improving outcomes for those in the care of the prison for all staff groups providing care.”
The health needs assessment also raised concerns around the size of the prison population.
Increased prison population
Under the contract between SPS and Serco, the prison population has normally stayed under 548 inmates, despite the actual capacity of the facility being 692.
While SPS have not finalised the capacity they plan to operate at, the report indicates that it is likely to increase to around 600.
This would mean that individuals normally placed in HMP Kilmarnock will no longer be diverted to other establishments in order to maintain the population below 548.
The report adds: “There may also be a change in the demographic and turnover of people in the care of the prison which would have an impact on the workload of the health care team.”
Increased numbers would make pressures "more acute"
There has been ongoing criticism of the healthcare facilities at the prison, in particular the dental facilities.
The report states: “At this time there has been no change in relation to the dental facilities in the prison. This continues to limit the dental procedures that can be provided in the prison.
“Work to develop the facilities will be dependent on the development of a business case by SPS to secure the required funding.
“Failure to achieve improvement in the physical facilities at HMP Kilmarnock will have a continued negative impact on the healthcare provision to those in the care of the prison and lead to poorer health outcomes.
“These pressures would become more acute if the prison population were to increase.”