Mental health care in United Kingdom prisons

MENTAL HEALTH CARE IN UNITED KINGDOM PRISONS
Abstract
The mental health of a prisoner is responsible for the individual’s thought-process and therefore, it is prime factor for the assessment of a person in the context of recidivism. The amount of crime in UK has remained consistent and has
ought forth the fact that a majority of the criminals are repeated offenders. The repetitive offenders are contributing in the occu
ence of recidivism and the cu
ent prison system, which prioritises discipline and captivity as the means of purging criminal activity, are failing to what they were intended to do.
Considering the gravity of the issue, the cu
ent research is framed. It aims at exploring the role of mental health of the prisoners, therefore in the first chapter, an elaborate introduction along with research aim, research questions are provided. As the research topic cannot be discussed further without the support of proper literary references and assessment of, variables connected to the research topic, ample literary sources has been discussed in great length in the second chapter. The concepts of imprisonment, the background of prison system in UK, the positive-negative aspect of imprisonment, the Theory of reasoned action and Health Belief Model (HBM) are incorporated within literature review chapter.
In the chapter, three of the research an a
ay of methodological tools has been used. Considering the layers of the research onion, research philosophy, design, type, approach, data collection technique has been considered appropriate. In order to give the cu
ent research some real life data, a sample size of 75 respondents and 3 officers from the UK prison has been selected. The respondents are prisoners of UK prison, while the officers are selected from the same prison that provided the prisoners. As only the legit data can be used for decision making, in the fourth chapter data has been collected as well as interpreted to generate information. In the form of survey, 10 close-ended questions have been asked and based on the collected data majority is identified.
In case of the interview, open-ended questions are asked. It is worth consideration that all three interviewee are asked the same question to find a pattern in the answers. Based on all the data findings and their analysis, a comprehensive and well-assessed conclusion is provided in the last chapter of the research. The generated information is also used for proper suggestions that would help in reducing the frequency of recidivism among the UK prisoners as well as improve the mental health for normal thought generation.

Acknowledgement
The cu
ent research has been an absolute joyride for me. I enjoyed the entire research from the very beginning to the very end. I learnt many new things but I have to admit that with my solo effort I could have never been able to finish this mammoth task. Firstly, I would like to thank my mentor for assisting me from until the very end and offering his valuable suggestions at every stage of the research. I would also like to thank my colleagues and friends for their unwavering support for me.
As the research is not an affair of a day, I had to invest a lot of time into it, during which my friends and colleagues helped me by offering their honest opinion about my research and helped in its refinement. Lastly, I would like to thank my members of family for offering their hundred percent for my cause. I thank you all from the bottom of my heart and hope that you will all be there to support me in my future endeavours.
Thanking you all,
____________________
Table of Contents
Chapter 1: Introduction    9
1.1 Topic    9
1.2 Research Problem    9
1.3 Background and Justification    10
1.4 Deficiencies in the Evidence    10
1.5 Audience    11
1.6 Definition of Terms    11
1.7 Purpose of the Research    13
1.8 Research Questions    13
1.9 Summary    13
Chapter 2: Literature Review    14
2.1 Preface    14
2.2 Concept of Imprisonment    14
2.3 Causes and Justification for Imprisonment    14
2.4 Positive Aspects of Imprisonment    15
2.5 Prisons of the United Kingdom— the System    15
2.6 Negative Aspects of Imprisonment    16
2.7 Mental Health Issues amongst Prisoners    16
2.8 Causes behind Mental Health Issues of Prisoners    17
2.9 Theory of Reasoned Action relating to Mental Health Issues amongst Prisoners    17
2.10 Health Belief Model relating to Mental Health Issues amongst Prisoners    18
2.11 Suitable Ways to Care for Mental Health within Prisons    18
2.12 Significance of Sustaining Mental Health in Prisons    19
2.13 Linking Literature with the Cu
ent Research    19
2.14 Gaps in Literature    20
2.15 Summary    20
Chapter 3: Research Methodology    21
3.1 Overview    21
3.2 Research Method Proposition    21
3.3 Research Onion    21
3.4 Research Philosophy    22
3.5 Research Approach    22
3.6 Research Design    22
3.7 Research Strategy    22
3.8 Type of Research    23
3.9 Data Sources    23
3.10 Population, Sample size and Sampling Techniques    23
3.11 Data Collection Method    23
3.12 Data Analysis Techniques    24
3.13 Ethical Considerations    24
3.14 Accessibility Issues    24
3.15 Time Plan    24
3.16 Summary    25
Chapter 4: Data Findings and Analysis    26
4.1 Introduction    26
4.2 Quantitative Data Findings and Analysis    26
4.3 Qualitative Data Findings and Analysis    36
4.4 Summary    38
Chapter 5: Conclusion and Recommendations    39
5.1 Conclusion    39
5.2 Linking Findings to the Research Questions    39
5.3 Recommendations    40
5.4 Limitations of the Research    40
5.5 Future Scope of the Research    41
References    42
Appendices    47
Appendix 1: Timeframe    47
Appendix 2: Survey Questionnaire    48
Appendix 3: Interview Questionnaire    51
List of Figures
Figure 3.1: Research onion    20
Figure 4.1: Gender of Prisoners    25
Figure 4.2: Age Group of Prisoners    26
Figure 4.3: Duration of Sentence    27
Figure 4.4: Duration of Cu
ent Sentence Serving    28
Figure 4.5: Economic Condition of Prisoners    29
Figure 4.6: Frequency of Re-imprisoned in Last 5 Years    30
Figure 4.7: Mental Health Issues Experienced by Prisoners    31
Figure 4.8: Frequency of Mental Healthcare Satisfaction    32
Figure 4.9: Frequency of getting back to Normal Life Post Imprisonment    33
Figure 4.10: Frequency of Prisoners Perspective on Acceptance of by Society    35
List of Tables
Table 4.1: Gender of Prisoners    25
Table 4.2: Age Group of Prisoners    26
Table 4.3: Duration of Sentence    27
Table 4.4: Duration of Cu
ent Sentence Serving    28
Table 4.5: Economic Condition of Prisoners    29
Table 4.6: Frequency of Re-imprisoned in Last 5 Years    30
Table 4.7: Mental Health Issues Experienced by Prisoners    31
Table 4.8: Frequency of Mental Healthcare Satisfaction    32
Table 4.9: Frequency of getting back to Normal Life Post Imprisonment    33
Table 4.10: Frequency of Prisoners Perspective on Acceptance of Society    34
Table 3.1: Gantt chart    46
Table 4.11: Transcript for Q1    50
Table 4.12: Transcript for Q2    51
Table 4.13: Transcript for Q3    51
Chapter 1: Introduction
1.1 Topic
The mental health of person kept inside prison for considerably lengthy periods, creates a lasting impression on the personality, and determines the level of deviation from crime and alignment with the flow of society. In the cu
ent research, the significance of the mental health of the prisoners has been considered, with a special reference to the prisoners of UK prisons.
1.2 Research Problem
It is seen that the criminal activity conducted by persons, in most cases are mentally inclined towards extreme outburst of sensual and social emotions. After committing a crime, criminals are imprisoned for the sole of purpose of restricting them from coming in contact with greater masses; thereby prevent the chance of harm and purge their minds from criminal thoughts. Sadly, even at the time of being captive in prison, prisoners often indulge in criminal activities. After serving in prison, prisoners are often found committing crimes in loop, leading to rea
ested and imprisonment (The Sun, 2018). The occu
ence of crime, before, during, and after imprisonment hints at a significant lack of the assessment of mental health of the prisoners.
The lack of assessment of the mental health of the prisoners is undermining the process of crime control and criminal thought discouragement. Criminals are neither getting discouraged from committing crime nor are they opting for a normal life after serving sentence in prison. With the advent of the social diversities, the thought process of men is getting more complex and more inclined towards crime. The connection of crime with mental health of prison is being ignored and as a result, which frequency of crime is on the rise (Mercury News, 2018).
The ignorance of the assessment of the mental health of the prisoners is an issue cause as it is blocking the understanding of criminal thought processing and their reasons. Due to the lack of focus on the mental state of a criminal before and after crime, makes the predictability of crime very difficult. The assessment of a prisoner’s deviation from crime can also become uncertain, as it is believed that, prisoners would not indulge in crime after going through the pain of imprisonment. However, in reality the opposite happens, as seen from the increasing rate of repetitive offenders.
The lack of mental health assessment of prisoners is an issue now, for the cu
ent trends of criminal activities are indicative of psychological perversion of human mind. With the passing of time, the social development is reaching new heights; however, the frequency of crime has also risen significantly. In earlier era, crimes were mainly centred on the aspects of money and violence. However, in recent times, the criminal activities have developed complex and psychological in majority, causing the occu
ence of crime, the reason of which needs to comprehended immediately (BBC, 2018).
The cu
ent research sheds light on the importance of assessing the role of mental health of the prisoners, with a specific reference to the prisoners in UK. The research explores the influence of mental health of prisoners in the context of their tendency to commit crime repetitively, namely recidivism. The research makes it logical that assessment of alongside physical health assessment, mental health assessment inside the prison is equally important for improving predictability of criminal activities.
1.3 Background and Justification
The birth of crime is the
ainchild of a wide range of human psychological activities. Aligning with the birth of crime, justice has evolved over thousands of years and developed the concept of punishment through imprisonment. Criminals kept in imprisonment are expected to learn from the mistakes and crave for a healthy social life that would nurture their mental needs.
As the prisoners are kept for varied duration, within a prison, psychological issues gradually creep in. However, as pointed out by Johnson et al. (2018), due to the reluctance in understanding the psychological aspect and mental health of the prisoners, crime is taking place within the prison and outside it through the form of recidivism. As per Brown et al. (2018), the assessment of the mental health issue among the prisoners, can help in identifying the pattern of criminal activity formation and develop a mechanism for preventing a crime from happening.
1.4 Deficiencies in the Evidence
The advancement of human society has led to the consideration of the rights of prisoners, especially in First World Countries. In prisons, the prisoners had to undergo an atmosphere, which often takes toll on the physical health. The philanthropists around the globe have been very vocal about the rights of prisoners, in the context of their physical health. However, it has been overlooked by ages that confinement within the prison also affects the mental health of the prisoners.
Despite providing an atmosphere, which is satisfactorily healthy for the prisoners’ physical health, and writing huge number of articles, researches and journals on the physical health of the prisoners, criminal activities are on the rise, within and outside the prison. Therefore, it becomes apparent that the mental health of the prisoners has their roots in the development of crimes and unfortunately, there is very little literature available on the topic, thus making the cu
ent research topic relevant and worth consideration.
1.5 Audience
The first, who are affected by the mental health of the criminals are the criminals themselves. Those who are able to retain a normal mental health during and after their time in the prison, in most cases get back to the mainstream of social life and abstain themselves from any criminal activity. The family members of the criminals gets affected the most as after a criminal is sent to prison, neighbours, and society outcasts the family members.
Another problem faced by the family members of a criminal is the possibility of the recu
ence of the crime. A lack of mental health assessment in the prison leads to further defragged resolve, resulting in repetitive crimes, which affects the prisoners as well as their family. Last but not the least, it has to be mentioned that the society in which everyone leaves are affected by the mental health condition of the prisoners, as crimes do not restrict themselves within a fixed genre.
1.6 Definition of Terms
The definition provided for the following terms hold satisfactory significance in the cu
ent research topic. All the mentioned variables act as interconnecting dots of the central idea of the research.
Crime
The term ‘crime’ is a relative term, which has a very complex structure of assessment. The norms, as argued by Quinney and Shelden (2018), for terming an action as crime differ from governing body of one country to another. However, a crime, in general is an act that violates the laws imposed by a country on its citizens. According to LaFree (2018), crime can take arise out of
eaking laws that form the basic human rights or can even form out of actions that a governing authority prohibits. In order to discourage people from doing crime, punishment is imposed through the form of fine or imprisonment.
Imprisonment
Imprisonment is the act of confining criminals inside a large compound that would enable absolute control of personal liberty, social interaction, and exercise of will. As defined by Mundt et al. (2018), imprisonment is the state in which persons associated with unlawful actions are held captive for periods respective of the degree of their crime. As pointed out by Meijers et al. (2018), during imprisonment criminals are allowed the basic need and are denied all forms of leisure including mental and physical saturation of pleasure.
Prison
In general perspective, prisons are places for keeping the criminals. A closer and more minute observation of the prison and its actions, as mentioned by Belcher (2018), show that it is a purgatory, a co
ection house and a security hub which enables that crime is controlled, criminals and discouraged from committing crime and co
ected mentally to that they can adjust themselves within the society without causing harm to anyone.
Prisoners
The people, based on evidence and under the order of a legislature, who are kept captive in a secured place, are termed prisoners. Loeffler et al. (2018) argued that criminals and prisoners are not same, although there is a vast similarity existing between the two. Criminals are people, who commit unlawful acts and can avoid becoming a prisoner by paying a fine. However, prisoners are also criminals; nevertheless, they are sentenced to spend a specific period in confinement.
Mental Health Issues of Prisoners
Inside a prison, the general norms of the society does not come into play, instead, it has its own way of functioning. As prisons impose the feeling of captivity, bereavement, and torture, prisoners often develop mental health issues. As per Gatherer et al. (2018), prisoners suffer from mental issues like low self-esteem, violent emotional outburst, isolation, faithless ideology and mental instability. It is worth the mention that the degree of mental health deterioration depends on the duration of the imprisonment.
Recidivism
Recidivism refers to the recommitting of crime by criminals even after serving sentence and spending time in prison. As per Loza (2018), recidivism is directly proportional to the level of mental distu
ance developing within the minds of criminals during their sentence in prison. According to Brame et al. (2018), recidivism is the result of negligent assessment of mental health of the prisoners before, during and after their imprisonment.
Mental Health Care
According to the observation of Cabassa et al. (2018), the requirement for the physical wellbeing and mental wellbeing are different. In case of mental health care, the factors, which causes the mental health of a person stabilised and healthy is taken under consideration and care services are, applied with the help of medical carers, who have the practical and theoretical knowledge of keeping the mental state of a person rational, health and functioning.
1.7 Purpose of the Research
The purpose of the study is to provide, an all in assessment of the significance of prisoners’ mental health, which includes the factors that shape the deteriorating thought process and development of crime. The cu
ent research explores the unexplored aspects of prisoners’ mental health and its effect on the shaping of the society, seen from a
oader spectrum. The research would also how important is the assessment of the mental health prisoners, as the prisoners are locked up in an atmosphere where the normal terms of social life does not apply. The research aims at providing valuable information about mental health and its associated issues, their solution in the context of prisoners, in UK.
1.8 Research Questions
Placing special emphasis on the research topic and its implied objectives, the following qualitative and quantitative questions have been framed.
Qualitative Research Questions
What is the significance of mental health care for prisoners in UK prisons?
Based on the above qualitative questions the following questions are framed.
· What are mental health issues faced by prisoners?
· How can the mental health issues be addressed in prisons?
· Why is mental healthcare needed for avoiding recidivism?
Quantitative Research Questions
· How far the mental health issues have had affected UK Prisoners?
· How frequently do the UK prisoners tend to commit recidivism?
· What mental healthcare procedures are useful for UK prisoners?
· How far are the mental healthcare procedures effective?
1.9 Summary
In the cu
ent chapter, the researcher has successfully provided details of the research topic, the area of concern, the significance of the research, the research questions, definition of research topic variables and affected audience. With the help of this chapter, the researcher would be able to discuss legible concepts, theories, and models in the following chapter, which is better known as literature review. Therefore, the importance of the cu
ent chapter cannot be ignored or considered causally.
Chapter 2: Literature Review
2.1 Preface
Similar to that of any regular literary research a wide range of variables interplays upon the backdrop of the context. In order to understand the core nature, character, and interaction of the variables, one has to go through each variable and connect the dots projected on the board of understanding, resulting in the formation as well as justification of research topic. In the cu
ent chapter, the base variables of the research topic have been discussed in details, with the aim of providing comprehension.
2.2 Concept of Imprisonment
The concept of imprisonment is very old. Earlier the rulers for offences committed put the offenders behind bars either petty or grave. The king was the sole person who acted as a judge and proclaimed the amount of punishment, which was to be handed over to the criminal. As per Reid (2018), modern day judiciary system is much more refined and sentences to criminals are passed by assessing the gravity of the crime and its impact on the society. Based on this the modern society has adopted four concepts of punishment namely dissuasion, vengeance, incompetence, reclamation and atonement. Fear of imprisonment of an individual dissuades the person from committing a crime.
However, mentalities of individuals differ, some mischievous types of persons wreck vengeance on the society by committing heinous crimes, and their punishment is very stiff. According to de Leon Villalba (2018), criminals with long standing past criminal records who intend to commit series of crimes in spite of warnings are rendered impotent so that these criminals cannot cause any further harm to the society. As argued by Mazerolle et al. (2018) persons with no criminal records or minors are provided reclamation and atonement to help them return to the main stream of the society.
2.3 Causes and Justification for Imprisonment
Co
ection is one of the most important aspects in life. The purpose of imprisonment can be segregated into four major parts as retribution, incapacitation, dete
ence, and rehabilitation. Retribution can be stated as compensating the crimes committed against society by holding back freedom. As argued by Scott (2018), retribution is one of the most commonly used punishment methodology that is being used in cu
ent judiciary of UK.
However, according to Earle (2018), the retribution method of penalising a criminal is the main cause for engaging maximum number of prisoners in cells as it is maximising the penalty period, which they need to serve. Eliminating criminals from society so that innocent people are unharmed is Incapacitation. Incapacitation is meted out to criminals who commit heinous crimes. The fear of imprisonment deters people from committing crimes and such dete
ence prevents future crimes. Proper rehabilitation activities such as education, imparting job-oriented trainings and proper counselling by experienced persons often transform a criminal to a law-abiding citizen.
2.4 Positive Aspects of Imprisonment
Although minute, there are some positive aspects of imprisonment. As defined by Wright and Cain (2018), the lonely environment of the prison cell helps in taking a recapitulation of the past life of the prisoner. Prisoners can assess their strength, weakness and plan a better strategy.
Nylander et al. (2018), on the other hand stated that courses in skill development and social behaviour help a lot in shaping the future life of prisoners after their release from detention. A prisoner has a lot of time for himself, as he is free from the daily chores of life and does not need to bother about time. The skill development courses keep the prisoner occupied with miscellaneous works thus, reducing the idle time.
However, the skill development courses should be imparted to prisoners by taking into account their knack for the particular type of training being imparted to them. Sometimes these prisoners become excellent artisans and the prison authorities in the market sell their products. The revenue earned from these sales is given to these prisoners at the time of their release.
2.5 Prisons of the United Kingdom— the System
There are certain regulations, which govern the prisons of UK. Officers of the Independent Monitoring Board monitor these who report to the Chief Inspector of Prisons a Government appointed official monitoring the security issues of the prison buildings, over occupancy and handling of the prisoners. As defined by Weeks (2018), the cu
ent state of the prisons in UK is far from satisfactory. Individuals committing offences are sent to prison. The more serious the crime is, the longer, the trial and sentence. Offences such as murder entail life imprisonment.
However, in some cases depending on the attitude of the person while serving the sentence in prison an early release from prison may be granted due to good behaviour and enough evidence to indicate a change in personality of the person for the better. Earlier prisons were considered countless number of small, dark dungeons. As per Moazen et al. (2018), of late the UK Government has constructed some spacious and hygienic detention centres with separate areas for each rehabilitation activity such as learning, skill-based training, medical activities and physical exercise. According to Martin et al. (2018), the modern-day prisons are designed with the concept of helping the prisoners to rehabilitate and change themselves into law-abiding citizens. These are constantly plagued by over occupancy resulting in prisoner safety and health issues.
2.6 Negative Aspects of Imprisonment
The most difficult stage of imprisonment is adaptation to a prisoner life. As mentioned by Toman et al. (2018), the process of imprisonment results in major psychological transformations. When imprisoned for the first time, the individual finds their life undergoing a drastic change. They have to adapt to very harsh and tough daily routines, which are very unpleasant, stressful, and difficult with no privacy and liberty. As argued by Meyers et al. (2018), the harsher the punishment for the prisoners the more they suffer from deep psychological disorders which are permanent in nature. Prisoners start thinking and behaving i
ationally.
However, for the seasoned and mentally insane ones the prison makes no difference. Since imprisonment denies a person’s independence, capability of decision-making, disappears causing problems to the prisoners in acclimatising to the situation. A few percentages of prisoners fail and those who do overcome this situation by silently obeying the tough routines imposed on them gradually lose their capability to take decisions on their own relying heavily on the authorities for guidance. In fact, when these inmates are released from prison they face a very tough time in coming back to normal life since prisoners are unable to do things on their own, which sometimes leads to self-destruction, which is a serious symptom of mental health issue of a prisoner.
2.7 Mental Health Issues amongst Prisoners
Inmates exploit the weakness and inattention of other prisoners and exploit them, which leads to an atmosphere of suspicion and mistrust. As per Cooper et al. (2018), some inmates adopt a tough attitude to avoid being exploited. Some prisoners avoid high-risk areas of the prison and others keep themselves confined to their cells to avoid exploitation. Few inmates also devise crude weapons and keep these handy to protect themselves.
This is another symptom of mental health issue of a prisoner. As stated by Young et al. (2018), mental disorder noticed amongst long serving inmates is that after release they totally move away from people of the society and lead a life of complete loneliness keeping completely unto themselves and do not speak with nor trust anyone. They are humourless and behave like terminally ill patients.
According to Wainwright et al. (2018), prison observers have found that particularly long serving inmates are prone to violent forms of prison culture, post release. This is also a sort of mental disorder. Since prison culture prohibits any sign of weakness the...