Did prisoners take their lives because they could no longer face violent, drug-ridden jail? – Chief Inspector

Peter Clarke, HM Chief Inspector of Prisons, has asked whether prisoners in HMP & YOI Nottingham took their own lives because they could no longer face life in the violent, drug-ridden jail.

In one of the most disturbing inspection reports in recent years, Mr Clarke posed the question in relation to eight apparent self-inflicted deaths between inspections in February 2016 and January 2018, part of an “appalling and tragic” picture of suicide and self-harm in Nottingham.

The formal cause of death in those cases will be decided by inquests but Mr Clarke said: “For too long prisoners have been held in a dangerous, disrespectful, drug-ridden jail. My fear, which may prove to be unfounded, is that some could face it no longer and took their own lives.”

HM Inspectorate of Prisons (HMIP) inspected the East Midlands jail in 2014. That was, like the vast majority of inspections, an unannounced visit. Safety then was assessed as poor, the lowest grade. The following inspections in 2016 and 2018 were, unusually, announced in advance. Despite this, safety was yet again found to have remained at a poor assessment. This spurred Mr Clarke to invoke the first ever use of a new ‘Urgent Notification’ protocol, which requires the Secretary of State for Justice, publicly, to take personal responsibility for improving a jail with significant problems. This centred on a “dramatic decline” at Nottingham and a “persistent and fundamental lack of safety”.

Mr Clarke said: “This prison will not become fit for purpose until it is made safe. It was clear from our evidence that many prisoners at Nottingham did not feel safe.” Inspectors identified disturbing findings:

  • Forty per cent of prisoners in the inspection survey said they felt unsafe on their first night in the jail; 67% that they had felt unsafe at some point during their stay; and 35% that they felt unsafe at the time of the inspection. Well over half reported bullying or victimisation.
  • Reported violence had not reduced since 2016, with 103 assaults against staff in the six months before the inspection. In the same period, there were nearly 200 incidents of prisoners climbing on the safety netting between landings. Inspectors said the overall level of disorder “contributed to a tense atmosphere at the prison.”
  • Well over half of prisoners said drugs were easily available and 15% had acquired a drug problem since entering the prison.
  • Use of force by staff had increased considerably since 2016 with nearly 500 incidents in the six-month period prior to the inspection, yet governance and supervision of such interventions were weak.
  • Just under half of prisoners had mental health needs and a “very high” 25% – 116 prisoners – were under psychiatric care. A quarter of prisoners said they felt suicidal on arrival in Nottingham.
  • Levels of self-harm were far too high, with 344 occurrences recorded in the six months up to the inspection.

Not surprisingly, Mr Clarke said, “in a prison which could be defined by the prevalence of drugs and violence, the level of suicide and self-harm was both tragic and appalling. Since our previous visit, eight prisoners had taken their own lives, with four of these tragedies occurring over a four-week period during the autumn of 2017.  Just a few short weeks after this inspection, a ninth prisoner was believed to have taken his own life.

“We were concerned that some repeated criticisms related to these deaths made by the Prisons and Probation Ombudsman (PPO) (which investigates prison deaths) had not been adequately addressed. For example, cell call bells were still not being answered promptly.”

Mr Clarke added: “We do not claim that the prison had been completely inactive in the face of these challenges. A new violence reduction strategy had been prepared in late 2017… However, this work was fitful and had yet to have an impact.” The prison also had a drug supply reduction policy, though it was not embedded and was not effective.

Inspectors also acknowledged an increase in staff numbers in recent months, though they noted that “too many staff were passive, lacked confidence in dealing with issues or in confronting poor behaviour, and prisoners did not yet see them as reliable or able to deal with the many daily frustrations they faced.”

Health care was reasonably good, and there were plans to improve mental health provision. Daily routines were more predictable and more activities were available for prisoners. There were also “some creditable efforts to prepare men for release”.

The prison governor assured inspectors they had understood the scale of the problems. Mr Clarke said: “I am hopeful that the Urgent Notification will galvanise Her Majesty’s Prison and Probation Service (HMPPS) to provide the support the prison needs to make it an acceptable environment in which to hold prisoners. If this is to happen, there will need to be levels of supervision, support and accountability that have been absent in the past.” The HMPPS action plan drawn in response to the Urgent Notification in January 2018 promised “much that is welcome in terms of review, audit and analysis. However, this must all be translated into tangible action to improve the day-to-day experience, safety and well-being of prisoners. Unless this happens, I fear that progress will be neither substantial nor sustainable.”

Overall, Mr Clarke said:

“This was yet again a very poor inspection at Nottingham that left me with no alternative but to bring matters directly to the attention of the Secretary of State by invoking the urgent notification procedure. The record of failure, as set out in this report, cannot be allowed to continue.”

Michael Spurr, Chief Executive of Her Majesty’s Prison & Probation Service, said:

“We published an immediate response to the Chief Inspector’s concerns on 14 February and have today published a comprehensive plan setting out the practical actions we are taking to improve conditions at HMP Nottingham. Drug testing has been increased, specialist staff are working with vulnerable prisoners and safety is the absolute priority for the Governor and staff every day. We have strengthened management arrangements, are providing external support and will monitor progress closely over the coming months.”

A copy of the full report, published on 16 May 2018, can be found on the HM Inspectorate of Prisons website at: www.justiceinspectorates.gov.uk/hmiprisons

Prison Deaths From New Psychoactive Substances Rises To 79 Says Ombudsman

spice

The number of prisoner deaths in which the use of new psychoactive substances (NPS) may have played a part has now risen to at least 79, said Prisons and Probation Ombudsman (PPO) Nigel Newcomen. Tonight (11/7/2017) he addressed the All-Party Parliamentary Group on Penal Affairs at the House of Lords.

Looking back at his six-year tenure, and discussing the rise in self-inflicted deaths in prisons, Mr Newcomen said the prison system was yet to emerge from a crisis. He discussed major themes that have emerged from his investigations and studies into deaths in custody that need to be acted upon, and mentioned the problem of mental ill-health among prisoners, which needs to be better recognised by staff and, if recognised, better managed.

 

Nigel Newcomen said:

“As well as mental ill-health, another contributory factor to the increase in suicide in prison is the epidemic of new psychoactive substances. My researchers have now identified 79 deaths between June 2013 and September 2016 where the deceased was known or strongly suspected to have taken NPS before death or where their NPS use was a key issue during their time in prison. Of these investigations, 56 were self-inflicted deaths.

In the past, Mr Newcomen has highlighted the four types of risk from NPS:

  • a risk to physical health – NPS use may hasten the effects of underlying health concerns;
  • a risk to mental health, with extreme and unpredictable behaviour and psychotic episodes, sometimes linked to suicide and self-harm;
  • behavioural problems, where the NPS user has presented violent or aggressive behaviour, which is often uncharacteristic for that prisoner; and
  • the risk of debt or bullying, as the use of NPS often results in prisoners getting into debt with prison drug dealers.

Nigel Newcomen said:

“Establishing direct causal links between NPS and the death is not easy, but my investigations identified a number of cases where my clinical reviewers considered that NPS led to psychotic episodes which resulted in self-harm. In other cases, NPS led to bullying and debt of the vulnerable, also resulting in self-harm.

“NPS is a scourge in prison, which I have described as a “game-changer” for prison safety. Reducing both their supply and demand for them is essential.

“But neither mental ill-health, nor the availability of NPS wholly explain the rise in suicides in prison. Every case is an individual tragedy with numerous triggers. And, in such complex circumstances, the safety net of effective suicide prevention procedures is essential. Unfortunately, too often my investigations identify repeated failings in prison suicide prevention procedures.”

Mark Leech editor of The Prisons Handbook said: “This further rise in prison deaths attributable to NPS is deeply concerning, it shows that despite a range of measures introduced by HMPPS, and a Thematic Review by the Chief Inspector of Prisons in December 2015, these dangerous drugs continue to cause deaths inside our prisons.

“Research shows that synthetic cannabinoids, usually known as Spice or Black Mamba, form the only category of illicit drugs whose use by prisoners is higher in prisons than in the community, 10% compared to 6%, and there is no easy answer to it – many of those who take NPS say they do so for reasons of boredom one solution therefore is to resource the Prison Service to deliver the active purposeful regimes that have been steadily stripped away since 2010.”

The Prisons Handbook: Further reading and research on NPS can be found at the following links

■ NPS in Prisons – a Toolkit for Staff: http://www.nta.nhs.uk/uploads/9011-phe-nps-toolkit-update-final.pdf

■ Drug Misuse: Findings from the 2015/16 Crime Survey for England and Wales https://www.gov.uk/government/statistics/drug-misusefindings-from-the-2015-to-2016-csew

■ Changing patterns of substance misuse in adult prisons and service responses. A thematic review by HM Inspectorate of Prisons https://www.justiceinspectorates.gov.uk/hmiprisons/ wp-content/uploads/sites/4/2015/12/Substance-misuseweb-2015.pdf

■ Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS)1st April 2015 to 31st March 2016 http://www.nta.nhs.uk/uploads/adult-statistics-from-thenational-drug-treatment-monitoring-system-2015-2016[0].pdf

■ HM Chief Inspector of Prisons for England and Wales Annual Report 2014–15 https://www.justiceinspectorates.gov.uk/hmiprisons/wpcontent/uploads/sites/4/2015/07/HMIP-AR_2014-15_TSO_ Final1.pdf

■ HM Chief Inspector of Prisons for England and Wales Annual Report 2015–16 https://www.justiceinspectorates.gov.uk/hmiprisons/wpcontent/uploads/sites/4/2016/07/HMIP-AR_2015-16_web-1. pdf

■ Spice: the bird killer (User Voice May 2016) http://www.uservoice.org/wp-content/uploads/2016/05/ User-Voice-Spice-The-Bird-Killer-Report-Low-Res.pdf

■ Project NEPTUNE guidance, 2015 www.neptune-clinical-guidance.co.uk/wp-content/ uploads/2015/03/NEPTUNE-Guidance-March-2015.pdf

■ Harms of Synthetic Cannabinoid Receptor Agonists (SCRAs) and Their Management. Novel Psychoactive Treatment UK Network NEPTUNE http://neptune-clinical-guidance.co.uk/wp-content/ uploads/2016/07/Synthetic-Cannabinoid-ReceptorAgonists.pdf

■ Ministry of Justice press release, 25 January 2015 www.gov.uk/government/news/new-crackdown-ondangerous-legal-highs-in-prison

■ Centre for Social Justice, ‘Drugs in prison’, 2015 http://www.centreforsocialjustice.org.uk/library/drugs-inprison

■ EMCDDA, European Drug Report 2015: ‘Trends and developments’, June 2015 www.emcdda.europa.eu/publications/edr/trendsdevelopments/2015

■ Drugscope, ‘Not for human consumption: an updated and amended status report on new psychoactive substances and ‘club drugs’ in the UK’,2015 http://www.re-solv.org/wp-content/uploads/2015/06/Notfor-human-consumption.pdf

■ PHE, ‘New psychoactive substances. A toolkit for substance misuse commissioners’, 2014 www.nta.nhs.uk/uploads/nps-a-toolkit-for-substancemisuse-commissioners.pdf

■ Home Office, ‘Annual report on the Home Office Forensic Early Warning System (FEWS). A system to identify new psychoactive substances (NPS) in the UK’, September 2015 https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/461333/1280_EL_FEWS_Annual_ Report_2015_WEB.pdf

■ Global Drug Survey 2016 https://www.globaldrugsurvey.com/past-findings/theglobal-drug-survey-2016-findings/

A copy of the speech can be found on the PPO’s web site from 14 July 2017. Visit www.ppo.gov.uk.

Six prison homicides in one year reflect unacceptable level of prison violence, says Ombudsman

Screen Shot 2016-09-21 at 15.56.17

Homicides in prison are still rare but the number has increased, vividly illustrating the unacceptable level of violence in prisons in England and Wales, said Nigel Newcomen, Prisons and Probation Ombudsman (PPO). Today he published a bulletin on lessons that can be learned from his investigations.

The PPO investigates all deaths in custody and his remit is to examine the circumstances surrounding the death and establish whether anything can be done to help prevent similar tragedies in the future. In December 2013 he published a bulletin which looked at 16 prison homicides investigated from 2003-4 to 2012-13, an average of 1.6 per year. The 2013 bulletin identified a number of concerns, in particular the need to improve the management of risk that vulnerable prisoners pose to one another. It led to operational changes in high security prisons.

In the three years that followed, from 2013-14 to 2015-16, another 13 prisoners were killed by another prisoner or prisoners (an average of 4.3 homicides per year). This bulletin considers the learning from six of those 13 homicides where investigations have been completed, and another two from the beginning of 2013.

The bulletin highlights the need for:

  • prisons to have a coordinated approach to identifying indicators and risks of bullying and violent behaviour, including the impact of new psychoactive substances and associated debt, and taking allegations of intimidation seriously;
  • prisons to have an effective security and cell-searching strategy, enabling weapons to be found and removed;
  • concerns about potentially vulnerable prisoners to be properly recorded and action taken to ensure prisoners are located in a place of safety; and
  • the police to be notified without delay when a prisoner appears to have been seriously assaulted, evidence preserved and all prisoners involved in an incident to be held separately until police arrive.

 

Nigel Newcomen said:

“The killing of one prisoner by another in a supposedly secure prison environment is particularly shocking, and it is essential to seek out any lessons that might prevent these chilling occurrences in future.

“The cases we studied had little in common beyond their tragic outcome. Nevertheless, what is clear is that the increased number of homicides is emblematic of the wholly unacceptable level of violence in our prisons.

“The bulletin does identify a number of areas of learning: the need to better manage violence and debt in prison, not least that associated with the current epidemic of new psychoactive substances; the need for rigorous cell searching to minimise the availability of weapons; the need for careful management of prisoners known to be at risk from others and the need to ensure prisons know how to respond when they have an apparent homicide.”

Mark Leech, editor of The Prisons Handbook for England and Wales and Converse, said:

“The rising tide of violence in our prisons is what happens when staffing levels are cut beyond safe levels, when budgets are slashed that allow already attenuated regimes to deteriorate further and when the Prison Service has yet to get to grips with the impact of high levels of New Psychotic Substances which are increasingly widely available across the entire prison estate.

“When you strip away the political rhetoric, the promises of more staff, the assertions that the Prison Service is doing all it can, the simple fact is that you cannot run a modern, safe, prison service on tuppence ha’penny – that’s the shockingly simple truth of the matter at the end of the day.”

A copy of the bulletin is here.

Better Safety Must Underpin Prison Reform Says Ombudsman As Suicides, Homicides and Deaths From Natural Causes Reach Record Levels

Screen Shot 2016-09-08 at 19.20.19

The past year saw a 34% rise in prison suicides, more deaths from natural causes and the highest number of homicides in prison for many years, said Prisons and Probation Ombudsman Nigel Newcomen. Today he published his fifth and final annual report and warned that prison reform could stall without a focus on safety and fairness.

The Prisons and Probation Ombudsman (PPO) independently investigates the circumstances of each death in custody and identifies lessons that need to be learned to improve safety. In 2015-16:

  • PPO investigations were started into 304 deaths, 21% more than the year before;
  • the PPO began 10% more investigations into deaths from natural causes (172 deaths), largely as a consequence of rising numbers of older prisoners (the average age of those who died of natural causes was 61);
  • investigations were started into 103 self-inflicted deaths, the highest number in a single year since the Ombudsman began investigating deaths in custody, and a 34% increase from 2014-15;
  • there were six apparent homicides, compared with four the previous year; and
  • a further 11 deaths were classified as ‘other non-natural’ (usually drug related) and 12 await classification.

Nigel Newcomen said:

“Over the past year, deaths in custody have risen sharply, with a shocking 34% rise in self-inflicted deaths, steadily rising numbers of deaths from natural causes and the highest number of homicides since my office was established.

“Together with rising levels of violence and disorder, these figures are evidence of the urgent need to improve safety and fairness in prison. Progress in prison reform will be limited unless there is a basic underpinning of safety and fairness on which to build.

“Unfortunately, I have been saying many of the same things for much of my time in office. While resources and staffing in prisons are undeniably stretched, it is disappointing how often – after invariably accepting my recommendations – prisons struggle to sustain the improvement I call for. Ensuring real and lasting improvement in safety and fairness needs to be a focus on the new prison reform agenda.”

On suicides, he said:

“It is deeply depressing that suicides in custody have again risen sharply but it is not easy to explain this rising toll of despair. Each death is the tragic culmination of an individual crisis. Some major themes do emerge from my investigations, for example the pervasiveness of mental ill-health and the destructive impact of an epidemic of new psychoactive substances, but no simple explanation suffices.

“In such a complex context, effective and thoughtful efforts at prevention by prison staff are vital. Unfortunately, too often my investigations identify repeated procedural failings. For example, I have frequently identified gaps in the assessment of risk of suicide and self-harm and poor monitoring of those identified as being at risk. More can and should be done to improve suicide and self-harm prevention in prison”

The other principal part of the PPO’s remit is the independent investigation of complaints. In 2015-16:

  • the total number of new complaints received was 4,781, a 4% decrease on the previous year;
  • 2,357 investigations were started, just 23 cases fewer than the year before;
  • overall, 2,290 investigations were completed, a 6% increase on 2014-15;
  • in 40% of the investigations, the PPO found in favour of the complainant, compared with 39% the previous year; and
  • the largest category of complaints was about lost, damaged and confiscated property.

Nigel Newcomen said:

“The ability to complain effectively is integral to a legitimate and civilised prison system. In each of my annual reports, I have listed the raft of challenges facing the prison system, which go some way to explaining the sustained levels of complaints reaching my office. These strains in the system may also be reflected in the increasing proportion of complaints from prisoners that I uphold because prisons got things wrong, often in contravention of their own national policies.

“Avoiding mistakes and ensuring basic fairness will also need to be at the heart of any prison reforms. Greater autonomy for governors must be balanced by clear statements of minimum entitlements for prisoners.”

The recommendations made as a result of PPO investigations are key to making improvements in safety and fairness in custody. The past year also saw the publication of a range of learning lessons publications which look across individual investigations to identify broader themes. In 2015-16, bulletins looked at how to avoid the increase of suicides by prisoners in segregation units, how to address deaths associated with new psychoactive substances and how to manage those at risk of suicide in the early days of custody. A thematic study looked at the issue of mental ill health, and a bulletin looked at how legal mail should be dealt with.

Nigel Newcomen said:

“I pay tribute to my staff who have worked so hard to enable me to deliver the commitments that I made on my appointment five years ago: to develop a new programme of learning lessons publications, to improve the quality and timeliness of fatal incident and complaint investigations and to do more with less. We will have to do still more in 2016-17. I know my staff will rise to the challenge.”

A copy of the report can be found here www.ppo.gov.uk.

£10m to reduce deaths in custody – but NOMS refuse to publicise deaths in custody details

prisons-goveAn extra £10 million is to be ploughed into prisons as part of urgent attempts to improve safety behind bars – at the same time as one expert commentator revealed the National Offender Management Service are refusing to proactively publicise deaths in custody at all.

Justice Secretary Michael Gove announced the funding as he conceded the most recent statistics on deaths in custody and violence in jails were “terrible”.

He disclosed the move in a letter to the Commons Justice Committee, which warned in a recent report that the issue threatens to “severely undermine” the Government’s prisons overhaul.

Figures published by the Ministry of Justice last month showed there were 100 apparent self-inflicted deaths in the year to March – the highest level for more than a decade.

There were more than 20,000 assaults in the 12 months to December, a rise of 27% year-on-year, and nearly 5,000 attacks on staff – a jump of more than a third compared with 2014.

Mr Gove said: “I am well aware that the most recent figures for deaths in custody and violence in prisons, which the Committee’s report highlights, are terrible.

“These cause me considerable personal concern, and I have no wish to minimise, excuse, or divert attention away from these increasing problems.

“I want to assure you and the Committee that there is no complacency in dealing with these issues.”

He set out a number of steps that have already been taken, including a net increase of prison officers of 530 since January last year, plans to roll out body-worn cameras across the estate and new laws to crack down on new psychoactive substances (NPS) – also known as “legal highs”.

Mr Gove said there is a need to “improve our ability” to respond to new threats faced by jails.

“I therefore wanted to make you aware that in addition to the £5 million which we have committed to rolling out body-worn cameras and additional CCTV, I have, with immediate effect, allocated an additional £10 million to deal with prison safety issues.”

He said the Government is “quite deliberately not being prescriptive” about how prison governors may use the additional funding, but set out possible uses including additional staff, investment in staff training, equipment and drugs testing,

Mr Gove added: “Ultimately I am clear that the only way to reduce violence in our prisons is to give Governors and those who work in prisons the tools necessary to more effectively reform and rehabilitate offenders.”

He also repeated his call for a rethink on the use of a scheme through which inmates can be let out for short periods towards the end of their sentence.

Mr Gove had signalled his backing for more prisoners to be released into the community on temporary licence in a recent speech.

He said in the letter: “Properly used, ROTL (release on temporary licence) can do a huge amount to improve a prisoner’s chances of finding a long-term job.

“ROTL eases the significant transition between custody and liberty, and enables prisoners to adjust to the expectations and demands of society.

“I am clear that allowing a prisoner out on temporary release is not an easy option – it is a preparation for the hard choices that life outside prison demands.”

An overhaul billed as the biggest shake-up of Britain’s prison system since the Victorian era was placed at the heart of the Queen’s Speech last week.

But Mark Leech, editor of The Prisons Handbook for England and Wales, revealed that the National Offender Management Service (NOMS) was refusing to publicise deaths in custody.

Mr Leech said: “I have recently asked the head of NOMS to change the policy by which they refuse to publicise on their own account deaths in custody as they occur.

“Regrettably NOMS have refused to do this citing what to me at least are arguments that have no logical reasoning.

“When someone in the custody of the State dies, whatever the cause of death, there is in my view a duty on the State to announce it and be transparent about it.

“I find it deeply regrettable that they refuse to do so.”

You can read the NOMS refusal correspondence here (read from the bottom up)

 

G4S deny MP’s claim they told family their loved one had hanged himself – only to call back later to say he hadn’t

birmingham prison

A family who were wrongly informed their son had killed himself in prison has received an apology from the Government – but G4S, whose staff allegedly made the call, have said it never happened.

MPs heard the HMP Birmingham inmate’s relatives received a call earlier this month in which they were told he had taken his own life.

HMP Birmingham is operated by G4S.

But 30 minutes later they were told he was still alive, according to Labour’s Stephen Doughty.

The Cardiff South and Penarth MP called for an investigation into the error, also noting his constituent has endured a “lengthy bureaucratic process” in efforts to transfer him to a secure mental health unit.

Prisons Minister Andrew Selous apologised to the family concerned and agreed to discuss the inmate’s case further.

Speaking in the Commons, Mr Doughty said: “I share the concerns of many honourable members about the situation involving prisoners with mental health issues and the risks they pose not only to themselves but also to others and indeed are faced by them in prisons, and the concerns that the staffing cuts are having on that.

“I’ve been in correspondence with the minister about a specific constituent of mine, who has endured a lengthy bureaucratic process about potential transfer to a secure mental health unit that would be more adequate for his needs.

“But also I’m sorry to say that his family had a call this month telling them that he had killed himself, only to be told half an hour later that he hadn’t.

“That’s an extraordinary situation, and I think I’d like to see the minister investigating that fully and also to be looking very closely at the case that has been made for him to be transferred away from HMP Birmingham, where he’s currently being held.”

Mr Selous replied: “I’d certainly like to apologise to the family through you for being given terrible news like that that clearly wasn’t true, and if you’d like to write to me again – or indeed even come and see me – about that particular issue, I’d be more than happy to further discuss it with you.”

However, following publication of the story on www.converseprisonnews.com we have been contacted by G4S who said the story was “incorrect”.

A G4S spokesman said: “It is something that was said in Parliament, but our investigations have shown that we didn’t call the prisoner’s family to tell them that the prisoner had died.

“We have checked phone records to that effect.

“In fact, we never call prisoner’s families to inform them of a death in custody, but instead we meet them in person.
“So we’re confident that any phone call referenced didn’t come from our prison.”

HMP WOODHILL – Some notable improvements but concerns over violence and suicides

woodhillThe provision of work, training and education had improved at HMP Woodhill and its rehabilitation services were good, but violence and a high number of self-inflicted deaths were significant concerns, said Martin Lomas, Deputy Chief Inspector of Prisons. Today he published the report of an unannounced inspection of the jail near Milton Keynes.

HMP Woodhill is as a core local prison, meaning while the bulk of its population is a mixture of remanded and short-sentenced men with the mental health, substance misuse and other issues typical of local prisons, it also has a high security function for a small number of category A prisoners. The prison also has a Close Supervision Centre (CSC), part of a national system for managing some of the most high-risk prisoners in the system, which is inspected separately. Previous inspections of HMP Woodhill have repeatedly raised concerns about the prison and, in particular, weaknesses in the support of men at risk of suicide or self-harm and the poor provision of work, training and education. This inspection found real improvements had been made but more still needed to be done to reduce the likelihood of further self-inflicted deaths. There had been five more self-inflicted deaths since the last inspection, making nine since 2012. This was an unacceptable toll.

Inspectors were concerned to find that:

  • early days in custody are a critical time and five of the nine deaths since 2012 had involved new arrivals who had been in the prison for less than two weeks;
  • reception processes were efficient but the role of the first night centre was undermined because it was also used to hold prisoners difficult to locate elsewhere;
  • some prisoners requiring opiate substitution treatment or alcohol detoxification were mistakenly placed in the first night centre rather than the specialist stabilisation unit, which was particularly dangerous for prisoners requiring alcohol detoxification;
  • too many first night cells were dirty and poorly equipped;
  • recommendations by the Prisons and Probation Ombudsman following previous deaths in custody had not been implemented with sufficient rigour;
  • there were not enough Listeners (prisoners trained by the Samaritans to provide confidential emotional support to prisoners);
  • mental health services had been hit by staff shortages and only 18% of residential staff had received mental health awareness training in the past three years; and
  • although the prison felt calm, a sizeable minority (one in five prisoners) said they felt unsafe at the time of the inspection and levels of violence were higher than elsewhere and included some serious assaults on prisoners and staff.

 

However, inspectors were pleased to find that:

  • impressive progress had been made in the provision of work, training and education, and the provision of activity for short-term prisoners was an example other local prisons could follow;
  • the quality of teaching and learning had improved and there was good emphasis on helping prisoners to improve their literacy and numeracy;
  • activities were intelligently geared to the labour markets in areas to which most prisoners would be returning;
  • the support given to prisoners at risk of suicide and self-harm was often better than the records showed and those prisoners subject to ACCT monitoring told inspectors they felt well cared for;
  • security arrangements were generally appropriate for the population;
  • drug availability was lower than elsewhere, although the prison needed to be alert to the increasing availability of Spice;
  • the environment in the segregation unit had improved and staff worked well with some very complex prisoners;
  • there had been good progress in reducing the backlogs in risk assessments and sentence planning and public protection arrangements were good; and
  • despite the complexity of new arrangements, including two new community rehabilitation companies working in the prison, most practical resettlement services were good.

 

Martin Lomas said:

“HMP Woodhill is an improving prison and its very good purposeful activity and good rehabilitation services are better than we have seen recently in many other local prisons. Good outcomes in these areas help to create a sense of purpose and hope and reduce frustration and tension. Despite this, levels of violence are a significant concern and the number of self-inflicted deaths in recent years has been unacceptably high. The main priority of the prison must be to tackle these two areas.”

 

Michael Spurr, Chief Executive of the National Offender Management Service, said:

“As the Chief Inspector says, Woodhill has made impressive progress in providing work, education, training and support to help prisoners turn their lives around.

“Given the significant operational pressures the prison has faced this is an excellent achievement.

“Tackling increased levels of violence and preventing suicides is the top priority for the Governor and for the Prison Service as a whole. Tragically, as recent incidents at Woodhill have demonstrated, the challenge is considerable – but we will use the recommendations in this report to further develop and improve our approach.”

A copy of the full report can be found at: justiceinspectorates.gov.uk/hmiprison

Jury highly critical of Winchester Prison staff who ignored self-harm warnings on prisoner later found hanging

commits-suicide-in-jailSheldon Woodford was found hanging in his cell in HMP Winchester on 9 March 2015 and was pronounced dead at hospital on 12 March 2015.

After a two-week inquest, the  jury has returned a highly critical narrative conclusion finding that lack of staff, training and consistent care across the prison and  healthcare led to a failure to spot obvious and escalating patterns of risk regarding Sheldon’s self-harm.

Despite the self-harm warnings accompanying Sheldon’s arrival at the prison, neither the reception officer nor the first nurse who assessed Sheldon, placed him under suicide and self harm management programme in part due to the fact that vital information was not properly shared or made available. His risk of self harm and suicide was not formally assessed until ten days later, after Sheldon had cut his wrists.

The level of observations Sheldon was monitored under did not always always reflect his risk of self-harm – including staff only being required to check Sheldon twice an hour when he returned to prison after a serious suicide attempt. Meetings in relation to his risk of self harm were often not multidisciplinary and the prison staff did not receive adequate training to identify and manage his risk of self harm.

At Sheldon’s final case review, held three days after he returned from intensive care having attempted to hang himself (and five days before he placed a ligature round his neck for the second, fatal time), Sheldon’s risk was graded as “low”. This was despite the fact that the hospital who had discharged Sheldon had described him as “high risk”, a prison GP considered his risk to stem from his “impulsive” and “unpredictable” behavior, and the prison psychiatrist, told the inquest that the “low” grading was incorrect and inappropriate.

The jury retuning a highly critical narrative conclusion, found that the failure to identify Sheldon’s escalating levels of risk of self harm, insufficient levels of prison and healthcare staffing, inadequate training on how to assess and manage risks of self harm contributed to Sheldon’s death.  They also identified unstructured application of the suicide and self harm management programme resulting inadequate integration between prison and healthcare as a contributory factor in his death.

The Coroner indicated that she will be making recommendations to prevent future deaths in relation to training of prison staff and officers in suicide and self harm management and also in relation to the sharing of information.

Sheldon Woodford’s partner Alex said:

“We always believed that Sheldon was badly let down by the system at HMP Winchester and we are pleased that the jury found that this was the case.To have had to visit him once in an induced coma after a hanging attempt was bad enough, but we had hoped that the prison would learn from the risks that Sheldon was clearly presenting and provide him with the care and support he needed.To have to return again to an intensive care unit less than two weeks later, and to have to make the horrendous decision to turn off his life support machine, was devastating and broke our hearts.



We hope that the jury’s highly critical findings and the coroner’s Prevention of Future Deaths Report will mean that eventually other families will not have to go through this. We also hope that the government will consider the failures in staffing levels and training which contributed to Sheldon’s death before making any further cuts to the prison system”

Alex Tasker’s solicitor Karen Rogers said:

The failure to properly implement ACCT procedures in this case was shocking. The evidence showed there was far too much reliance on prisoners’ self-report, and insufficient attention paid to obvious and escalating risks of self-harm.”

Deborah Coles : Director of INQUEST said :

“Sheldon’s risk of suicide should have been obvious to anyone who was responsible to keep him safe. That the jury found such fundamental failings in care, training and staffing levels sends a clear warning to Government about the crisis in prisons. There have been 3 further self inflicted deaths in HMP Winchester. The Prisons Minister must account to Sheldon’s family as to what action is to be taken in response to the serious failings identified.”

 

Mentally ill inmate admits battering cell-mate to death

copsinwannoA mentally ill prisoner has admitted battering his cell mate over the head with a television set as he awaited trial for a random attack on a walker at popular beauty spot.

In June 2014, Taras Nykolyn, 46, pounced on Roger Maxwell as he took an early morning stroll near the Windmill landmark on Wimbledon Common in south-west London.

He forced the victim to the ground, smashing his face and breaking his wrist.

Then, while he was on remand at Wandsworth prison, Nykolyn killed Wadid Barsoum by hitting him with a TV, punching and stabbing him in their cell.

Ukrainian Nykolyn, of no fixed abode, pleaded guilty to both attacks at the Old Bailey with the help of an interpreter.

He admitted inflicting grievous bodily harm to Mr Maxwell on June 19 2014 and the manslaughter of Mr Barsoum on May 4 last year.

Alternative charges of grievous bodily harm with intent and murder were ordered to lie on file by the Recorder of London, Nicholas Hilliard QC, after hearing the defendant was suffering from mental illness at the time.

Prosecutor Simon Denison QC said: “Two psychiatric reports concluded that the defendant suffers from an abnormality of mental function, namely paranoid psychosis.

“They are satisfied that at the time of the killing of Mr Barsoum his responsibility was diminished.”

Although there was a possible defence of insanity to the attack on Mr Maxwell, the Crown was satisfied it was dealt with appropriately with the plea to a lesser charge.

Diana Ellis QC, defending, told the court that Nykolyn had been moved to HMP Belmarsh since the killing.

Then in November last year, he was transferred to Broadmoor secure hospital for an assessment before being sent back to the top security jail.

As the requirements have not been met for a hospital order, the defendant faces a jail sentence, the court heard.

Sentencing was adjourned to Friday, January 22.

HMP Wandsworth was built in 1851 and is now the largest prison in the UK, holding 1,877 inmates

Alongside HMP Liverpool, which is of similar size, the category B jail is one of the largest prisons in Western Europe.

The spot where Mr Maxwell was attacked is not far from where young mother Rachel Nickell was stabbed to death by schizophrenic Robert Napper on July 15 1992

In 2008, Napper pleaded guilty at the Old Bailey to manslaughter on the grounds of diminished responsibility bringing to an end the inquiry into one of the most notorious killings in modern British criminal history.

Police sergeant among accused in manslaughter trial over death in custody

Kingshott, Marsden, Tansley
Kingshott, Marsden, Tansley

A police custody sergeant and two detention officers are to go on trial accused of killing a schizophrenic church caretaker who collapsed while in custody.

Sergeant Jan Kingshott, 44, and civilian staff Simon Tansley, 38, and Michael Marsden, 55, face trial at Bristol Crown Court.

The three defendants each deny two joint charges of the manslaughter of Thomas Orchard.

The first charge alleges that on October 10 2012 they did an act or series of acts which unlawfully killed Mr Orchard.

The second charge alleges that on the same day the Devon and Cornwall officers unlawfully killed Mr Orchard by gross negligence.

Mr Orchard died in hospital seven days after he was allegedly restrained at Exeter’s main police station having been earlier arrested on suspicion of a public order offence.

The trial is expected to last up to seven weeks before High Court Judge Mr Justice King.