![handle is hein.journals/cbmh32 and id is 1 raw text is: DOI: 10.1002/cbm.2227
EDITOR I AL WILEY
A review of services for vulnerable people
detained in Northern Ireland prisons: The impact
of underfunding
Northern Ireland (NI) is a distinct jurisdiction within the United Kingdom (UK), with a population of about 1.9 million.
It has a 25% higher prevalence of mental ill-health than the rest of the United Kingdom (UK; Brooke et al., 2020;
O'Neill & Rooney, 2018), attributed to the intergenerational trauma and enduring social deprivation of its post-con-
flict society. As might be expected, this higher level of need is reflected within its prison population of around 1400
men and 50-70 women at any one time (East, 2018). Between 2012 and 2019, there were 18 suicides and 5217
recorded incidents of self-harm within Northern Ireland prisons (Northern Ireland Audit Office, [May] 2019). During
the same period, a number of prison inspections and reviews reported that the care of vulnerable people in custody
required significant improvement (Criminal Justice Inspection Northern Ireland and the Regulation and Quality
Improvement Authority, 2014; European Committee for the Prevention of Torture and Inhuman or Degrading Treat-
ment or Punishment [CPT] 2017).
In November 2016, following the deaths of 5 prisoners in the preceding 12 months, and a Prison Ombudsman
for Northern Ireland (2016) report which was highly critical of the care provided to a vulnerable prisoner, the North-
ern Ireland Ministers for Justice and Health made a joint announcement that there would be a review into services
provided to vulnerable people in Northern Ireland prisons. Initial review work was undertaken by the Northern Ireland
Prison Service (NI PS) and the provider of healthcare in prisons, the South-Eastern HSC Trust (SEHSCT), but this work
did not progress to completion and it was subsequently deemed that a fresh independent review was necessary.
In July 2020, the Regulation and Quality Improvement Authority (RQIA) was jointly commissioned by the Depart-
ment of Health and Department of Justice to undertake the Review of Services for Vulnerable Persons Detained in
Northern Ireland Prisons (RQIA, 2021). For the purposes of the review, a 'vulnerable person' was defined as 'a person
with mental ill-health at increased risk of self-harm or suicide'. In keeping with its terms of reference, review team
members were primarily interested in whether the needs of people with mental ill-health and other vulnerability
factors, known to increase the risk of self-harm and suicide, were being met by the existing arrangements for plan-
ning, commissioning and delivery of care.
Determining the prevalence of vulnerability factors amongst the NI prison population is beset with challenges
due to the absence of a robust system for data collection and needs assessment. The self-reported level of vulner-
ability amongst this population, however, is high. Among pre-trial prisoners, 58% reported a history of substance
misuse, 44% history of self-harm, 16% drugs or alcohol withdrawal and 36% that they were receiving care from
community mental health services; 1% were considered to require immediate attention by mental health services
(Northern Ireland Audit Office, 2019). It should be noted that many people entering the prison system have more
than one vulnerability factor, in addition to co-morbidities, as measured against the United Nations Standard Mini-
mum Rules for the Treatment of Prisoners, known as the Mandela Rules (United Nations Office on Drugs and Crime
[UNODC], 2015). The scale and complexity of vulnerability highlights the need for high-quality mental health and
addiction services, in addition to robust safety arrangements, for vulnerable people detained in NI prisons.
The RQIA Review Team found that, although the NIPS and health care provider (SEHSCT) had made progress
in relation to safer custody arrangements and partnership-working and governance, improvement has been consid-
erably constrained by limited resources. Prison healthcare in Northern Ireland is significantly underfunded when
© 2022 John Wiley & Sons Ltd. 1 1
Crim Behav Ment Health. 2022;32:1-4.
wileyonlinelibrary.com/journal/cbm](ViewImageLocal?handle=hein.journals/cbmh32&div=1&collection=&method=preview&ext=.png&size=3)
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