Prisoners with a cognitive impairment are more likely to be exploited by other prisoners and demonstrate deterioration in their mental health and adaptive skills due to the demands of prison life. Sadly, institutionalisation was very common among the cognitively impaired cohort, with one, incarcerated since the age of 14, now referring to prison as ‘home’ and having great difficulty in making decisions as simple as what to have for lunch. They may also learn a variety of negative institutionalised behaviours such as violence and victimisation through the modelling of peer group behaviour. People with a cognitive impairment are more vulnerable to this occurring since they tend to be aware that they are different and strive to be accepted by others. Imprisoning a person with a cognitive impairment so serious that they cannot stand trial should be a last resort.
Similar criticisms have been levelled at the imprisonment of those with a mental illness, as there are conflicting cultures and priorities between health and custodial staff within prisons. Mental illnesses can be exacerbated by the unfamiliar and threatening prison environment, and regular psychiatric follow-up can be disrupted when an individual transfers between facilities. The presence of people with an acute mental illness can also affect the entire prison. There is an increased burden placed on staff and an increased risk of self-harm, suicide, aggression, assault, and behavioural disturbance.
A forthcoming report by this Office has found that prisoners with a mental impairment are greatly over-represented in incidents involving an assault on a staff member. Between 2008 and 2012, prisoners with an identified psychiatric illness or intellectual disability comprised 14 and 2.6 per cent of the daily average prison population respectively. However, this cohort accounted for more than half of the assaults on staff.
The 2003 Holman Report on the operation and effectiveness of the Act recommended that amendments be made to remove references to prisons or detentions centres as a potential place of custody. The review stated that people under the Act should be separated from mainstream prisoners, and placed in facilities appropriate for their detention, care and protection. Inspection of case files indicated that many people under the Act have had their transition to release impeded by their behaviour in prison; however, the prison environment itself undoubtedly contributes to that behaviour occurring in the first place.