Head in bucket

This week I’ve been reading back through Integritas’ web archive. And I was struck by just how many of the news articles have been about the inverse correlation between imprisonment and mental health. One piece in particular resonated with my own experiences of jobbing behind UK bars, so I decided to give it a personalised refresh…

Bucket

Sometime during the first half of the pandemic, one of our fellows attended a panel discussion hosted by the Liberty Choir. Titled ‘Prison isn’t working’, the discussion drew on people’s lived experiences of the UK criminal justice system.

One panellist shared the funniest and darkest moments of his prison days. He described an incident when a fellow prisoner ran through the prison stark naked - except for the bucket on his head. That’s a classic prison tragicomedy!

Over the last two decades, I’ve worked in more than 25 UK secure establishments. In fact, at the time of this panel event, I was working in one of the same London prisons in which the Liberty Choir sings - an incredibly old and overcrowded male remand jail. I could reel a dozen incidents like this, from just this one estate.

Whilst that streaking incident may have provided some light comic relief for the he other prisoners who witnessed it, the underlying tragedy is that this man was so severely mentally distressed in the first place. Quite simply, he was in the wrong place to get the support he so badly needed. 

Bad

The inadequacy of mental healthcare provision within UK prisons is not exactly a state secret. It’s been documented ad nauseum. For example, a pandemic era House of Commons Justice Committee report stated:

While there have been improvements in prison mental healthcare, provision is still not adequate. The high unmet need for treatment for mental illness in prisons is surprising and disappointing. Around 10% of prisoners were recorded as receiving treatment for mental illness with one suggestion that as many as 70% may have some form of mental health need at any one time.

Incarceration is never a boon to mental health:

  • You get separated from your usual support network.

  • Your new abode is unfamiliar, noisy and often scary.

  • And you get locked in a small room to share a lidless toilet with a stranger.

How much worse this must feel, if you are already mentally ill.

Bed

The above-mentioned report also highlighted the use of prisons as so-called places of safety for those requiring an inpatient psychiatric bed when none is available.

This means that people with serious mental illness, but with absolutely no criminal convictions, are being kept on remand in prison. Seriously mentally ill convicted prisoners, requiring transfer to hospital under the Mental Health Act, are being held back in prison - due to a lack of suitable NHS beds. And these problems extend right across the prison estate including those holding highly vulnerable women.

The inappropriate housing within the prison system of seriously mentally ill people is the commonest problem of the majority of my working days behind bars.

Blame

The two largest UK political parties - Labour and Conservative - continue to blame each other. But that is neither fair (as both have spent substantial times in power over the last two decades) nor constructive.

Passing the buck-et whilst in power and promising to build more prisons doesn’t help. Making plans whilst in opposition to turn prisons into even scarier places most definitely doesn’t help. And even the well-intentioned writing of yet more non-political reports doesn’t (necessarily) help.

Better?

I’ve just returning to working at the very same London prison I mentioned at the start of this reflection. Its healthcare service is still run by the same provider, which is one of the best providers of mental healthcare for the UK National Health Service (NHS).

Still, since my last stint there, the UK has undergone a significant change of political party in power. Despite this shift in the political landscape though, absolutely nothing has changed in terms of the mental health neediness of a large proportion of the prisoners. The enormous wave of human tragedy washing into the establishment, when new remand prisoners arrive from court, is still exactly the same - night after night after night - as it is within every other UK prison.

So, other than political grand plans, could we explore this enormous issue in a different way?

Two things I know for sure:

  • Growing up, I was cared for in my home and community.

  • Growing up, the vast majority of my detained patients were not so lucky. The stories I hear in my consulting room should break the heart.

Yes, British (and worldwide) society needs a radical rethink of better ways to care for each other - in the home, in school, in community, in hospital, and (when absolutely necessary) in prison.

The alternative is to stick a proverbial bucket on our own heads and keep it there for the next couple of decades. Then we’ll end up like the USA with ghettoed living. For the most privileged that will mean retreat into gated communities. But for the most vulnerable, it’ll likely be mass incarceration in mega jails. And that’s one vision of the future that really makes me shudder.

First published in 2021, the original version of this article was written by one of our fellows. Prison GP Dr Rachael Pickering gave it a major edit before republication in October 2025. Her personal opinion does not necessarily represent that of Integritas Healthcare.

Defend the weak and the fatherless;
    uphold the cause of the poor and the oppressed.
Psalm 82:3