When Bryony was held in prison, she says self-harm was “rife”.

The then 27-year-old – who had no criminal record – was arrested when she was having delusions she was being poisoned.

After her mother’s death from pancreatic cancer, Bryony (not her real name) started to develop mental health problems while she was a university student.

They culminated in a psychosis where she believed there was a tapeworm in her brain which was killing her. Bryony thought a local takeaway worker had poisoned her food with tapeworm eggs.

In the midst of her psychosis in 2017, she threatened to kill the man if he didn’t admit to drugging her and put a match through the door of the takeaway.

Bryony was arrested for malicious communication and attempted arson and placed on remand in the mental-health wing of HMP Styal in Cheshire.

Warning: This story contains references to self-harm

Once in prison, Bryony said she was “so depressed” that she self-harmed for the first-time.

“I couldn’t see any other option,” she said.

“It was basically a way to cope with my surroundings.

“When you’re psychotic and depressed, being locked away in a cell is one of the worst things you can do to someone.”

Prisoner ‘tried to disembowel himself’

The extent to which mentally unwell prisoners are going to hurt themselves has been revealed in a new report seen exclusively by Sky News.

And there are concerns the problem is being worsened by people with mental health problems being held in prisons for too long before they are transferred to psychiatric hospitals.

The report, from chief inspector of prisons Charlie Taylor, says some mentally unwell prisoners are “so driven to harming themselves they have… removed teeth or maimed themselves to the point of exposing their own intestines, frequently causing life-changing injuries”.

Mr Taylor told Sky News: “We came across a case where a prisoner was, in effect, attempting to disembowel himself.”

Despite these shocking examples, some prisoners are waiting more than a year to be transferred to psychiatric hospitals. 

NHS guidance says the time between the identification of the need for hospital admission and the transfer to hospital should take no more than 28 days. For those with an urgent need, the transfer should take place faster. 

Mr Taylor said this is not happening in 85% of cases – and the average wait time is almost three months.

Prison officers receive limited training in mental health and risk being injured in their interactions with unwell prisoners.

Therefore, many unwell prisoners who are dangerous or difficult to manage end up in solitary confinement for long periods, worsening their condition.

Latest figures show there was a 17% increase in the rate of self-harm incidents among prisoners in England and Wales in the year to June 2023 – with a record level for female inmates.

The Ministry of Justice said there were “notable differences in self-harm trends by gender” – as the rate in female prisons increased “considerably by 63% to a new peak (6,213 incidents per 1,000 prisoners)”, compared to a rise of 3% in male prisons (555 incidents per 1,000 prisoners).

‘She was suffering, really suffering’

Sarah Reed had schizophrenia and was sent to HMP Holloway in 2015.

She was sent to the prison for psychiatric reports to be obtained to confirm whether she was fit to stand trial for an alleged assault, which occurred while she was sectioned as a patient at a psychiatric hospital. 

In prison, Sarah was taken off her antipsychotic medication and placed in segregation, where her health rapidly declined.

Sarah’s mother Marilyn Reed told Sky News: “She kept saying ‘mum, I need my meds, I can’t sleep’. She also had these two black eyes. She was suffering, really suffering. 

“The last thing she said to me was ‘get me out of here’.”

On 11 January 2016, Sarah was found unresponsive in her cell. 

An inquest jury concluded unacceptable delays in psychiatric assessment and failures in care contributed to her death.

A court heard how she spent her final days in a filthy cell, kept in virtual isolation with no visits or telephone calls to family.

The prison closed in July 2016.

According to the chief inspector for prisons, there are two reasons for the long delays in transferring acutely mentally unwell prisoners to mental health facilities: bureaucracy and the lack of beds in psychiatric facilities.

Latest NHS figures show 90.5% of overnight beds reserved for mental illness are occupied.

Read more:
Ex-prisoner gives shocking account of life in a women’s jail
Huge cost of keeping inmates on indefinite sentences revealed

While there are long delays in transferring prisoners to hospital, Mr Taylor says he has concerns about the way prisons are used “as an alternative to a hospital bed”.

Prisons continue to be used “as a place of safety”, which means people can be remanded in custody during a mental health crisis solely because there are no available hospital places.

Mr Taylor described hearing about a woman who had deliberately jumped in front of traffic four times in the hope that it would end her life. The woman was arrested for a public order offence and remanded in prison.

The draft of the Mental Health Bill sought to remove the use of prison as a place of safety and to reform the Bail Act to prevent courts from remanding defendants for their own protection, solely for mental health reasons.

The bill also proposed a statutory time limit of 28 days to complete transfers from prisons to hospital. 

However, the bill was not included in the King’s Speech in November 2023, meaning that there will be no legislative reform of the Mental Health Act.

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Prison ‘made illness 10 times worse’

Bryony spent six months in prison before appearing in court where she was given a hospital order and transferred to a mental health facility. 

There she was given a diagnosis of bipolar disorder and began treatment.

“I started to get better straight away,” she said.

“I don’t know if getting arrested and getting sent to prison was the right response.

“I think perhaps it might have been more beneficial if I’d have been taken straight to hospital instead of prison.

“I’ve never seen people so ill before. And prison just made that illness 10 times worse.”

A government spokesperson said: “Offenders are entitled to access mental health support in prison, where they are also helped to get off drugs and into rehabilitation.

“NHS England is investing in post-custody care to help prison leavers access their community-based health services – helping to reduce reoffending, cut crime and protect the public.”

Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email [email protected] in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK

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