Task imposed on prisons is impossible

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7421.989-a (Published 23 October 2003) Cite this as: BMJ 2003;327:989
  1. Richard J Simpson, senior medical officer (richard.simpson{at}hushmail.com)
  1. Glasgow Problem Drug Service, Woodside Health Centre, Glasgow G20 9LR

    EDITOR–The paper by Nurse et al confirms reports by HM inspectors of prisons on the detrimental effects of isolation and lack of quality programmes in custody.1 I worked as a prison doctor before becoming deputy justice minister in the Scottish Executive in 2001-2 and subscribe strongly to community based solutions, particularly for drug related crime, since custody often worsens associated mental health problems while providing opportunities to establish networks for future drug dealing.

    The courts remand increasing numbers of prisoners and imprison many for two weeks or less for fine default (in Scotland 6000/25000 admissions for fine default; similar numbers on remand). Nearly half of these prisoners, more than 80% of whom have drug problems, then reoffend. This expensive custodial approach (> £28 000 per prisoner per year) is ineffective in protecting the public, as punishment, and in preventing reoffending. Moreover, the rapid turnover of prisoners imposes an intolerable burden on the staff of our overcrowded prison system.

    For many offenders with pre-existing mental health and drug problems custody should be replaced by a community based approach with treatment followed by reparation to the victim or the community.

    Community solutions should include bail hostels, electronic tagging on remand, community reparation orders, and “time out” community drug treatment centres. The first for women offenders opens in Glasgow this year to treat 500 short term offenders annually.

    These measures should be combined with more imaginative overnight or weekend custodial approaches.

    Until we stop overcrowding our prisons with those whose main problem is drug addiction our justice system will continue to unintentionally harm the society it should be protecting.


    • Competing interests None declared.


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