Auditing Controversial Areas

Audit is easy when you are presented with a vanilla topic unlikely to generate controversy or strong emotions.

It is challenging – and incredibly rewarding – when you are tasked to review an area that by its very nature or subject is controversial.

When presented with that opportunity (for an opportunity it is) then you would be very well served to read the recent National Audit Office report on mental health in prisons.

This is one of the great examples of how to handle an emotional topic in a dispassionate framework based approach and by doing so more likely to bring about real change to a marginalised constituency.

Firstly some context provided by the report:

  1. Circa £400m is the estimated amount NHS England spent in 2016-17 providing mental and physical healthcare in adult prisons in England
  2. 31,328 people in prison who report having mental health or well-being issues at any one time, based on HM Inspectorate of Prisons surveys (37% of the average monthly prison population)
  3. 7,917 people recorded by NHS England as receiving treatment for mental health illnesses in prison in England in March 2017
 Of concern:

Rates of self-inflicted deaths and self-harm have risen significantly in the last five years, suggesting that mental health and well being in prison have declined. The number of self-harm incidents rose by 73% between 2012 and 2016.

The findings are damning:

NOMS, NHS England and Public Health England have set ambitious objectives for providing mental healthcare in prisons, but it is not clear how they will achieve these in practice. The partnership agreement outlines their responsibilities and shared objectives for the system overall, but some objectives are not well defined, and do not take account of the complexities of the prison environment.

And incredibly:

Government does not collect enough, or good enough, data about mental health in prisons, which makes it hard to plan services and monitor outcomes. There are no reliable data on the prevalence of mental illness in prisons.


NHS England does not know how much it spends on mental healthcare in prisons.

As the report notes:

If they refocus their efforts on some clear and achievable objectives, and collect the information they need to manage their performance against these, they will have a greater chance of making progress in this important area.

The Ministry of Justice, HMPPS, the Department of Health, NHS England, and Public Health England need to determine the scale of the challenge as a matter of urgency.

Not surprisingly:

Improving the mental health of those in prison will require a step change in effort and resources.

This is an important report on a fundamental – and controversial – area of societal policy.

It is also a model report as to how to handle controversies of whatever magnitude when they visit your organisation.


Download PDF

Subscribe to Receive Our Email Updates

  • This field is for validation purposes and should be left unchanged.