"They’re just waiting for her to die": How austerity turns mental health patients into prisoners

As mental health crises spiral, many like Lucy find themselves caught in a broken system where prison is seen as the only place of safety

An illustration on the mental health crisis by Kaitlan Bachan for The Lead

David* last saw his daughter, Lucy*, shortly after Christmas. They were in a taxi together, on their way to a homeless shelter in Cardiff. Lucy was enduring a major mental health crisis, complete with frightening hallucinations, and had been evicted from her home.

“I told her she only needs to do three things each day: Sleep, eat, and wash,” David says. “If she could only do one, then try to get some rest.” Two days later, he discovered Lucy was in prison.

David describes his daughter as a creative, kind, and politically engaged young woman, whose mental health struggles began in her teenage years and reached crisis point during the first COVID lockdown in 2020.

“She started hearing voices that she attributed to the U.S. and Chinese governments,” he says. “These voices were often hostile, instructing her to harm herself.”

Lucy and her dad repeatedly sought help from mental health services, but, David says, her symptoms were not taken seriously. They were told Lucy just had difficulty regulating her emotions, and didn’t require more intensive support. During this time she became increasingly withdrawn. She stopped sleeping, rarely bathed or changed clothes, and skipped meals. Terrorised by the voices she was still hearing, Lucy took to wandering the streets alone at night, and on one occasion was detained by police on a railway bridge in London.

As her distress grew, Lucy began to lash out. She smashed up the small flat she rented around the corner from her dad and his partner Kyle*, and was evicted. Eventually, she was placed in prison “for her own protection”. It would not be the last time.

“She’ll die if this continues,” David fears.

Prison as a “place of safety”

In 2023, broadcaster and poet Scout Tzofiya-Bolton faced a similar ordeal across the border in England. A multiyear battle with worsening episodes of psychosis culminated in an incident in which she attempted to rob a shop with a toy gun, believing herself to be acting out a movie scene for an omnipresent audience of adoring fans.

“I don't really remember committing the crime itself,” Scout says. “The clearest memories start to come back when I'm in the police cell. I remember honestly thinking: ‘this is a big misunderstanding, they're going to let me go home.’” She went on to spend six months in prison, and has written a book, The Mad Art of Doing Time, about her experience.

Like Lucy, Scout’s symptoms had been attributed to emotional dysregulation. Her official diagnosis was Emotionally Unstable Personality Disorder [EUPD], a label that many mental health professionals oppose and that Scout passionately believes was an active barrier to her recovery.

“Suddenly my pain was no longer valid - I was seen as a nuisance, an attention-seeker,” she remembers.

In prison, Scout’s diagnosis was changed to Schizoaffective Disorder – “imagine bipolar and schizophrenia ganging up on you” – and with treatment and time she felt more like herself.

Lucy’s nightmare, however, is ongoing.

Under the Mental Health Act [MHA], people experiencing severe mental illness in England and Wales can be sent to prison “as a place of safety” if there are no available beds at a mental health unit – a situation that, after more than a decade of austerity, is now commonplace.

Alongside this is Schedule 1 of the Bail Act, which allows people who are arrested during a mental health crisis to be denied bail and imprisoned for their own protection – even if the crime they’re accused of would not normally result in a prison sentence. Children can be imprisoned “for their own welfare” under this same law.

In 2023, the Independent Monitoring Boards [IMB], a volunteer-led public body charged with independently tracking standards at prisons, raised the alarm about the increasing number of women incarcerated solely on mental health grounds – finding that a single prison received an average of five women per month over a year. Last year, an IMB inspection of HMP Bronzefield, a prison in Surrey, found that the prison’s intake of women on mental health grounds had almost doubled. In monitoring these trends, the IMB says it relies on prison staff taking it upon themselves to note down when a prisoner’s warrant cites their mental health, as the Ministry of Justice does not collect this data.

With its Mental Health Bill, the UK Government has pledged to ban the use of prison as a place of safety. The Bill, adopted from a draft that was produced and then scrapped under a succession of Conservative prime ministers, introduces a range of reforms to the Mental Health Act – but there are glaring omissions.

Pervasive inequalities

“Frankly, we want to see the Bill be more ambitious in tackling the shocking racial injustices enabled by the Mental Health Act,” says Gemma Byrne, Policy Manager at mental health charity MIND.

According to official figures, Black people in England and Wales are nearly four times more likely to be sectioned than white people, and eight times more likely to be given a Community Treatment Order [CTO] – strictly supervised treatment outside of hospital that can dictate where a person is allowed to live, and require them to submit for mandatory drugs and alcohol testing. Abolishing CTOs has been a key demand from mental health and racial justice groups, and partial abolition was recommended by a cross-party parliamentary committee, but the Mental Health Bill does neither.

“The Bill falls short of delivering the transformational change that the mental health system needs,” Gemma says. “It's taken such a long time to get to this point, and we need to be ambitious - this chance doesn't come around often.”

To date, Lucy has been to prison three times. Though a transgender woman, she has been placed in a men’s prison on each occasion.

In the weeks leading up to Lucy’s first imprisonment, David remembers, there was a cycle: The police would find his daughter on a bridge, detain her under the MHA and drop her off at Cardiff’s only mental health unit, Hafan y Coed at Llandough Hospital. The unit would then immediately discharge Lucy, only for her to be detained by police again hours later. To date, David says, this has happened on more than a dozen occasions.

“They’re just not trying to keep her alive,” he says. “It feels like the mental health team isn’t interested - that they’re just waiting for her to die so they don’t have to do anything.”

It’s a pattern and a feeling that Scout Tzofiya-Bolton recognises.

“I had a two-year period that was very similar to what Lucy is going through now,” she tells The Lead. “I was constantly in crisis. I remember thinking: ‘the mental health team wants me to kill myself, because then I'm not a problem anymore, I'm not calling the crisis team or presenting at A&E.’”

Mental health services in Lucy’s area are chronically overstretched. Hafan y Coed has had an average bed occupancy rate of 92 per cent since 2016 – well above the maximum “safe” level of 85 per cent recommended by the Royal College of Psychiatrists.

An inspection in 2019 discovered the unit was in fact caring for more people than it had beds, with acutely unwell patients sent to other parts of the hospital to sleep at night and brought back to Hafan y Coed in the daytime – while a more recent audit found that a dedicated psychologist had not been employed at the unit for years. In the summer of 2023, a group of patients and their families held a protest at the hospital gates over care they described as “neglectful”, with one dad recounting how his 19 year-old daughter – who was also being assessed for an EUPD diagnosis – was being sectioned “up to three times per day” by police.

A spokesperson for Cardiff and Vale University Health Board said they were unable to comment on individual cases, but asserted that the Health Board does not miss the opportunity to divert people from court where there is a clear mental health issue, “depending on offence and circumstances”.

The Welsh Government told The Lead that improving the quality and safety of mental health services is a policy priority in Wales, and a Mental Health Patient Safety programme has been set up by the NHS Executive with a specific focus on inpatient care.

These shortfalls are not unique to Cardiff. Police detentions under the MHA have sharply increased across England and Wales – a rise of 45 per cent between 2016-2022 - and neither country’s health service is equipped to cope with demand. Mental health bed shortages remain critical, with the number of available hospital places in both England and Wales currently at their lowest point since 2010. As a result of these shortages, NHS England spent more than £2 billion sending its patients to private mental health facilities in 2023, an eye-watering increase of £279m on the previous year.

“These services are completely overstretched after decades of underfunding, so when people ask for help at an early stage – really begging, sometimes – they’re being repeatedly turned away,” MIND’s Gemma Byrne says. “People are passed between different services, none of which have capacity for them, and so their mental health deteriorates, and they end up reaching crisis point.”

For Scout, who’s been a mental health service user since 2007, the shrinking of care under austerity has been palpable. “Years ago you could see a psychiatrist, you could get help – it’s like I’ve watched the money disappear over the years,” she says.

Ever-deeper public spending cuts

Baroness Natalie Bennett, former leader of the Green Party, participated in the Committee Stage debates for the Mental Health Bill at the House of Lords. She tabled an amendment that would have prohibited the use of for-profit companies to deliver NHS mental health facilities and services – the Government’s prompt dismissal of which, she says, was disappointing.

“Even leaving aside that significant sums of public money are going into private profit instead of patients, using these companies – which are often highly leveraged, in significant debt - still presents a huge risk to care quality and stability,” she tells The Lead, referencing the near-collapse of a leading private mental healthcare provider, Active Care Group, last year, and a wave of insolvencies that has seen dozens of care homes closed across the UK over the past decade. “The danger of extremely vulnerable patients seeing their care systems collapse in a flash of bank foreclosure is obvious,” she adds.

Reforms to the Mental Health Act will be meaningless without remedying this volatile mixture of underfunded public services and creeping privatisation, says the National Survivors User Network [NSUN], a grassroots organisation of people with lived experience of the mental health system.

“The drive to reduce police and prisons in mental healthcare can only be a good thing,” says Courtney Buckler, the group’s Policy Manager. “But there are more pernicious ways in which policing enters mental health settings.”

She points to Serenity-Integrated Mentoring [SIM], a scheme that until recently was in use at NHS Trusts across England and Wales. Devised by police officer Paul Jennings, the model was sold to the NHS as a cost-saving “innovation” by his private firm. Under SIM, the NHS worked with police to identify and monitor people who frequently used services like 999 and A&E. In a bid to discourage these “high intensity users” – often people in serious distress and at risk of self-harm – services were instructed to withhold care, threaten fines, or take other punitive measures.

“As services become more depleted, people seeking care are increasingly viewed as problems – they are costs to reduce and risks to manage,” Courtney says.

This view flows from the top. Successive governments, committed to ever-deeper public spending cuts, have all demonstrated “a clear inability to think about care and support without linking them to economic productivity”, according to NSUN.

In recent months, public statements by government ministers have relentlessly focussed on the economic cost of people too ill to work, with PM Keir Starmer writing about the “bulging benefits bill blighting our society” and Health Secretary Wes Streeting lamenting that “our sick society is holding back our economy”. These comments have accompanied policy documents like the Get Britain Working white paper – it too largely focussed on getting those on sickness benefits back into work – and the Fraud, Error and Debt Bill, which will allow the Government direct access to benefit claimants’ bank accounts if they are overpaid in error.

Chancellor Rachel Reeves announced significant cuts to disability benefits in her Spring Statement, seeking to cut £5 billion from Personal Independence Payments and Universal Credit, largely by making it more difficult to qualify.

“This is the backdrop upon which reforms to the Mental Health Act are arising,” says Courtney Buckler. “These choices are setting the tone.”

Government funding commitments for mental health services, meanwhile, have remained vague. The Autumn Budget was met with near unanimous disappointment from mental health experts, pledging just £26m to establish mental health “crisis centres” – a figure less than 2 per cent of the £1.6billion committed to tackle waiting lists for physical health services - and no further detail has since been shared.

Following the removal of key mental healthcare targets from NHS England planning guidance, MIND has warned that the government “appears to be deprioritising mental health.”

Policy Manager Gemma Byrne adds: “We're very clear that the success of the Mental Health Bill will be contingent on there being adequate funding – otherwise, there’s a very serious risk that it’ll just fall flat.”

For David and Lucy, these questions are life and death. Though the NHS is devolved in Wales, the Welsh Government’s funding is still determined by decisions made in Westminster. David struggles to feel anything but bitterness about the Mental Health Bill: “Unless these plans guarantee prison will be replaced with quality care – and I’m sure they don’t – for us it just feels like they’re rearranging deckchairs on the Titanic.”

Scout shares this skepticism: “People who are in crisis obviously shouldn't be in prison, it’s ludicrous and it’s horrible, but realistically speaking – where are people like me going to be held? There’s no beds!”

Key too, she says, is recognising just how miserable life in hospital has become under austerity – even compared to prison. “I’m really loath to admit it, but I would much rather be in prison than hospital,” she says.

“There were components to prison life – access to education, exercise, recreational activities, easier access to mental health treatment – that just weren’t present in hospital. There was stability – you’re not going to get kicked out of prison for not being unwell enough,” Scout adds.

“If we take those components and integrate them into crisis houses and hospital care, then prison would not have to be used as a place of safety at all.”

For those who may be facing a situation similar to her own experience or Lucy’s, Scout urges: “Always take someone trusted, who knows you, to your appointments – get an advocate, get everything in writing, and remember that you can and should question your diagnosis if it doesn’t feel right.

“Keep fighting – you’re fighting for your life.”

The UK Government did not respond to a request for comment by the time of publication.

How to get support

Information and support for those living with severe mental illness can be found at MIND and ReThink Mental Illness. A list of mental health advocacy services across England and Wales can be found here.

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Go deeper with Scout’s story

For subscribers to The Lead, we have an exclusive conversation between Rebecca Wilkes and Scout Tzofiya-Bolton where you can hear directly from Scout about her experiences. It’s a raw account - and uncomfortable listening - but an important story to be told. It’s part of our The Lead in Conversation series, for paying subscribers to The Lead, which takes you behind the headlines and closer to our stories and writers.

The Lead in conversation: how austerity jails the mentally ill

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About the author: Rebecca Wilks is a Cardiff-based freelance journalist with a particular interest in the shared England and Wales criminal justice system, housing, austerity and inequality. She has written for the The Welsh Agenda - where she is a member of the Editorial Advisory Group - The New Internationalist and Voice.Wales.

Here at The Lead we frequently cover stories about the scandals and injustices entrenched in our healthcare system, from the damaging impact of birth trauma in maternity settings, to the deep racial inequalities in dementia care, and the invisible children with Long Covid left without care. Help us to continue our independent journalism on these underreported issues by considering a paid-for subscription.