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Failing healthcare in jails is killing female prisoners | Deborah Coles

Those in prison and other places of detention are entitled to a standard of healthcare equivalent to that offered in the community, as established in both national and international guidelines. Yet the inquest into the death of Annabella Landsberg concluded on Thursday that her death was contributed to by serious failures at HMP Peterborough, including the absence of diabetic care that is readily available in local health services.

The work of Inquest, the charity I’m a director of, shows that prisons consistently fail to provide care and support for physical and mental ill health. But these state failures begin far beyond prison walls.

Annabella was 45 when she died of complications arising from type 2 diabetes in September 2017. She came to the UK after fleeing persecution in Zimbabwe, where she was a victim of serious sexual violence. Annabella’s family report that her behaviour became challenging and “childlike” after she suffered a brain injury in 2007. She spent time in supported accommodation and was in touch with social services, but her family say she did not receive enough support.

In prison Annabella was seen as difficult. She was segregated, restrained, and her pain was ignored and disbelieved. Before her death, Annabella collapsed in her cell, complaining of symptoms that anyone with knowledge of diabetes would immediately recognise. Yet none of the prison healthcare professionals or officers carried out medical checks. Instead, they said she was faking it. After 21 long hours lying on the floor of her cell, a senior nurse saw Annabella and recognised she was in medical crisis. By then it was too late.

Annabella Landsberg

‘Before her death, Annabella Landsberg collapsed in her cell, complaining of symptoms that anyone with knowledge of diabetes would immediately recognise.’ Photograph: Family handout/PA

Peterborough is a private prison run by Sodexo. Evidence heard at the inquest showed that concerns around the lack of diabetic care available in the prison had been raised previously over several months, if not years. Sodexo were aware the systems for dealing with chronic illness were inadequate. Yet no effective action was taken by Sodexo to address this prior to Annabella’s death.

In November 2018, an inquest into another death in Sodexo’s care found that systemic failures by prison and healthcare staff amounted to neglect of Natasha Chin, who died in HMP Bronzefield in July 2016. Natasha was a 39-year-old black woman from north London who had alcohol and drug dependencies. She was found unresponsive in her cell after less than 36 hours in the prison. Natasha had been vomiting for at least nine hours and was unable to collect essential medication prescribed to her. Healthcare staff at Bronzefield did not ensure she got her medication or respond to calls to check on her. Experts told the inquest that had Natasha’s condition been properly treated, it is likely she would have survived.

The inquest found that Natasha’s death was caused by the failure of Sodexo to ensure there were appropriate systems in place for prompt administration of prescribed medication, and to ensure that observations were undertaken. Previous inquests and numerous inspection reports dating back to at least 2010 had documented longstanding concerns about these poor aspects of healthcare in Bronzefield. By the time the inquest was held, still nothing had changed.

Sarah Reed

‘The acute distress of Sarah Reed, a black woman who died in Holloway prison in January 2016 while experiencing serious mental ill health, was ignored.’ Photograph: Lee Jasper

Nobody, particularly those in detention, where they are entirely dependent on others for medical care, should be dying because of easily treatable conditions such as diabetes or vomiting from withdrawal. Like Annabella and Natasha, the acute distress of Sarah Reed, a black woman who died in Holloway prison in January 2016 while experiencing serious mental ill health, was ignored.

The distress of black women is too often disbelieved and viewed as a discipline and control problem, rather than requiring care and support. The role of race in the dehumanising treatment these women received cannot be ignored. Annabella, Natasha and Sarah needed and deserved care and therapeutic support, which could best be delivered in the community – but it was not.

Inquest’s work with bereaved families seeks to make visible those who die in prison and the structural issues behind their treatment. Women who end up in prison are among the most powerless and disadvantaged in our society, largely due to traumatic life experiences such as sexual and physical abuse, mental and physical ill health, racism and discrimination, underpinned by poverty and inequality. Since the publication of the Corston report in 2007, a total of 104 women have died in prison. Many of these preventable deaths raise serious concerns about the impact of imprisonment on both physical and mental ill health. They raise questions about human rights violations – not only the failure to provide a safe and dignified environment, but also the failure to act to prevent future deaths.

Decades of inquests and government, parliamentary and NGO reports have shown the vulnerabilities and challenges faced by women in prison and argued for investment in community services and diversion from the criminal justice system. Yet familiar political rhetoric on reform and “learning lessons” has resulted in no decisive action to make the structural change needed.

Properly conducted inquests provide an important opportunity to uncover neglectful state services and publicly hold state and corporate bodies to account. Much more needs be done to build national mechanisms to ensure the lifesaving recommendations arising from inquests and other forms of detention monitoring are implemented, not left to gather dust until another person dies. But to prevent deaths and harm we must look beyond prisons and redirect resources into community, health, welfare and specialist, women-centred, culturally specific services.

Deborah Coles is the executive director of Inquest, an independent charity working with families bereaved by state-related deaths


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