Cornton Vale has been criticised for its management of women with complex mental health needs.
Scotland's female prison has been criticised for how it is managing women with complex mental health needs.
Cornton Vale was found to be using segregation as a way to manage "high levels of distress" experienced by some inmates.
The Mental Welfare Commission for Scotland found some were experiencing up to 82 days in segregation.
This meant up to 22 hours a day in cells described as "sparse and lacking in comfort".
A report compiled by the commission noted that the women "seemed more disturbed" within the separation and reintegration unit (SRU).
It added: "For women who were floridly unwell with acute psychosis or manic psychosis, the severity of their symptoms and level of disturbance significantly worsened in the SRU."
The commission went on to say it was "concerning to see how little mental health staff were sometimes able to engage with and support women who were acutely mentally ill or distressed".
During 2020, a total of 23 women prisoners were kept under Rule 41 - where a health professional requests they are either confined to their cell or put into segregation - for mental health reasons.
A total of 25 of these episodes were recorded, with these lasting from one day to 82 days.
The average stint in segregation was just over a month (32 days).
Segregation 'lead to escalation'
The commission said: "For those women with more complex mental health problems and vulnerabilities, for whom hospital care was often not an option, segregation appeared to be used as a way to manage their high levels of distress and behavioural disturbance in the custody environment, though it appeared to only lead to escalation."
A contract was awarded last year to replace the existing Cornton Vale women's prison with a new facility on the same site outside Stirling. The commission noted that it was "planned that women with mental health needs will no longer be cared for in the SRU".
The report said the segregation unit in the new building would be "used solely for women requiring segregation for disciplinary issues" and that women with significant mental health needs should be cared for in what was described as an "enhanced needs area".
The Commission said it has also been told by the Scottish Prison Service that it had updated mental health and trauma-informed care training for new prison officers in autumn of 2020.
The report was produced in the wake of work by the European Committee for the Prevention of Torture (CPT), which visited prisons and police facilities in Scotland in 2018.
It found cases of delays in transferring mentally unwell prisoners to hospital, saying that the records showed "patterns of escalating symptoms, indicating that each woman's acute illness was evolving whilst they were not receiving the inpatient care and treatment they urgently required".
It also highlighted "repeated inequalities" of women in prison being unable to readily access intensive psychiatric care unit beds due to a lack of facilities and pressure on local services.
Claire Lamza, senior manager at the Mental Welfare Commission, said: "This document opens a window on the lives of some of the most marginalised women in society.
"It gives some insight into the irreparable damage that is being done to those individuals, and we can only imagine the wider impact on their families and communities.
"We hope this detailed review will be read and acted upon by those who are examining Scotland's future approach to the best ways to care for mentally unwell people in prison.
"While changes are being made at Cornton Vale, the wider situation needs to be addressed, and Scotland as a society needs to do more."
'Properly supported'
Mental Wellbeing Minister Kevin Stewart said the report's recommendations would be considered carefully.
He added: "Our mental health transition and recovery plan published in October last year made clear our commitment to continue to work with partners to seek better support for those with mental ill health within the criminal justice system."
He said the plan was backed up by £120m from the recovery and renewal fund.
And he said the government would work with the Scottish Prison Service and other partners to ensure that frontline staff were properly supported.
