A woman who has been in and out of prison for 25 years is trying to become the first to publicly sue the NHS over claims of bad mental health care in jail.
Farah Damji, 54, has four convictions for 28 offences, including multiple counts of theft, fraud, stalking and breach of a restraining order, which date back to 1995.
She has spent time in eight UK prisons, following her first six-month sentence at the notorious Rikers Island jail in New York.
After years of mental ill health, a psychologist diagnosed her with complex post-traumatic stress disorder (PTSD) in 2019.
Since 2013, the NHS has been responsible for prisoners’ health care in England, which it says is “guided by the principle that those who have committed a criminal offence should be able to access equivalent medical care to civil patients”.
Ms Damji is suing Central and North West London NHS Foundation Trust over claims she was repeatedly denied mental health care at HMP Bronzefield, HMP Downview and HMP Send between 2014 and 2020.
“Women are so reluctant to complain about anything in prison, because they are too frightened of the repercussions,” she told Sky News.
She is currently living in Dublin, having fled her most recent trial for breaching a restraining order in March 2020, which she claims was because she suffered a breakdown.
According to Ministry of Justice figures, more than 71% of the female prison population have mental health issues.
Andy Bell, deputy chief executive of Centre for Mental Health, describes “poor wellbeing” as the “norm” in women’s prisons.
“Many women in prison have very complex needs coming from a lifetime of abuse and neglect,” he said. “So the NHS is trying to meet an awful lot of need in an environment which is inherently difficult and far from conducive to providing good mental health support.”
Ms Damji says she has consistently sought psychological help in prison but was only able to get a final diagnosis 20 years after her first conviction – through a paid-for court report.
While serving time at HMP Downview in 2005, she was told she had borderline personality disorder (BPD), which her lawyers now claim was a misdiagnosis.
Nine years later in 2014, she was back inside and on remand at HMP Bronzefield when she says she told prison staff she felt suicidal.
“I felt like I wasn’t going to get through what was happening to me,” she said. “I kept asking and asking for help, but they did nothing. It’s a campaign of ignore them and they’ll shut up.”
HMP Bronzefield in Surrey is privately run, with health care services provided by CNWL NHS Foundation Trust.
After Ms Damji complained about her treatment there, the Parliamentary and Health Service Ombudsman ruled in 2015 that the trust breached guidelines by refusing her psychotherapy.
They had claimed she wasn’t entitled to it because she was a remand prisoner – not a sentenced one.
Three years later she was transferred to HMP Send in Woking, where she says she asked for mental health care again.
“I was told I wasn’t a priority. They told me ‘you’re going to have to get help when you’re out,” she told Sky News.
She was released the following year but recalled a few months later after criticising her probation accommodation and support workers in a tweet.
Her solicitors ordered a detailed psychological report, which finally gave a diagnosis of complex PTSD.
“It made sense – with the trauma of my childhood – but also the retraumatisation of being in prison so many times,” she said. “It made me feel angry. Angry that my mental health had meant so little to so many people and agencies.
“‘Why didn’t they help me years ago? Why have I spent my life in and out of prison?”
Ms Damji and her legal team are seeking damages of at least £70,000, with their first High Court date due later this year.
Caron Heyes, senior associate in medical negligence at the law firm Fieldfisher, told Sky News cases like hers are rarely heard in public and almost always settled out of court.
“If this case goes on to be argued in a trial and brings out the medical issues into open court, it could be really, really important,” she said. “It could establish some case law, so when we’re trying to win cases for other people, it gives us precedent to refer back to.”
She said that although the NHS has a statutory duty of mental health care to prisoners, inmates are “at the mercy” of prison GPs and officers to refer them to specialists and take them to appointments.
“There is a double resourcing issue – of the NHS and the prison service. It doesn’t matter what you say should happen, if it’s not actually happening on the ground, people will continue to be harmed,” she said.
Ms Damji and her team are still crowdfunding their legal costs, which include another expensive psychological report.
She says she is trying to get mental health support in Ireland, but still feels “very fragile”, is hyper-vigilant and struggles with sleep.
Currently fighting extradition and in the process of trying to appeal her restraining order at the Supreme Court, she is also unable to return to the UK and see her family.
But she says the court case is keeping her going.
“There has to be another way for women who have gone through the trauma and abuse that I have and end up in the criminal justice system,” she said.
“The state is not meant to put you in a position where your mental health deteriorates to the point you can’t function.
“Mental health is a human right – your right to life is your most basic human right.
“I don’t want the same thing to happen to anyone else.”
Central and North West London NHS Foundation Trust said in a statement: “While we are sympathetic towards Ms Damji, we don’t accept the claims made and we are unable to comment further as legal proceedings are underway.”
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email firstname.lastname@example.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK