Major concerns over mental health at Whitemoor prison were highlighted after the number of prisoners self-harming in the segregation unit doubled last year, an independent report revealed.
"The mental health team has been consistently understaffed," says the findings of the Independent Monitoring Board (IMB).
The prison had been unable to deal effectively with the 25 to 45 mental health referrals per month made by the medical staff.
Forty six prisoners self-harmed 261 times last year in the segregation unit - where prisoners at risk were kept.
The high security prison in March was assessed by the watchdog from June 2018 up to May 2019
"There are a number of difficult, complex cases where referrals have been made for transfer to secure mental hospitals," says the IMB.
"The time taken both for assessment and relocation remains excessive.
"This leaves the local staff and facilities to cope with men with challenging needs they are not trained or equipped to meet."
One death in custody, awaiting an inquest, and 11 serious incidents were also noted by the board.
The high security prison in March was assessed by the watchdog from June 2018 up to May 2019.
Conditions on wings were found to be "well below acceptable standards" causing "high levels of frustration" among inmates.
Showers had peeling paint, rusting pipes, poor drainage and broken tiles with jagged edges.
"The condition of some of the basic facilities on the wings has continued to be well below what the board considers to be an acceptable standard," the report said.
Wing showers, washing and bathing facilities remain in an "unacceptably dilapidated and unhygienic condition" with no significant improvements since 2016.
Staff and prisoner concerns including bullying had increased from 25 to 40 and 151 drug finds were confiscated from inmates.
Work was unfulfilling and "opportunities in the prison are mundane and do not contribute to a useful future outside the prison".
Lost teaching time due to officer shortages was also "unacceptably high" at 27 per cent.
Overall the IMB noted that the "prison is generally well managed, calmer and safer than many other establishments.
"In most cases the relationship between officers and prisoners has remained positive".
HMP Whitemoor has around 453 prisoners, a total of 133 that are category A and three high risk.
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