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Mental health in-reach in an urban UK remand prison

Andrew Forrester (Consultant and Honorary Senior Lecturer in Forensic Psychiatry, based at Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK)
Jagmohan Singh (Consultant Forensic Psychiatrist, based at Beech Unit, Hertfordshire Partnership University NHS Foundation Trust, Radlett, UK)
Karen Slade (Senior Lecturer, based at School of Social Sciences, Nottingham Trent University, Nottingham, UK)
Tim Exworthy ((Visiting) Senior Lecturer in Forensic Psychiatry, based at Department of Forensic and Neurodevelopmental Science, Kings College London – Institute of Psychiatry, London, UK)
Piyal Sen (Consultant Forensic Psychiatrist, based at Personality Disorder Service for Young Males, St Andrew's Healthcare, Essex, UK)

International Journal of Prisoner Health

ISSN: 1744-9200

Article publication date: 9 September 2014



Prison mental health in-reach teams (MHITs) have developed in England and Wales over the last decade. Services have been nationally reviewed, but detailed descriptions of their work have been scarce. The purpose of this paper is to describe the functions of one MHIT in a busy, ethnically diverse, male remand prison in London, UK.


Clinical and demographic data were collected for prisoners referred to the MHIT using a retrospective design over an 18-week period in 2008/2009 (n=111).


Foreign national prisoners and sentenced prisoners were significantly under-referred. Most referrals were already known to community mental health services, although around a quarter accessed services for the first time in prison. Around a third presented with self-harm/suicide risks. Substance misuse problems were common. Although the MHIT had evolved systems to promote service access, prisoner self-referrals were limited.

Practical implications

Foreign national prisoners require enhanced investment to improve service access. MHITs identify people with mental disorders for the first time in prisons, but better screening arrangements are needed across systems. An evaluation of multiple MHIT models could inform a wider delivery template.


One of the first ground-level evaluations of MHITs in England and Wales.



Forrester, A., Singh, J., Slade, K., Exworthy, T. and Sen, P. (2014), "Mental health in-reach in an urban UK remand prison", International Journal of Prisoner Health, Vol. 10 No. 3, pp. 155-163.



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