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Prisoners are at greater risk of developing mental health problems compared with people of a similar age and gender in the community. They are less likely to have their mental health needs recognised, are less likely to receive psychiatric help or treatment, and are at an increased risk of suicide. Prison mental health in‐reach services have been developed in the UK to address these problems. An organisational case study method was used to generate theory about the links between the aims, processes and impacts of the introduction of mental health in‐reach teams to prison contexts. Case studies were undertaken on six sites and included interviews and focus groups with in‐reach team staff, prison healthcare staff, and discipline staff. The aims of prison mental health in‐reach were related to providing an equivalent service to a Community Mental Health Team, with a primary focus on serious mental illness, but a widening role. Achievement of these aims was mediated by the organisational context, active relationship development and leadership. Overall effects were positively reported by all stakeholders. Successful development was not just a function of time in post, but also a function of the effectiveness of leadership within the in‐reach teams. The more effective teams were having a wide impact on the response to mental health problems in the prison setting

Prisoners are supposed to receive health care that is equivalent to that provided in the community. There is a high prevalence of mental ill health in prisons, and prisoners tend to have complex needs. Prison mental health care has received only limited attention until recently. The impact of the new in ‐reach teams appears to have been positive, but primary mental health care is weak across the prison estate and the vast majority of prisoners with mental health problems still receive little or no service. The development of prison mental health care has not been evidence‐based and there has been no policy implementation guidance that compares to that provided for reforms in services for the wider community. There is no model for prison mental health care and the role of the prison mental health practitioner is not well defined, nor is the health care workforce prepared for the task.

This paper aims to capture some of the issues raised by those working on the development of mental health services in the prison environment. Each establishment in England and Wales will be different in terms of prison category and prisoner status, but its principle aim will be the same: to follow the strategic plans for the development of mental health services outlined in the National Service Framework. The purpose of the paper is to begin to facilitate and promote further open discussion of the development of services in prisons in order to improve clinical care.

Approximately 90% of prisoners experience mental health problems, substance misuse problems or both. However, prison reception screening tools are not always effective in enabling staff to identify mentally disordered prisoners. Therefore, to ensure that these individuals get access to appropriate care, custodial staff should be trained in recognising the signs and symptoms of mental health disorders, and in effectively working with these individuals. This paper charts the pilot implementation of a mental health awareness workbook designed for use in custodial settings across England. It examines the variety of approaches adopted to implement the workbook, staff views on the usefulness of the workbook, and barriers to implementation encountered in each area. Recommendations made for best practice in delivering the workbook in other areas suggest a need for changes to its format, but also that time should be ring‐fenced for staff to participate in this training, in groups led by experts such as in‐reach team members.

In December 2007, Lord Bradley was asked by the Government, in a six‐month period, to review court liaison and diversion schemes for mentally ill people. A year and a half later, and having extended the brief to encompass the entire criminal justice system, Lord Bradley has reported. The Government has now responded to Bradleys’ findings (Ministry of Justice, 2009) so it is timely to comment on the review particularly in relation to prisons in England. The English prison population is almost at its highest ever level and currently stands at around 82,000 people ‐ according to the Prison Service’s standard of certified normal accommodation, the prison population is now 8000 more than it should be. As HM Chief Inspector of Prisons, Anne Owers, has noted ‘activity and support from staff . . . were the two things thought to be most helpful by prisoners with mental health and emotional problems, in over‐crowded and under‐resourced prisons these essential elements of care are at a premium’ (HM Inspectorate of Prisons, 2007).

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.

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.

Previous studies have demonstrated high rates of psychiatric morbidity in the female prison population and difficulty in transferring women to psychiatric hospital. This study examines whether female prisoners found by consultant forensic psychiatrists to need hospital are admitted and explores the factors affecting this. All women referred to a specialist prison forensic mental health in‐reach service during 2003 were identified and written documentation from assessing consultant forensic psychiatrists was obtained. This was used to identify demographic, offence, clinical and outcome data. Missing data were sought from the prison database, and individual clinicians were interviewed to clarify clinical records. 119 women were referred for assessment. Of these, 50% of those with personality disorder were rejected compared with only 38% of those with a psychotic illness. A sizeable minority of those identified by specialist forensic mental health in‐reach services as needing treatment in hospital were not transferred. There appears to be a particular problem for those with personality disorders. Long delays in transfer to hospital remain a problem for prison mental health services.

Aboriginal and Torres Strait Islander (Aboriginal) people are overrepresented in Australian prisons, where they experience complex health needs. A model of care was designed to respond to the broad needs of the Aboriginal prisoner population within the nine adult prisons across South Australia. The purpose of this paper is to describe the methods and findings of the Model of Care for Aboriginal and Torres Strait Islander Prisoner Health and Wellbeing for South Australia.

The project used a qualitative mixed-method approach, including a rapid review of relevant literature, stakeholder consultations and key stakeholder workshop. The project was overseen by a Stakeholder Reference Group, which met monthly to ensure that the specific needs of project partners, stakeholders and Aboriginal communities were appropriately incorporated into the planning and management of the project and to facilitate access to relevant information and key informants.

The model of care for Aboriginal prisoner health and wellbeing is designed to be holistic, person-centred and underpinned by the provision of culturally appropriate care. It recognises that Aboriginal prisoners are members of communities both inside and outside of prison. It notes the unique needs of remanded and sentenced prisoners and differing needs by gender.

Supporting the health and wellbeing of Indigenous prison populations can improve health outcomes, community health and reduce recidivism.

Only one other model of care for Aboriginal prisoner health exists in Australia, an Aboriginal Community Controlled Health Organisation-initiated in-reach model of care in one prison in one jurisdiction. The South Australian model of care presents principles that are applicable across all jurisdictions and provides a framework that could be adapted to support Indigenous peoples in diverse prison settings.