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The purpose of this paper is to evaluate the current service provision offered by a mental health service in a young offenders institute (YOI) in England.

A qualitative exploratory approach was adopted. Five prison officers (POs) (four male and one female) with direct experience supporting young people through mental health intervention were interviewed using semi-structured interviews. Data was analysed using thematic analysis (Braun and Clarke, 2006), which allowed evaluation of the current mental health provision to evolve.

Five overarching themes (process of referrals; intervention and its impact; role and function of the health and well-being team; collaboration and involvement; and feedback, communication and intervention) were found to be highly salient when evaluating service provision. Notably all themes interrelated with one another, demonstrating that changes or improvements made to the service need to consider all factors individually and collectively.

This study was based on a small sample of POs in only one YOI in England, and therefore cannot be generalised to the entire prison estate. However, it does offer a rich insight into local service provision from the perspective of a group whose opinion is rarely sought.

POs’ perspectives of service provision are important in informing service developments. Lessons can be learnt from their unique insight into how prison mental health services are run to improve processes and collaborative working in the management of young offenders with mental health difficulties.

This preliminary and exploratory study is, to the best of the authors’ knowledge, the first study evaluating service provision by using the perspectives of POs. The findings suggest that POs make valuable contributions to the service development and should be involved in similar evaluations in future.

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non‐binding or so‐called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.

South America is a heterogeneous continent, with diverse prison realities. Its prison population is estimated at 600,000 inmates, of whom 10,000 are declared insane. Physical and mental health care supplied to the inmates is precarious and preventive programs in progress are rare. The authors’ comment on the Roman Law tradition and describe the situation in Brazil and Argentina, from the point of view of their legal backgrounds. They also consider the kind of mental health resources found and the types of treatment offered, mainly in Forensic Psychiatric Hospitals. Their conclusion emphasizes the need to improve the conditions of penitentiaries in South America, which, because of their deficiencies, often violate the human rights of prisoners.

Supermaxes across the United States detain thousands in long-term solitary confinement, under conditions of extreme sensory deprivation. Almost every state built a supermax between the late 1980s and the late 1990s. This chapter examines the role of federal prisoners’ rights litigation in the 1960s and 1970s in shaping the prisons, especially supermaxes, built in the 1980s and 1990s in the United States. This chapter uses a systematic analysis of federal court case law, as well as archival research and oral history interviews with key informants, including lawyers, experts, and correctional administrators, to explore the relationship between federal court litigation and prison building and designing. This chapter argues that federal conditions of confinement litigation in the 1960s and 1970s (1) had a direct role in shaping the supermax institutions built in the subsequent decades and (2) contributed to the resistance of these institutions to constitutional challenges. The history of litigation around supermaxes is an important and as-yet-unexplored aspect of the development of Eighth Amendment jurisprudence in the United States over the last half century.

This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.

This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.

This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.

This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.

An opinion survey of mentally disordered prisoners was undertaken to ascertain their views on the responsiveness of mental health and criminal justice services to their perceived needs while in the community.The findings reveal that their illness and offending behaviour were not deemed serious enough to warrant intervention by forensic psychiatric services but their needs were too complex for mainstream community care services. They felt vilified and marginalised by many professional workers and were unlikely to seek help themselves. Psychiatric intervention was therefore usually precipitated by a crisis. Hospital and prison aftercare was not always pursued, leading to deterioration in mental health and/or offending behaviour, followed by further detention.The authors argue the need to broaden the referral criteria of community agencies to avoid excluding MDOs. They make a number of recommendations to ensure this vulnerable group receives adequate ongoing care and support following release.

Imprisonment for public protection (IPP) has been the subject of much attention and some controversy since its implementation in April 2005. High numbers of IPP prisoners, combined with a low release rate, have meant that IPP has had a significant impact on the prison population. This paper charts the genesis of IPP and its historical antecedents. It also explores IPP as an exemplar of the ‘rise of risk’ and focuses on its links to the ‘dangerous severe personality disorder’ pilots. It presents two hypotheses on the mental health implications of IPP.

Mental illness affects the majority of prisoners. Mental health issues are beginning to take a central position in the development of prison health services, reflecting this burden of disease. This change in focus is not before time. But prison mental health services cannot exist in isolation. Public health systems should lead provision of care for patients with acute and severe illness. A whole prison approach to health and, specifically, mental health will offer the greatest likelihood that offenders will thrive, benefit from imprisonment, and lead law‐abiding lives after release. Public awareness of the scale and commitment of prisons to mental health and illness, and understanding of prisons’ role in society, are necessary developments that would protect and enhance public mental health, as well as creating a healthier and safer society. This article draws on recent reviews, information and statements to set out a public health agenda for mental health in prisons.

Donna L. Van Raaphorst provides a detailed statistical analysis of a large sample of Alcatraz Prison inmates using the Social Science Statistical Package. The data, drawn directly from the inmate files, is compared whenever possible with similar data provided by the Bureau of Prisons in order to determine if Alcatraz, often regarded as America's Devil's Island, really incarcerated the so-called “Worst of the Worst” in its time. The results would seem to indicate that Alcatraz inmates were, in fact, not remarkably different from those in any other Federal prison in the system.

Over the last decade many ‘diversion from custody’ schemes have been established and there is evidence of their effectiveness in reducing the number of mentally disordered offenders inappropriately remanded in custody. In North Wales there has been pressure to establish such a scheme but it is not clearwhether models developed in large urban areas are applicable to the problems of a rural community.This paper describes a study of male prisoners remanded in custody from North Wales during a four month period to identify need for such a service. In four months 298 prisoners were remanded from North Wales. Only seven courts remanded more than 16 (equivalent to one remand per week); the busiest court remanded 83, equivalent to five per week.In total, 42 prisoners reported a history of mental disorder; records were available on 28 of these, of whom ten were considered to have a mental disorder requiring admission.Only a small number of individuals in this study required diversion from custody (approximately one per week), but in those cases there was significant unmet need. The conclusion was that an effective diversion scheme would have to be able to provide a service to numerous and widely spread courts, most with a low level of activity.