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In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

The numbers of psychologists employed in HM Prison Service have doubled in the past three years to over 600 staff. HM Prison Service is the largest single employer of applied psychologists. With a governmental focus firmly on ‘joined up’ services in the criminal justice field (Boateng, 1999), the launch of the National Probation Service (NPS) in April 2001 has set the scene for closer partnership working between the two organisations. There has not historically been a national structure for the employment of psychologists in the probation service. With the creation of the NPS and an increased emphasis on partnership working, a national integrated role for psychologists is ripe for development. This presents both organisations with some significant partnership challenges and opportunities (Towl, 2000).

This paper describes the current levels of ‘self‐harm’, suicide and violence in prisons in England and Wales, outlines key high‐risk groups within the prison population and gives relevant national targets on self‐inflicted deaths and serious assaults ‐ now included in the National Offender Management Service (NOMS) national targets for 2005‐06. It outlines the case for Safer Custody Group to continue to provide on‐going services to tackle ‘self‐harm’, suicide and violence, as part of health and offender partnerships. The link with the ‘health agenda’ is explored, and concrete examples are given of successful collaborative work with the Department of Health and others. The delivery of services intended to promote and mainstream safety, health and well‐being in both public and private prisons is described, as are current and future projects aimed at delivering better services to prisoners, staff and bereaved families.

This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March –June 2020).

The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies.

The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care.

Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored.

The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic.

There are significant numbers of prisoners with complex substance misuse, health and mental health needs. Although there have been substantial developments in drug and mental health services within prisons and the wider criminal justice system, this has occurred with little inter‐agency collaboration. To gauge the level of involvement and inter‐agency collaboration for prisoners with complex needs, a brief questionnaire was circulated to mental health and substance use teams in East Midlands prisons. There are limits to the conclusions drawn, but the findings suggest that there is a lack of a dual diagnosis strategy, very little collaborative work, and an urgent need for training and service development.

This chapter explores the work of a library adult literacy programme working closely with other education providers in Risdon Prison in Australia. The Literacy Service operates as a form of outreach to the prison population who have low literacy levels and are not yet engaged in education or using the prison library. In this context, it is a form of radical inclusion, creating opportunities for those most disadvantaged to access learning. The library services help to create a literate environment for prisoners and provide opportunities for prisoners to increase their engagement in lifelong learning and everyday literacy practices, giving them a better chance of developing their literacy skills. Strategies explored for engaging this cohort include a range of creative projects, small group work and one to one tutoring. The Literacy Service has developed best practice approaches to deliver effective literacy support using strategies and approaches that align with research and these are adapted for work in the prison context. The Literacy Service approach is aligned with the wider prison goals of rehabilitation and reintegration and the chapter explores a theory of change to identify how prison education may be most effective in supporting rehabilitation (Szifris, Fox, & Bradbury, 2018). The library Literacy Service offers safe spaces, opportunities to create social bonds, reshape identity, engage in informal learning and set new goals – key elements found to be critical in rehabilitation. The Prison Library Impact Framework, developed by Finlay and Bates (2018), connects these elements with the theory of change model to propose a tool that may be useful to evaluate prison library services in the future.

In 1999, the national health service (NHS) was made responsible for the commissioning of prison health care. Mental health inreach teams (MHIT) were set up to mirror community mental health teams and provide secondary care to prisoners diagnosed with severe and enduring mental illnesses (SEMI). Since then, the provision of mental health care to prisoners without a diagnosis of a SEMI has been variable. A rapid review of NHS health care in prisons conducted by Public Health England (PHE) (2016) highlighted the need for provision to be more integrated and meet the needs of prisoners without a diagnosis of a SEMI. In response, an integrated mental health and substance misuse service was implemented within her majesty’s prison/young offenders institution Pentonville. This study aims to evaluate its impact and share lessons learned.

Routinely collected and anonymised data were reviewed for prisoners referred between 1 May 2018 and 31 December 2019. Data are presented on the quantity of referrals over time, and the type of support offered. Chi-square goodness of fit tests was conducted to determine whether the prisoners referred to the service were representative of the wider prison population in terms of age and ethnicity.

Referrals showed a general pattern of increase over time and were representative of the wider prison population in terms of age and ethnicity, indicating equitable access. Lessons learned are discussed. Demand for therapeutic and substance misuse services was higher than that for SEMIs. Notable was the high quantity of referrals which provides further evidence for the disparity between high need and limited provision within prison settings, particularly for therapeutic interventions.

To the best of the author’s knowledge, this is the first service evaluation of a recently implemented integrated and holistic model of prison mental health care in line with recommendations from PHE (2016).

Industrial relations problems in the UK Prison Service are part of the wider crisis within the penal system over the past 30 years, from the era of the Mountbatten Report of 1966 to the Woolf Report of 1990, and beyond. Incidents and disputes, concerning both industrial relations and the problems of prison regimes, attract wide media reporting, not all of it accurate. Attempts to redress this selectivity, and to demonstrate the complex linkages between industrial relations and the administration, management and reform of the penal system. Focusing mainly on the Home Office Prison Service (HOPS), and on the three main trade unions, highlights the differing political goals of the prison service, and the perpetual turmoil without clear purpose in which the principal actors seem to be enmeshed.

Stemming from substantial criticism during the late twentieth and early twenty‐first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions.

This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service.

While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed.

Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future.

This paper examines the social and institutional context of barriers to drug service throughcare and aftercare for prisoners in England and Wales, including those that specifically affect Black and minority ethnic prisoners. A research project in 2004 reviewed relevant literature and statistical data, mapped prison drug services, and sought the perspectives of relevant stakeholders: in total, 334 individuals were recruited to the study. The methodology facilitates analysis of the structure of services and the agency prisoner in accessing them. Recommendations are made for changes to the structure and delivery of prison drug services.