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There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security.

Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days.

There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days.

In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved.

This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

Community-based forensic support services (CBFSSs) were commissioned nationally by National Health Service (NHS) England in 2017 in response to “Building the Right Support” (NHS England, 2015). CBFSSs provide multidisciplinary support to adults with intellectual disabilities and/or autism who are in (or at risk of) contact with the criminal justice system and those transitioning from inpatient secure care. This paper aims to highlight potential systemic barriers to accessing community forensic services for people from an ethnic minority background. in one CBFSSs in Northern England.

This paper provides preliminary reflections on potential systemic barriers within the criminal justice system and health-care services that have implications for service users from ethnic minority backgrounds accessing CBFSSs.

There is a paucity of data, policy and literature that focuses on people with intellectual disabilities and autism with forensic needs from ethnic minority backgrounds. This lack of data obstructs further reforms to meet the needs of this population.

CBFSSs are commissioned across England. While some regional variation is to be expected, services should be aware of the systemic barriers people from ethnic minority backgrounds within their region face. These barriers should be considered and addressed when evaluating service efficacy and delivery. Recommendations are made to review and address issues of under-representation of ethnic minorities within CBFSSs.

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.

Forensic mental health services play an important role in providing treatment and accommodation for people diverted from prison or the courts who require secure and specialist mental health treatment. There are more than 3,500 people in medium and high‐secure hospitals who have been directed there by the courts or prison system, and nearly 1,000 new admissions are received each year. Yet, the facts and figures relating to these services are patchy and not widely published. This paper builds on an earlier statistical briefing produced by the Sainsbury Centre for Mental Health in 2007, and seeks to provide an up‐to‐date and improved understanding of this area of service provision by presenting the most recent data and figures.

The purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of individuals diverted subsequently from prison to psychiatric settings.

The authors conducted a retrospective review of 130 successive psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties. The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were retrospectively completed to assess security need.

In total, 8.6 per cent of all committals from liberty were referred by a general practitioner and 8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services, 51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and 59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have benefited from a low secure/intensive care setting.

The multifaceted need set of those referred strengthens the argument for the provision of multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons supports the need for Intensive Care Regional Units in Ireland.

Prisoners serving life sentences are known to be at a higher risk of suicide. This paper reports findings from a review of self‐inflicted deaths of life sentence prisoners over the years 1988‐2001 and an indepth analysis of 20 recent cases (1998‐2001) to identify the individual motivations and environmental triggers for self‐inflicted death in this population. There were 80 (9.5% of total prison suicides) self‐inflicted deaths among lifers in the study period. The prisoners were older and more likely to kill themselves a year or more into their sentence than were other prison suicides. Analysis of the 20 case studies showed that lifers who killed themselves less than a year into their sentence tended to be overtly suicidal from the start of their time in custody, to have committed domestic murders and to have killed themselves when faced with the reality of their sentence or tariff. Lifers who killed themselves more than a year into their sentence tended to have a previous history of self‐harm or suicide attempts but fewer signs of immediate risk. Problems in progressing through the lifer system seemed to be significant, including reduced status or a failed appeal, and inability to adjust following transfer. Other triggers included disrupted relationships in or out of prison. Among both early and late groups there was evidence of mental health problems contributing to the death. Warning signs immediately before the death included refusing food, work or medication. Mood and demeanour appear to be unreliable indicators of risk.

Almost 10 years ago, attention was drawn to the many pitfalls involved in the treatment of tuberculosis (TB) in prison settings, based on field experience from the ICRC (International Committee of the Red Cross) (Coninx et al., 1995). Since that time, the ICRC has continued working in the field of TB in prisons, either directly or by supporting the local programmes in different countries. Further experience gained since then has, if anything, confirmed and reinforced the worries caused by the specific problems posed both by the prison environment and by “prisoner‐patients” for the treatment of TB. Medical staff working in prisons need to be familiar with these issues if tuberculosis is to be managed and treated successfully. With the menace of drug‐resistant TB no longer merely a marginal problem but arguably becoming a direct menace to public health, it becomes all the more important to be aware of these pitfalls. This paper addresses the following: * why prison settings are especially difficult for TB detection and management; * why prisoners can be particularly difficult patients; * how different resistant strains of TB are produced or enhanced in prisons; * added difficulties in treating MDR‐TB in prisoners; and * how and why the association of TB and HIV complicate TB, and MDR‐TB, treatment in prisons even further. The photographs and additional illustrations are from the author’s collection. Permission was obtained from all persons photographed for reproduction.

The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana.

Data were gathered using different qualitative methods (interviews and participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a framework method for the thematic analysis of the semi-structured interview data; and interpreted with the theoretical perspective of health systems thinking and innovation.

The study concludes that health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates.

The limited facilities available and the sample size (healthcare workers and prison administrators) impeded the achievement of varied views on the topic.

The paper recommends the need for health policy makers and authorities of the Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to reform the prisons healthcare system.

The national health insurance scheme was found to be the financing option for prisoners’ access to free healthcare with supplementation from the Ghana Prison Service. The study recommends that policy makers and healthcare stakeholders should understand and appreciate the reality that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery in Ghana and as such should be given the needed attention.

This is one of few studies conducted on male only prisoners/prison in the context of Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system achieves set objectives in response to the primary healthcare concept.

This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.

The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.

The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.

This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.