Healthcare in Prison

Prisoners should have the same access to healthcare as everyone else. This page looks at what healthcare you should get if you are in prison. And at what to do if you are not getting the help you need.

Overview

  • You might go into prison because you have been given a prison sentence by a court. Or because you are waiting for a court hearing. This is sometimes called being ‘on remand'.
  • There are services that can help you while you are in prison, if you think you might need help for your mental health.
  • You have the same right to healthcare services as everyone else. Some prisons have a healthcare wing. You might go there if your health is very bad.
  • If you are too unwell to stay in prison, you could be transferred to hospital for specialist care under the Mental Health Act 1983.
  • Most prisons have 'Listeners'. You can talk to them if you need support. Or you can talk to the Samaritans.
  • There are services that can help you if you have problems with drugs or alcohol.
  • It is important that you get support when you are released from prison. The prison should help with this.
  • A lot of people going into prison already have a mental illness. People’s mental health can also get worse in prison.
  • A lot of people have a mental illness and use drugs or other substances. You may hear this being called 'dual diagnosis'.

What happens when I go into prison?

What happens when I arrive?

You will speak to a healthcare professional at reception. They will ask you questions, including questions about your health. Prison staff might call this a 'health screening'. Or a ‘first-stage’ health assessment’.

The assessment should be carried out before you are shown to your cell. They will ask you a lot of questions. Including questions about:

  • your mental health,
  • your physical health,
  • whether you have issues with substance misuse,
  • whether you self-harm, or have done in the past, and
  • whether you are experiencing suicidal thoughts, or have done in the past.

Although some of these subjects are hard to talk about, it is important to be honest. Being honest means you will get the help you need.

At the assessment, you should be told how to contact prison health services and book GP appointments. Staff can ask a healthcare professional to see you straight away, if they are worried about you.

You should get any help you need as soon as possible.

What happens after the assessment?

Staff will arrange for your medical records to be transferred from your GP to the prison healthcare team. This helps to make sure that you get the right care in prison.

They will also contact any other health services that were helping you in the community. For example, your Community Mental Health Team (CMHT).

They should ask for your consent before they do this.

What if I was getting care and support in the community?

You may have been getting care and support in the community from social services. This might be things like help with cooking, dressing, and paying bills. The local authority where the prison is based is responsible for continuing this help.

The local authority where you lived before should share information about your needs with the new local authority, so your care and support can continue.

Prison authorities should tell the local authority when someone arrives at their prison who may need care and support.

What happens once I've settled in?

Once you are settled in, you will have a full health assessment. This is sometimes called a ‘second-stage’ assessment. It should take place within 7 days of arriving in prison.

Staff will ask you how you are settling in, and about your health in general. They should check how you have got on with any support that was promised after your initial health screening. This is a good time for you to share any worries you have, and ask for information.

The prison can pass on your medical record to your new doctor if you are:

  • moved to another prison,
  • moved to hospital, or
  • released from prison.

 

Can I take my medication in with me?

You can't take your medication into prison with you. So you should tell staff about any medication you need as soon as you arrive at the prison. You can take your medication as far as the reception, so that staff can see exactly what you are taking.

The prison doctor can arrange a new prescription for you. You should get your new medication as soon as possible.

Healthcare staff will decide if you can keep your medication, and take it yourself. Or if you need to be supervised. This will depend on the sort of medication you take and the type of illness you have. Keeping your medication is called having it ‘in-possession’.

What help can I get?

You should have the same access to healthcare as people outside prison.

What services are there for my mental health?

Primary care services

Primary care services, like a GP, are usually the first step to getting help for any health problem. People who have less severe mental health conditions, such as mild to moderate anxiety or depression, can get all the help they need from primary care.

You can ask to see a GP at any time. Ask a member of staff or another prisoner how to do this.

Your GP may be able to arrange talking therapy for you. This is called a 'referral'.

In some prisons there is an Improving Access to Psychological Therapies (IAPT) service. This service offers talking therapies. It generally helps people with anxiety or depression. But people with other mental health conditions can find it helpful too.

IAPT services aren’t available in all prisons. Ask staff whether there is a service in your prison.

Secondary care services

Your GP might arrange for you to get help from secondary care services if you have a more severe mental health condition. For example:

  • severe depression or anxiety,
  • schizophrenia, or
  • bipolar disorder.

You might get help from an 'in-reach team'. This is a team of health professionals, like a psychiatrist, psychologist, social worker, or specialist nurse, who work together to support you. It is similar to a Community Mental Health Team (CMHT). The in-reach team may offer you:

  • cognitive behavioural therapy (CBT),
  • help to manage stress and anxiety,
  • help to manage self-harm,
  • help to manage suicidal thoughts or feelings,
  • medication,
  • help with your symptoms,
  • help for your carers, or
  • help to stop you becoming unwell again.

The psychiatrist can monitor your health and medication. They can also assess you under the Mental Health Act 1983, if your mental health is very bad, and you might need to be in hospital.

Protection if you are at risk of self-harm or suicide

Your prison will have a 'Safer Custody Team' (SCT). The SCT is there to keep vulnerable prisoners safe.

If staff think you are at risk of self-harm or suicide, you will get help under the Assessment, Care in Custody, and Teamwork (ACCT) process. This is where a plan is put in place to keep you safe.

Any member of prison staff who is worried about you must let the on-duty manager know. This doing this by filling out a form, which they give to the manager. The ACCT process should start within 1 hour of the staff member filling out this form.

What services are there for my physical health?

Your prison will have a healthcare team. You should have access to a doctor, nurse, dentist, and optician.

Some prisons have healthcare or hospital wings. Prisoners who have bad physical or mental health can stay here if they are not well enough to be in the main part of the prison. But most prisoners with health problems will stay on standard wings.

If you have a more serious condition, the healthcare team might ask a specialist to come into the prison to help you.

They could also transfer you out of prison to see a specialist. Or to get treatment in hospital.

If you leave prison to get help, you will have a prison escort. This is likely to be a prison officer. Although you are outside the prison, you stay in the custody of the Prison Service.

Can I get help for drug or alcohol use?

Your prison will have a substance misuse service.

Staff should refer you to the service if you mentioned the following things at your health screening.

  • You have used street drugs in the past month. ‘Streets drugs’ means things like heroin, cocaine, or cannabis.
  • You have problems with prescription medication. For example, you use medication that hasn’t been prescribed by a doctor. Or you take doses that are much higher than the doctor told you to take.

There is more information about help for substance misuse further down this page.

Can I be moved to hospital for my mental health?

is important that you get the care you need while you are in prison. A prison can support most prisoners with a mental illness. But, if you are too unwell to be treated in prison, you can be moved to a hospital, using the Mental Health Act. A psychiatrist will assess you to decide if this needs to happen.

If you have been sentenced, you would be moved under section 47 of the Mental Health Act. If you are on remand, you would be moved under section 48

If you get better in hospital, you could be transferred back to prison.

Does the Care Programme Approach (CPA) apply in prison?

CPA is a way of organising your care if you have complex mental health needs.

You might be under the Care Programme Approach (CPA) if you see mental health services, such as the Community Mental Health Team (CMHT).

If you are already on CPA when you go into prison, the prison should contact your care coordinator to get information about your care plan.46 This will help them to plan your care in prison.

While you are in prison, a member of prison staff will be your care coordinator. Staff on your wing should work with the in-reach team to give you the support you need for your mental health.

Wing staff, the in-reach team, and any other relevant professionals should work together on your care plan.

 

What other support is there for mental illness?

Health services are not the only option if you want support. Prisons often have ‘peer support schemes’. This means that you could talk to another prisoner about problems you are having and how you feel.

Listeners

The Samaritans train some prisoners as ‘Listeners’. This means that they can give you emotional support. They cannot offer you counselling but they can give you someone to talk to. It is completely confidential, so they would not normally tell anyone about what you say.

Listeners are expected to follow the same policies and values as other Samaritans volunteers. Ask staff if you would like to speak to a Listener.

Insiders

Some prisoners train as ‘Insiders’. They give basic information and support to new prisoners. The first few days in prison can be very difficult and Insiders can help you to feel better.

Samaritans

Samaritans give confidential emotional support. They can listen to your problems and worries. You can phone their helpline from prison for free, 24 hours a day. Or you can ask them to visit you.

What can I do if I'm not getting the help that I need?

Speak to someone

First try to speak to someone in healthcare. They may be able to arrange more help for you. Or signpost you to someone else who can help.

You might be able to get help from an advocate if you find it hard to explain your problems.

Advocates are independent people who can help you to get your voice heard. Some advocacy services help people in prison. You can find contact details for advocacy services in the Useful Contacts section at the end of this factsheet.

Complain

If you still have problems, you can make a complaint.

Complaints about healthcare are different from complaints about other things in prison.

You should complain to NHS England if they are responsible for the healthcare in your prison.

If a private company manages healthcare in your prison, the prison should have its own procedure to manage healthcare complaints. Ask a member of healthcare staff about this.

Release

It is important that you get support when you are released from prison. This support should be written down in a discharge plan. It can come from different professionals.

The prison healthcare team should do a follow-up interview with either you or your care coordinator 14 days after your release from prison. This is to see how you are getting on.

Your GP

You may already be registered with a GP in the community. The prison healthcare team should update your GP on the treatment you have been getting, if you give your permission.

If you do not have a GP, prison healthcare staff should help you to register with one. The healthcare team should make sure that you have enough medication until you are able to get a prescription from your GP.

A Community Mental Health Team (CMHT)

If you have a mental health condition, healthcare staff must think about whether you should be referred to a CMHT.

A CMHT is a team of different mental health professionals, who work together to support you in the community.

Other services

Healthcare staff should also think about whether you need help from other services. For example, support with housing or substance misuse.

If they think you need this help, they might refer you to support. Or they might just give you information about support, so you can access the help yourself.

If they want to refer you, they should ask for your permission.

What if I am on the Care Programme Approach (CPA)?

If you are on the CPA, the professionals that help you should work together to plan your care. The plan should look at all of your needs. For example, your mental and physical health. And whether you need help with things like:

  • cooking,
  • dressing,
  • housing,
  • money,
  • education, or
  • finding a job.

If you have been in hospital under certain sections of the Mental Health Act, you might be able to get ‘section 117’ aftercare. This means that you could get some support for free.

Which local authority will support me?

Generally, the local authority where you are ‘ordinarily resident’ will be responsible for your housing and social care needs. Ordinarily resident’ means where you normally live. If you don't always live in the same place, this may not be easy to work out.

When you are released, services will assume that you are ‘ordinarily resident’ in the area where you lived before you went into prison. But you might not go back to this area.

If you are going to live in a new area, the local authority that covers that area should assess you before you are released from prison. If this is not possible, they should continue to meet your needs until they can do their own assessment. Prison managers and healthcare professionals can ask the local authority to assess you. Or you can ask them yourself.

If it is not clear which local authority should assess you, the local authority for the area where you plan to move should do this.

 

Additional information.

Our printable factsheet version of this page includes additional information, letters and important contacts. Please use the download button at the top of the page to down this. 

 

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