Mental health care in prison
This information looks at what healthcare you should get if you’re in prison. And at what to do if you aren’t getting the help you need. Prisoners should have the same access to healthcare as everyone else. This information is for people affected by mental illness in prison in England who are 18 or over. It’s also for their carers, friends and relatives and anyone interested in this subject.
If you would like more advice or information you can contact our Advice and Information Service by clicking here.
- You might go into prison because you have been given a prison sentence by a court. Or because you’re waiting for a court hearing, known as being ‘on remand'.
- If you need help for your mental health while you’re in prison, there are services that can help you.
- 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.
- 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. Different professionals should help you with this.
How common is mental illness in prisons?
The National Audit Office say:
- around 4 in 10 prisoners say they have mental health or wellbeing issues, and
- prisoners are more likely to experience mental health problems than people in the community,
- many prisoners self-harm, there were 40,161 incidents of self-harm in prisons in 2016, and
- there were 120 suicides in prison in 2016.
Your mental health can also get worse in prison.
You might find it hard to manage your mental health because a lot of your day-to-day life is controlled by the 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 about my mental health care when I go into prison?
What happens when I arrive?
You will speak to a healthcare professional who will ask you questions, including ones about your mental 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 should 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 NHS community mental health team (CMHT).
They should ask for your consent before they do this.
What if I was getting social care 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 prison might be in a different local authority (LA) area to where you live. The LA where you lived should share information about your care with the LA where the prison is located. This is 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.
There is more about release further down this page.
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. 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
- 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?
What help can I get for my mental health?
You should have the same access to healthcare as people in the community.
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. Primary care can help with less severe mental health conditions, such as mild to moderate anxiety or depression.
You can ask to see a GP if you need to. 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 symptoms of anxiety or depression. But people with other mental health conditions can find it helpful too.
IAPT services aren’t available in all prisons. You can ask staff whether there is a service in your prison.
Secondary care services
Your GP might refer you to NHS secondary care services if you have a more severe mental health condition. For example:
- severe depression or anxiety,
- personality disorder,
- 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 an NHS 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,
- 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. They do 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 might be transferred there if they’re very unwell. 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 in the section below.
Can I get help to stop smoking?
All closed prisons in England are now smoke free. But you can use a vape or e-cigarettes in your cell.
Your prison will have a service to help you stop smoking.
To help you stop smoking you can be offered things like:
- nicotine replacement therapy in the form of medication, patches or chewing gum, and
- a referral to a behavioural service, which gives advice and support given to just you or to a group.
Can I be moved to hospital for my mental health?
It’s 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’re very unwell you might be moved to a hospital under the Mental Health Act. A psychiatrist will assess you to decide if this should 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 become well enough to go back to prison, you might be transferred back there.
For more information see our webpages on the following:
What other mental health support is there?
Health services aren’t 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.
The Listener scheme is a peer-support scheme within prisons, which aims to reduce suicide and self-harm. Listeners are prisoners who provide confidential emotional support to their peers. This can help prisoners who are struggling to cope or feel suicidal. They are specially selected and trained for the role by Samaritans volunteers.
Listeners don’t provide counselling.
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.
You can read more about the Samaritans’ Listener scheme here:
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 give confidential emotional support. They can listen to your problems and worries. You can phone their helpline from prison for free. It’s open 24 hours a day.
If the prison you’re in doesn’t have a Listeners scheme a volunteer from the Samaritans might visit you, if you ask them to.
What support might I get if I have an issue with drugs or alcohol?
You can get help from the prison’s substance misuse team. This is sometimes called a ‘CARAT’ team. CARAT stands for counselling, assessment, referral, advice and throughcare.
The help you can get varies. It may include:
- advice and information,
- one-to-one support, and
- support groups.
If you have both a mental illness and problems with substance misuse, doctors may call this dual diagnosis.
Some prisons have specialist dual diagnosis teams. If there is no dual diagnosis team, the mental health and substance misuse teams should work together to help you.
The substance misuse team should also work with physical health teams if you need their support.
You may also be able to get help from specialist teams that aren’t based in the prison. They should be allowed in to see you if you need this.
What help will I get to come off drugs?
Opiates – heroin, morphine
You might be addicted to drugs like heroin and morphine. When you arrive in prison you should be supported to stabilise your use for at least 2 weeks. You could be given replacement medication, like methadone or buprenorphine.
During this time, the prison mental health team should assess you. The prison may gradually reduce the dose of your replacement medication, but this shouldn’t be rushed. If you have serious mental health problems, your doctors may decide to use the replacement medication for longer.
Benzodiazepines – diazepam, lorazepam
If you are addicted to benzodiazepines, like diazepam or lorazepam, prison staff will help you to stop taking them. They will do this by gradually giving you smaller and smaller doses, until you stop completely.
The healthcare team and substance misuse workers should offer you support if you drink too much alcohol. They may offer you therapy.
If you are very dependent on alcohol, you may be given medication to help you to stop drinking. Once you have stopped drinking, you may be given medication to help you to stay alcohol-free.
Stimulants – crack, cocaine, mephedrone
You might be addicted to a stimulant like crack, cocaine, or mephedrone. You may feel very depressed for weeks, or even months, when you stop taking it.
This will wear off eventually. But it’s important to tell someone if you are feeling down. You might find it helps to speak to a doctor or a Listener.
See our webpage on Drugs, alcohol and mental health for more information.
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 bottom of this page.
If you still have problems, you can make a complaint.
Complaints about healthcare are different from complaints about other things in prison.
You can complain to the prison healthcare team or NHS England about problems with your healthcare. fund all prison healthcare services, even if they’re managed by a private company.
You can find NHS England’s contact details in the Useful contacts section at the bottom of this page.
For more information see our webpages on the following:
What happens when I am released from prison?
It’s 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.
You may already be registered with a GP in the community. The prison healthcare team should update your GP on the treatment you’ve had, if you consent.
If you don’t 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’re able to get a prescription from your GP.
NHS mental health teams
If you have a mental health condition, healthcare staff must think about whether you should be referred to an NHS mental health team. This might be:
- a community mental health team (CMHT), or
- a team that deals with a specific condition, like personality disorders.
NHS mental health team are made up of different mental health professionals, who work together to support you in the community.
What are NHS forensic community mental health teams?
In some areas there are forensic community mental health teams. They provide specialist support to assess, treat and manage you if:
- you have a mental illness or personality disorder,
- because of that you’ve committed a crime, or you are thought to be a risk to others.
The aim of the support is to:
- maintain and improve your mental health,
- improve the quality of your life, and
- manage the risk of you being violent or re-offending.
See our webpage on NHS mental health teams for more information.
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 for 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.
See our webpage on Drugs, alcohol and mental health for more information.
What is section 117 aftercare?
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 mental health and social services support for free.
See our webpage on Section 117 aftercare for more information.
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 isn’t possible, they should continue to meet your needs until they can do the 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.
See our webpage on Social care assessment – Under the Care Act 2014 for more information.
What can I do if I’m worried about my loved one’s mental health?
It can be difficult if you have a loved one in prison and you’re worried about their mental health.
You can use our sample letter below to write to the prison. The best person to write to would be the Healthcare Manager or the prison Governor.
You can also contact the Prisoners’ Families Helpline for advice. You can find their contact details in the Useful contacts section at the bottom of this page.
NHS Self-Help Factsheets
The NHS in Northumberland, Tyne and Wear has written factsheets to
help prisoners to manage:
- depression and low mood, and
- post-traumatic stress disorder (PTSD).
You can find them on their website.
For more information see our webpages on the following:
You can ask staff, a friend, or relative to get this information for you too.
Care Quality Commission (CQC)
They monitor, inspect and regulate prison health and social care services to make sure people who use them receive the same quality of care as the rest of the population.
Forward helps people with drug or alcohol addiction in some prisons, and in the community. They offer advice, counselling, and group work. They can work with prisoners and their families.
They work to improve health and social care services by listening to service users and speaking out on their behalf. Their local services work to improve health and social care in their area, including in prisons.
They deal with complaints about NHS healthcare services in prison.
Telephone: 0300 311 22 33.
Address: NHS England, PO Box 16738, Redditch, B97 9PT
Prisoners’ Families Helpline
The Prisoners’ Families Helpline can support anyone in England and Wales whose family member is in the criminal justice system. They give advice and information on all aspects of the system. For example, what happens when someone’s arrested, visiting a prison, and preparing for release.
POhWER delivers advocacy in some prisons. If you have an NHS complaint, they might be able to help.
Prison Phoenix Trust
They encourage prisoners in their spiritual lives through meditation and yoga.
Prison Reform Trust
This is an independent charity that works to improve support for prisoners. They run a helpline that advises prisoners.
Helpline: 020 7251 5070.
Freephone helpline: 0808 802 0060.
Address: Prison Reform Trust, FREEPOST ND 6125, London, EC1B 1PN
Prisoners’ Advice Service (PAS)
PAS gives free legal advice and information to prisoners in England and Wales on their rights, conditions of imprisonment, and Prison Rules.
Pact is a charity that supports prisoners, people with convictions, and their children and families. They can also provide advocacy.
VoiceAbility delivers NHS Complaints Advocacy in some prisons.
Women in Prison
A national charity that supports women affected by the criminal justice system. They campaign to end the harm caused to women, their families and our communities by imprisonment.