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Tagged In:  Mental Health

Mental health services in prisons need to improve, says Prisons and Probation Ombudsman (PPO), Nigel Newcomen. 

Whilst there have been significant improvements to managing the mental health requirements of prisoners, PPO investigations show there’s still much more that needs to be done. 

The PPO’s thematic review considers the lessons learned from investigations into 557 deaths in prisons (between 2012 and 2014), where the prisoner had been identified as having mental health issues prior to their death. 

Here, we summarise the 12 key PPO recommendations that will be of interest to the offender healthcare professionals we recruit. 


1. Reception staff should ensure they review all the documentation that arrives with a prisoner and that this is passed onto the offender health professional responsible for screening prisoners as they enter custody. 
2. The health professional responsible for screening a prisoner at this stage should make sure that all the information they receive is considered when making their assessment, including existing SystmOne records (prison electronic medical record system). 

Prison transfers

3. Currently, staff do not always understand how to use the SystmOne system the PPO concludes. This leads to it being completed incorrectly and documents not being uploaded when they should be. In several cases, vital information about a prisoner’s mental health was missed off. All staff using SystmOne should be trained in its use.
4. NHS England should make sure community GPs provide comprehensive details of a prisoner’s health records upon the request of a prison healthcare professional.  
5. When a prisoner is transferred to another custodial setting, the mental health team of the prison transferring them should provide comprehensive handover to the receiving mental health team. 
6. The mental health team in the receiving prison should always request and make sure they obtain a thorough handover from the sending prison’s mental health team.

Making referrals

7. All staff have a responsibility to make a mental health referral any time that they have concerns.  Prison officers are in a good position to notice changes in behaviour that might indicate a decline in a prisoner’s mental health, the PPO reports. 
8. Mental health assessments must be carried out promptly following a referral, as in 29% of self-inflicted deaths, referrals had not been made when they should have been. 
9. Prisons should ensure they have a clear process for prison staff to refer prisoners directly to the mental health team and that prison and healthcare staff understand how they can make urgent referrals. 


10. Mental health assessments should take into account all relevant information and use standard mental health assessment tools in accordance with NICE, since the PPO investigations found that these are not always used.  
11. NHS England should produce guidance for prison healthcare to advise them on best practice

Mental health awareness

12. Mental health awareness training should be made compulsory for all prison officers and prison healthcare staff so that they are able to identify the signs of mental illness and vulnerability. 

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