The impact of integrating mental health services within a prison setting

Abstract

Purpose 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. Design/methodology/approach 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. Findings 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. Originality/value 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).