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Research project: The pathway of prisoners with mental health problems through prison health services and the effect of prison environment on the mental health of prisoners - Dormant - Dormant

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In 1999, a joint Prison Service NHS Executive working group concluded that prisoners should have access to the same range and quality of healthcare as the public receives from the NHS' and recognised that prison healthcare staff should identify prisoners with health problems continue any care started in the community, contribute to a seamless service and facilitate through care on release'.


The standard of mental healthcare in prisons has been strongly criticised and research has shown mental health needs frequently go undetected and therefore untreated in prison (Birmingham et al. 1998), whilst continuity of care between prison and the community remains patchy. The introduction of mental health in-reach teams may go some way to improving mental healthcare in prison, but in order to inform service planning there is a need to map the actual care received by those with mental health problems, both in prison and in the community, to identify the gap between prisoners' needs and current service delivery.
Environment study - It is often claimed that the prison environment creates or exacerbates mental health problems. However, other than studies applying measures of the quality of prison life to the risk of suicide (Liebling et al. 2006), little research has been done to establish whether imprisonment or the prison environment do create mental health problems or whether prisoners with mental health problems are likely to experience deterioration in their symptoms compared with people with mental health problems in the community.

Main question(s)

  • To track prisoner-patient pathways to care from the community through prison and back into the community.
  • To map the barriers and facilitators to contact and support at different points of prisoners' custodial careers.
  • To examine whether imprisonment and the prison environment create or exacerbate mental health problems. 
  • To explore prisoner and environment-related factors which are associated with any increase in the incidence of mental illness or the worsening of mental health symptoms.


The research is taking place in five prisons across the country. Southampton researchers (led by J. Lathlean) are conducting fieldwork in two prisons in the south.

Pathways study - Longitudinal cohort design and qualitative interviews. The sample of participants for this research will be drawn from the national evaluation of prison mental health in-reach services. With their consent, details of prisoner-patient contact with mental health services in the NHS and prisons will be gathered using documentary analysis of medical and mental health records, and information from prisoners and healthcare professionals. A small number of qualitative interviews will be carried out with patients with severe and enduring mental health problems to explore how they first made contact with services and have experienced subsequent mental health care.

Environment study - Longitudinal cohort design. All prisoners who have participated in the national evaluation of prison mental health in-reach services will be asked to complete a follow-up interview including various clinical measures, after 6 months or when they leave prison (whichever is sooner). This interview will examine whether those identified as having mental health problems experience an increase in mental health symptomology during their imprisonment.

Main outcomes

The findings of the studies will be fed back to relevant stakeholders for debate and development of a model for improved service delivery, and the development of services and facilities in prison to promote mental well-being. 

Project team

Judith Lathlean 

Project funder

National Programme Forensic Mental Health Research and Development

Related research groups

Health Work and Systems
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