Systemic limitations in the delivery of mental health care in prisons in England.

There is a high prevalence of mental health need in prisons, much of which is currently unmet. Although considerable research has identified and described this mental health need, there has been limited research focussed on reviewing the delivery of mental health care in prisons. This study uses content analysis to review 36 unannounced prison inspection reports in England to establish whether mental health care was provided to an appropriate standard, and whether it is equivalent to services that are provided in the wider community. The analysis identified four main categories, each of which had further sub-categories: managing the process; staffing; range of services; and quality of service. Numerous concerns were identified, including: delays to service access; lack of appropriate interventions; low staffing levels; limited specialist support; and limited access to supervision, training and reflective practice. Despite these difficulties, many teams had adopted open referral systems to improve service access, had good working relationships and were thought to be providing care of good quality. The delivery of mental health care within prisons is still not equivalent to that which is provided in the community, and this study has identified a number of areas for further improvement.