Prison mental health: vision and reality

The principle of equivalence means that prisoners should receive the same quality of care for their health as they would receive outside prison. It does not mean that health care will be identical to that outside but that services will aim to achieve the same quality of care as the prisoner receives elsewhere. The need for better mental health care in prisons has been evident for some time. Reports throughout the last two decades have shown that prisoners have dramatically higher rates of the whole range of mental health problems compared to the general population. Not only is prison itself a risk factor for emotional distress but the prison population is comprised disproportionately of people from disadvantaged backgrounds with a history of trauma, loss and low resilience to distress (Durcan, 2008). With high levels of mental ill health in prison, the last decade has witnessed the creation of new inreach teams in every establishment in England. These new teams were designed to be broadly equivalent to the community mental health teams that operate outside and to incorporate within them the outreach and crisis resolution functions of the specialist teams that were set up across the country following the publication of the National Service Framework for Mental Health (DH, 1999). This publication aims to examine what has been achieved in prison mental health over recent years from a number of different personal perspectives and individual observations of working in England. It looks at the specific achievements of inreach teams and of efforts to divert offenders from custody. It also looks more broadly at the rapid growth of the prison population during the same period and the treatment of offenders with mental health problems outside as well as inside prison