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The Royal College of Psychiatrists Improving the lives of people with mental illness

CR141. Prison Psychiatry: Adult Prisons in England and Wales

Price: £0.00

Approved: Apr 2006

Published: Feb 2007

Status: current

Number of pages: 52

Review by: 2008

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The principles of providing health services to prisoners remain constant, but the prison environment has changed very considerably since completion of this report in 2007. Readers should also be aware of the NICE guidance on physical healthcare in prisons of November 2016 and the NICE guidance on mental healthcare of March 2017. The College is in the process of updating this report accordingly, but with these caveats, we believe that readers will find useful information in this report pending completion of the  next edition.

(May 2017)

The prison environment is radically different from that with which most psychiatrists are familiar. Doctors may have limited control over health facilities in prisons and the delivery of services follows a radically different philosophy, being principally centred on security and control. Resources are also likely to be limited both in quantity and diversity. The epidemiology of mental disorder and the nature of the prison environment result in the role of the psychiatrist in prison being a particularly challenging one.


This report concerns itself with the development of psychiatric services in adult prisons in England and Wales. It is hoped that the guidance will be of relevance to other jurisdictions (it is not applicable to people under the age of 21 in prison establishments). It concentrates on generic services in prisons, and so does not generate recommendations on the needs of prisoners with special needs, nor on the particular needs of women or people from Black or minority ethnic groups with mental health problems in prison.


The report makes 26 recommendations to improve mental healthcare in prisons. These cover the areas of:


  • Role of the consultant psychiatrist in prison.
  • Commissioning mental health services in prisons.
  • Addiction services in prisons.
  • Learning disability services in prison.
  • Female prisoners.
  • Old age psychiatry in prisons.
  • Rehabilitation psychiatry in prison.
  • Psychotherapy services in prison.
  • Training.

(This report replaces CR15: Ethical issues in psychiatric practice in prisons from 1992.)


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