Prison mental health in Northern Ireland
CR219, November 2018

Prison mental health care presents the single most significant challenge to the delivery of forensic mental health care in Northern Ireland. This report, which has been prepared by the Forensic Faculty of the Royal College of Psychiatrists in Northern Ireland, sets out the issues that need to be addressed and potential solutions to support progress.

Recommendations for action 

Immediate

• An evidence-based model of care be applied by the South Eastern Health and Social Care Trust to the delivery of mental health care within the prisons in Northern Ireland in line with national guidance.
• A residential healthcare facility providing 24-hour mental health care be established by the South Eastern Health and Social Care Trust within the prison estate.

Medium term

• A steering group be established by the Department of Health with respect to prison mental health care with input from the Forensic Faculty of the Royal College of Psychiatrists in Northern Ireland as the subject matter experts.
• Prison mental health services in Northern Ireland join the Prison Quality Network and participate in a peer review process.
• Prison mental health services comply with the promoting quality care guidelines. Prison psychiatry job plans conform to national guidelines.
• All prisoners requiring transfer from prison to hospital be considered at a regional bed management forum. 
• Screening of prisoners for mental health problems be introduced by the South Eastern Health and Social Care Trust in accordance with National Institute of Clinical Excellence guidelines.

Longer term

• The low secure agenda be revisited by the Department of Health with a view to meeting the needs of mentally disordered prisoners.
• The transfer of prisoners to hospital against the recommendation of the treating clinician cease.
• Research be commissioned by the Department of Health into the prevalence of mental disorder within the Northern Ireland prison population in order to determine mental health need.
• Reviews of individual prison suicides should not be framed in terms of predictability and preventability.
• Therapeutic opportunities be provided by the South Eastern Health and Social Care Trust in accordance with National Institute of Clinical Excellence guidelines within prison mental health services.
• A managed clinical network be established and resourced by the Department of Health. Prison healthcare providers must engage with regional fora at senior management level.