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In 1999, the national health service (NHS) was made responsible for the commissioning of prison health care. Mental health inreach teams (MHIT) were set up to mirror community mental health teams and provide secondary care to prisoners diagnosed with severe and enduring mental illnesses (SEMI). Since then, the provision of mental health care to prisoners without a diagnosis of a SEMI has been variable. A rapid review of NHS health care in prisons conducted by Public Health England (PHE) (2016) highlighted the need for provision to be more integrated and meet the needs of prisoners without a diagnosis of a SEMI. In response, an integrated mental health and substance misuse service was implemented within her majesty’s prison/young offenders institution Pentonville. This study aims to evaluate its impact and share lessons learned.

Routinely collected and anonymised data were reviewed for prisoners referred between 1 May 2018 and 31 December 2019. Data are presented on the quantity of referrals over time, and the type of support offered. Chi-square goodness of fit tests was conducted to determine whether the prisoners referred to the service were representative of the wider prison population in terms of age and ethnicity.

Referrals showed a general pattern of increase over time and were representative of the wider prison population in terms of age and ethnicity, indicating equitable access. Lessons learned are discussed. Demand for therapeutic and substance misuse services was higher than that for SEMIs. Notable was the high quantity of referrals which provides further evidence for the disparity between high need and limited provision within prison settings, particularly for therapeutic interventions.

To the best of the author’s knowledge, this is the first service evaluation of a recently implemented integrated and holistic model of prison mental health care in line with recommendations from PHE (2016).

Prisons are uniquely challenging working environments. Staff are often exposed to direct and indirect trauma, impacting negatively on their mental well-being. Due to the limited research into prison staff experience, this paper aims to explore what staff find most challenging, how they cope, what support they would like and rewarding aspects of their work.

This service development project was facilitated through a staff well-being event. A qualitative approach was used and 74 staff members provided anonymised responses. An inductive and data-driven approach was used to analyse the data, and the trustworthiness of the analysis was considered using criteria established by Lincoln and Guba (1985).

Thematic analysis identified six themes, namely, the challenging nature of the work, interactions with prisoners, staff interactions, inadequate resources, staff support and development and coping strategies. Key findings include managing distress, self-harm and violence and limited resources presenting challenges. Role variety and opportunities to support prisoners were reported as positive. A variety of coping strategies were identified. Wider availability of supervision and reflective practice was suggested by staff.

Recommendations for increased staff support are made. Suggestions for future research investigating methods to increase rewarding aspects of work within prisons are given.

This analysis adds to the limited body of qualitative research investigating prison staff experiences; in particular, aspects of the work that they find rewarding such as the role variety and opportunities to make positive changes to prisoners’ lives. Novel coping strategies were identified, including cognitive reframing and behavioural strategies for managing stress, which could be encouraged to increase resilience.