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There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security.

Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days.

There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days.

In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved.

This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

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.

The ‘Terrible Mother’ traditionally connotes monstrous aspects of motherhood and devouring femininity, encompassing two stereotypical representation of women in myth, fairy tale and fantasy: The Seductress and the Wicked stepmother. The Seductress personifies female malevolence and is characterized as rebellious, manipulative and relentless. Furthermore, she often adopts male aggressiveness, especially sexual, thus usurping male prerogative. Ironically, the temptress is condemned for exhibiting traits which the male hero is lauded for, while also embodying a warning to other women regarding their fate should they rebel against male authority. These narrative strands converge in Cersei, who becomes an embodiment of male anxiety and stands as the chief moral foil and greatest sociopolitical threat to male hegemony.

Concomitantly, Cersei plays the part of the wicked stepmother to Sansa Stark, the series' archetypal damsel in distress. Like Sansa, Cersei began with starry-eyed dreams of womanhood, but quickly grew disillusioned. Despite this, Cersei subjects Sansa to the same injustices she suffered. This re-enactment of her own mistreatment situates Cersei as the female accomplice to the patriarchy. Yet, Cersei also attempts to educate Sansa about women's position vis-à-vis the patriarchy and the tools at their disposal, thus layering the role of the wicked stepmother. Furthermore, Cersei's narrative is complicated as she becomes a point of view character: her focalization becomes a fertile ground for myriad challenges to an androcentric culture, opening avenues for social criticism and possible reimagining of gender roles.