By Meg Huntly

It is unfortunately well-known that a prison environment can exacerbate poor mental health. Dr Graham Durcan writes in his review for the Centre of Mental Health, The future of prison mental health care in England, that “mental health and other visiting providers [clash] with a punitive culture within prisons.”

He describes how the idea of ‘prison as punishment’ rather than ‘prison for punishment’ has led to a “barrier for rehabilitation” and goes onto state that “those contributing evidence to this review felt that such a culture change is of critical importance.”

With 45% of adults in prison in England experiencing anxiety or depression, 8% having had a diagnosis of psychosis, and more than 70% of prisoners meeting the criteria for two or more diagnoses (according to figures taken from Dr Durcan’s report), it is clear that “by default, prisoners are vulnerable and have multiple and complex needs” with a “prevalence rate [of mental health diagnoses] in prison very much higher than in the general population.”

However, so often any kind of mental health support for prisoners is left lacking. Initial mental health screenings in English prisons takes place in two stages, but Dr Durcan found that the secondary screenings were not required to be completed by mental health professionals and were “at best a hit and miss process”, with many prisoners not receiving the second screening at all.

Mental health care itself was found to be vastly varied across English prisons in terms of both provider and what was offered. Help for those who did not qualify for secondary mental health care was very limited and in instances where there was cross-over in prisoner needs (for example, requirement for both mental health and substance abuse support) there were reported to be “continued difficulties in joint working.”

Recorded instances of self-harm in English prisons have also been rising since 2016; in March 2020 there was an 11% increase on the previous 12 months with a staggering 64,552 incidents recorded.

Between 2016 and 2018, there were 285 self-inflicted deaths, 26% of which occurred in the first 28 days of arriving in prison – confirming Dr Durcan’s assertions that this is a particularly high-risk period –while 67% has their screening carried out by a nurse without mental health qualifications and 53% did not receive a secondary mental health screening at all.

Dr Durcan also notes that the period after release from prison is a particularly vulnerable one, citing unstable housing, delays in accessing financial help, finding work, and re-registering with a GP to access healthcare – issues that our Resettlement team help to deal with every day. He states that spending cuts due to austerity policies have hampered probation services, such as the ‘Transforming Rehabilitation’ policy, which should have enabled some prisoners to serve the end of their sentence in the community with support and supervision, but unfortunately did not receive the financial uplift required.

Prisons have also been subject to financial and staffing cuts that have led mental health services to suffer as a result, with 26% of English prison staff being cut between 2010 and 2017, leading to “staff taking on responsibility in prison sooner than might previously have been expected.”

Coupled with poor mental health awareness and low take-up of mental health awareness training, it is easy to see how many prisoners with mental health conditions are slipping under the radar and not receiving the support they desperately need.

This is despite evidence to show that mental health support for prisoners can make a real difference. Dr Durcan recommends that all prisons adopt a “trauma-informed approach”, as “understanding behaviours, motivations and thinking processes, and how these might be impacted by poor mental health, personality disorder, substance misuse or neurodiversity, is pivotal to good practice in a prison setting.” In one prison where this was done, “it was reported in at least one case that the quality and nature of referrals to the prison mental health team had changed, and the degree of joint working across agencies within the prison had improved.”

As Dr Durcan writes, “of course, some behaviours may not have a deep underlying meaning, but the failure to recognise the potential for the existence of one has resulted in staff adopting a punitive response to vulnerable people and losing opportunities for rehabilitation.”

Another study by Oxford university highlights links between support for mental health disorders in prisons and reoffending rates. While keen to stress that the study should not lead to assumptions that mentally ill people are more prone to violence that others, Seena Fazel who headed up the study says that “‘[while] a lot of people have been very cautious in this area not to place too much emphasis on mental health problems linked with reoffending risk’… small studies have shown that other adverse outcomes, including deaths and suicides, go up if ex-offenders are not treated. The study supported putting resources into prison health, he said. Not only do prisoners have a right to health, ‘but beyond that there are other consequences because we have to improve public safety as well.’”

At Prisoners Abroad, we see beyond the conviction; we see the human and the support they should have access to no matter what their situation.

Our purpose is to safeguard the welfare and human rights of British citizens detained overseas and to reduce the isolation experienced by them and their families. By providing a listening ear, alongside practical life-saving actions, we hope to help those living through overseas imprisonment survive with dignity and face the future with hope.

Imprisonment overseas can be an incredibly isolating and stressful experience; in 2021, 23% of the prisoners we were supporting abroad reported a mental health issue, whilst 37% of those on our Resettlement programme told us they were struggling with their emotional wellbeing.

“The distance, the lack of communication and the worry start to eat away at you.” Karim*, who was imprisoned in France.

While Prisoners Abroad provide practical support to help with these struggles – such as grants for food, water and vitamins for those in prisons that fail to provide the basic necessities, and emergency accommodation, travel grants and assistance accessing healthcare and welfare benefits for those who have been deported – we also strive to deliver emotional support wherever possible.

We believe that listening and sharing can be powerful tools. Our freephone helpline is available Monday-Friday and provides support for family members and friends, whose lives are often turned upside down the moment they find out about their loved one’s detention. Having a non-judgemental place to turn for practical and emotional support can be crucial; as one family member says:

“Over the phone - [they] made something unbearable, manageable right from the start.”

We also hold volunteer-led Family Days and Family Support Groups, giving family members a safe place to share with others who are in a similar position. The struggles of having a family member of friend in prison are unique and can often lead to feelings of intense loneliness, so knowing that others are experiencing the same emotions can be of huge help:

“Listening and talking about one's predicament in a small group is like therapy... a problem shared is a problem halved, knowing you are not alone emotionally."

For prisoners, we provide freepost envelopes enabling them to keep in touch with us and with loved ones. Christmas and birthday cards remind them that there are others supporting and thinking of them, while language materials break down barriers and enable prisoners to talk with other inmates and officials more easily.

Our Resettlement team, meanwhile, provide not just practical support to help returnees get back on their feet, but also offer a space to share anxieties and frustrations during an incredibly challenging transition period:

“I have lost everything as I am sure many others have as well […] It's wonderful to know that there is such a caring organisation as Prisoners Abroad who can steer one in the right direction on first arrival back home. I can assure you that your dedication is greatly appreciated.”

Like Prisoners Abroad, Samaritans aim to deliver their services without judgment. They work with individuals and communities – in hospitals, schools and prisons – to support people through difficult times. Their goal is to help people cope – both during a moment of crisis and for the longer term – and to give us the skills to be there for others. Every year on 24th July, Samaritans raise awareness for their Talk to Us campaign, reminding us that they are here to listen 24/7. Their message is very simple:

Talk to us, we’ll listen.

In 2021, Samaritans volunteers spent over a million hours answering calls for help at all times of the day and night – that’s one call every ten seconds taken by almost 20,000 volunteers. They are contactable via phone, email and post, and also offer a self-help app to keep track of thoughts and feelings and find recommendations for coping during a crisis. They believe moments of connection should be encouraged, promoted and celebrated, because, ultimately, they can save lives. This is why we recommend Samaritans to any of our service users who need some extra support with their mental health.

To find out more about our work or if you require advice on overseas imprisonment, please visit:

If you need to talk to someone about a problem, no matter how large or small, day or night, you can visit the Samaritans website to get in touch with them or to find more information on their ‘Talk to Us’ campaign: