Prison mental health — structured clinical viva

Epidemiology anchors. Cite meta-analyses: psychosis roughly 3–4%, major depression roughly 10–12%, SUD markedly elevated — several-fold community rates for SMI and very high SUD burden.[1][2][9] This justifies universal reception screening and robust in-reach capacity.

Equivalence of care. Same clinical standards as community care adapted to security: assessment, evidence-based treatment, psychological therapies, and transfer when prison cannot meet need.[3][10]

Reception standards. 24/7 capable process: suicide/self-harm, psychosis, withdrawal, medication continuity (including LAI and OAT), vulnerability. Night arrivals are high risk — no "wait until morning" for active ideation or severe withdrawal.[3][4]

Suicide and self-harm systems. Use risk-factor evidence (prior self-harm, psychiatric morbidity, ideation, single-cell/isolation issues) to structure care, not as false-precision scores.[4][6] Self-harm clusters and associates with later suicide — every episode needs psychosocial assessment and safety planning.[5] Observation ladder + environmental prevention + treatment of underlying illness.

Dual diagnosis. Concurrent integrated care for mental illness and SUD is the default model.[9][3]

Segregation. Clinical policy: segregation is not treatment; associated with adverse psychological effects; if used for security, mental health input increases and step-down is pursued; hospital transfer when needed.[7]

Transfer. When acuity exceeds prison healthcare capacity — principles only; local lawful pathways vary. Equivalence of care includes timely external hospital pathways when prison care cannot meet need.[3][10]

Special populations. Women (self-harm/trauma), youth, older adults, Indigenous cultural safety, ID/ABI vulnerability — adapt pathways within the same safety and equivalence standards.[3][5]

Release transition. Pratt: early post-release suicide elevation — throughcare is mandatory (scripts, appointments, OAT, housing, crisis plan).[8]

Governance ask of the governor. Fix night reception staffing, ban segregation-as-psych-care culture, joint self-harm review with health, and a release-planning KPI as systems measures against known early-custody and self-harm risks.[4][5][3]