title: Implementing change: staff experiences of changes to prison mental healthcare in England and Wales.
abstract: OBJECTIVE
  Stemming from substantial criticism during the late twentieth and early twenty-first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions.
  
  
  METHODS
  This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service.
  
  
  RESULTS
  While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed.
  
  
  CONCLUSIONS
  Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future.
authors.affiliation: Senior Lecturer in Psychology, School of Social Sciences, Birmingham City University, Birmingham, UK.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Caulfield
authors.forename: Hannah
authors.initials: H
authors.lastname: Twort
mesh_terms: D001291:Attitude of Health Personnel; D004739:England / Q000453:epidemiology; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000379:methods / Q000458:organization & administration; D006291:Health Policy / Q000639:trends*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000458:organization & administration* / Q000639:trends; D009936:Organizational Innovation; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons / Q000458:organization & administration* / Q000639:trends; D014852:Wales / Q000453:epidemiology
keywords: Government health policy; Mental health; Mental health services; Prison staff; Prisons; United Kingdom