title: Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.
abstract: OBJECTIVE
  This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services.
  
  
  METHODS
  A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified.
  
  
  RESULTS
  Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners.
  
  
  CONCLUSIONS
  The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.
authors: Informed Thinking, 10 Grove Road, London, SW19 1BL, UK. chiara.samele@kcl.ac.uk.|Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK. chiara.samele@kcl.ac.uk.
authors: Chiara
authors: C
authors: Samele
authors: Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.|South London and Maudsley NHS Foundation Trust, 108 Landor Road, London, SW9 9NT, UK.
authors: Andrew
authors: A
authors: Forrester
authors: Informed Thinking, 10 Grove Road, London, SW19 1BL, UK.|Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
authors: Norman
authors: N
authors: Urquía
authors: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
authors: Gareth
authors: G
authors: Hopkin
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons / Q000458:organization & administration*; D036301:Qualitative Research; D012017:Referral and Consultation; D019037:Urban Health Services / Q000458:organization & administration*
keywords: In-reach; Integration; Multi-agency; Prison mental healthcare; Prisoner