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Health of people in the criminal justice system

About

What is covered

This interactive flowchart covers:
  • Assessing, diagnosing and managing physical health problems of people in prison or young offender institutions. It aims to improve health and wellbeing in the prison/young offender institution population by promoting more coordinated care and more effective approaches to prescribing, dispensing and supervising medicines.
  • Recognising, assessing, treating and preventing mental health problems in adults who are in contact with the criminal justice system (police and court custody, prison custody, street triage and liaison and diversion services, as well as probation service providers). There are recommendations on care planning and pathways, and organisation and structure of services, as well as training for health, social care and criminal justice professionals and practitioners.

Updates

Updates to this interactive flowchart

20 March 2017 Mental health of adults in contact with the criminal justice system (NICE guideline NG66) added.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on managing the physical and mental health of people in prison, and the mental health of people in the criminal justice system

What is covered

This interactive flowchart covers:
  • Assessing, diagnosing and managing physical health problems of people in prison or young offender institutions. It aims to improve health and wellbeing in the prison/young offender institution population by promoting more coordinated care and more effective approaches to prescribing, dispensing and supervising medicines.
  • Recognising, assessing, treating and preventing mental health problems in adults who are in contact with the criminal justice system (police and court custody, prison custody, street triage and liaison and diversion services, as well as probation service providers). There are recommendations on care planning and pathways, and organisation and structure of services, as well as training for health, social care and criminal justice professionals and practitioners.

Updates

Updates to this interactive flowchart

20 March 2017 Mental health of adults in contact with the criminal justice system (NICE guideline NG66) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Physical health of people in prison (2016) NICE guideline NG57

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Questions for first-stage health assessment

Topic questions
Actions
Prison sentence
1. Has the person committed murder, manslaughter or another offence with a long sentence?
Yes: refer the person for urgent mental health assessment by the prison `mental health in-reach team if necessary.
No: record no action required.
Prescribed medicines
2. Is the person taking any prescribed medicines (for example, insulin) or over-the-counter medicines (such as creams or drops)? If so:
  • what are they?
  • what are they for?
  • how do they take them?
Yes: document any current medicines being taken and generate a medicine chart.
Refer the person to the prescriber for appropriate medicines to be prescribed, to ensure continuity of medicines.
If medicines are being taken ensure that the next dose has been provided (see access to medicines).
Let the person know that medicines reconciliation will take place before the second-stage health assessment.
No: record no action required.
Physical injuries
3. Has the person received any physical injuries over the past few days, and if so:
  • what were they?
  • how were they treated?
Yes: assess severity of injury, any treatment received and record any significant head, abdominal injuries or fractures.
Document any bruises or lacerations observed on body map.
In very severe cases, or after GP assessment, the person may need to be transferred to an external hospital. Liaise with prison staff to transfer the person to the hospital emergency department by ambulance.
If the person has made any allegations of assault, record negative observations as well (for example, 'no physical evidence of injury').
No: record no action required.
Other health conditions
4. Does the person have any of the following:
  • allergies, asthma, diabetes, epilepsy or history of seizures
  • chest pain, heart disease
  • chronic obstructive pulmonary disease
  • tuberculosis, sickle cell disease
  • hepatitis B or C virus, HIV, other sexually transmitted infections
  • learning disabilities
  • neurodevelopmental disorders
  • physical disabilities?
Ask about each condition listed.
Yes: make short notes on any details of the person's condition or management. For example, 'Asthma – on Ventolin 1 puff daily'.
Make appointments with relevant clinics or specialist nurses if specific needs have been identified.
No: record no action required.
5. Are there any other health problems the person is aware of, that have not been reported?
Yes: record the details and check with the person that no other physical health complaint has been overlooked.
No: record no action required.
6. Are there any other concerns about the person's physical health?
Yes: make a note of any other concerns about physical health. This should include any health-related observations about the person's physical appearance (for example, weight, pallor, jaundice, gait or frailty).
Refer the person to the GP or relevant clinic.
No: note 'Nil'.
Additional questions for women
7. Does the woman have reason to think she is pregnant, or would she like a pregnancy test?
If the woman is pregnant, refer to the GP and midwife.
If there is reason to think the woman is pregnant, or she would like a pregnancy test: provide a pregnancy test. Record the outcome and if positive make an appointment for the woman to see the GP and midwife.
No: record response.
Living arrangements, mobility and diet
8. Does the person need help to live independently?
Yes: note any needs. Liaise with the prison disability lead in reception about:
  • the location of the person's cell
  • further disability assessments the prison may need to carry out.
No: record response.
9. Do they use any equipment or aids (for example, walking stick, hearing aid, glasses, dentures, continence aids or stoma)?
Yes: remind prison staff that all special equipment and aids the person uses should follow them from reception to their cell.
No: record response.
10. Do they need a special medical diet?
Yes: confirm the need for a special medical diet. Note the medical diet the person needs and send a request to catering. Refer to appropriate clinic for ongoing monitoring.
No: record response.
Past or future medical appointments
Has the person seen a doctor or other healthcare professional in the past few months? If so, what was this for?
Yes: note details of any recent medical contact. Arrange a contact letter to get further information from the person's doctor or specialist clinic. Note any ongoing treatment the person needs and make appointments with relevant clinics, specialist nurses, GP or other healthcare staff.
No: record no action required.
12. Does the person have any outstanding medical appointments? If so, who are they with, and when?
Yes: note future appointment dates. Ask healthcare administrative staff to manage these appointments or arrange for new dates and referral letters to be sent if the person's current hospital is out of the local area.
No: record no action required.
Alcohol and substance misuse
13. Does the person drink alcohol, and if so:
  • how much do they normally drink?
* how much did they drink in the week before coming into custody?
Urgently refer the person to the GP or an alternative suitable healthcare professional if:
  • they drink more than 15 units of alcohol daily or
  • they are showing signs of withdrawal or
  • they have been given medication for withdrawal in police or court cells.
No: record response.
14. Has the person used street drugs in the last month? If yes, how frequently?
When did they last use:
  • heroin
  • methadone
  • benzodiazepines
  • amphetamine
  • cocaine or crack
  • novel psychoactive substances
  • cannabis
  • anabolic steroids
  • performance and image enhancing drugs?
Yes: refer the person to substance misuse services if there are concerns about their immediate clinical management and they need immediate support. Take into account if:
  • they have taken drugs intravenously
  • they have a positive urine test for drugs
  • their answers suggest that they use drugs more than once a week
  • they have been given medication for withdrawal in police or court cells.
If the person has used intravenous drugs, check them for injection sites. Refer them to substance misuse services if there are concerns about their immediate clinical management and they need immediate support.
No: record response.
Problematic use of prescription medicines
15. Has the person used prescription or over-the-counter medicines in the past month that:
  • were not prescribed or recommended for them or
  • for purposes or at doses that were not prescribed?
  • If so, what was the medicine and how did they use it (frequency and dose)?
Yes: refer the person to substance misuse services if there are concerns about their immediate clinical management and they need immediate support.
No: record response.
Mental health
16. Has the person ever seen a health professional or service about a mental health problem (including a psychiatrist, GP, psychologist, counsellor, community mental health services, alcohol or substance misuse services or learning disability services)?
If so, who did they see and what was the nature of the problem?
Yes: refer the person for a mental health assessment if they have previously seen a mental health professional in any service setting.
No: record response.
17. Has the person ever been admitted to a psychiatric hospital and if so:
  • when was their most recent discharge?
  • what is the name of the hospital?
  • what is the name of their consultant?
Yes: refer the person for a mental health assessment.
No: record response.
18. Has the person ever been prescribed medicine for any mental health problems? If so:
  • what was the medicine
  • when did they receive it
  • when did they take the last dose
  • what is the current dose (if they are still taking it)
  • when did they stop taking it?
Yes: refer the person for a mental health assessment if they have taken medicine for mental health problems.
No: record response.
Self-harm and suicide risk
19. Is the person:
  • feeling hopeless, or
  • currently thinking about or planning to harm themselves or attempt suicide?
Yes: refer the person for an urgent mental health assessment. Open an ACCT plan if:
  • there are serious concerns raised in response to questions about self-harm, including thoughts, intentions or plans, or observations (for example, the patient is very withdrawn or agitated), or
  • the person has a history of previous suicide attempts.
Be aware and record details of the impact of the sentence on the person, changes in legal status and first imprisonment, and the nature of the offence (for example murder, manslaughter, offence against the person and sexual offences).
No: record response.
20. Has the person ever tried to harm themselves and if so:
  • do they have a history of suicide attempts?
  • was this inside or outside of prison?
  • when was the most recent incident?
  • what was the most serious incident
Yes: refer the person for a mental health assessment if they have ever tried to harm themselves.
No: record response.

Examples of critical medicines where timeliness of administration is crucial to prevent harm from missed and delayed doses

This table contains examples only and should be used in conjunction with clinical judgement. It is important to assess each person on an individual basis.
Area
Medicines
Cardiovascular system
Anticoagulants
Nitrates
Respiratory system
Adrenoceptor agonists
Antimuscarinic bronchodilators
Adrenaline for allergic emergencies
Central nervous system
Anti-epileptic drugs
Drugs used in psychoses and related disorders
Drugs used in parkinsonism and related disorders
Drugs used to treat substance misuse
Infections
As clinically indicated, such as anti-infectives or anti-retrovirals
Endocrine system
Corticosteroids
Drugs used in diabetes
Obstetrics, gynaecology and urinary tract disorders
Emergency contraceptives
Malignant disease and immunosuppression
Drugs affecting the immune response
Sex hormones and hormone antagonists in malignant disease – depot preparations
Nutrition and blood
Parenteral vitamins B and C
Eye
Corticosteroids and other anti-inflammatory preparations
Local anaesthetics
Mydriatics and cycloplegics
Glaucoma treatment
Obtain, evaluate and integrate all available and reliable information about the person when assessing or treating people in contact with the criminal justice system. For example:
  • person escort record (PER)
  • pre-sentence report
  • all medical records
  • custody reports
  • ACCT document
  • reports from other relevant services, including liaison and diversion, substance misuse services, social service or housing services and youth offending services
  • Offender Assessment System (OASys) or other assessment tools.
Take into account how up to date the information is and how it was gathered.
Work with a family member, partner, carer, advocate or legal representative when possible in order to get relevant information and support the person, help explain the outcome of assessment, and help them make informed decisions about their care. Take into account:
  • the person's wishes
  • the nature and quality of family relationships, including any safeguarding issues
  • any statutory or legal considerations that may limit family and carer involvement
  • the requirements of the Care Act 2014.
Carry out assessments:
  • in a suitable environment that is safe and private
  • in an engaging, empathic and non-judgemental manner.
When assessing a person, make reasonable adjustments to the assessment that take into account any suspected neurodevelopmental disorders (including learning disabilities), cognitive impairments, or physical health problems or disabilities. Seek advice or involve specialists if needed.
Be vigilant for the possibility of unidentified or emerging mental health problems in people in contact with the criminal justice system, and review available records for any indications of a mental health problem.
Ensure all staff working in criminal justice settings are aware of the potential impact on a person's mental health of being in contact with the criminal justice system.
Consider using the Correctional Mental Health Screen for Men (CMHS-M) or Women (CMHS-W) to identify possible mental health problems if:
  • the person's history, presentation or behaviour suggest they may have a mental health problem
  • the person's responses to the first-stage health assessment suggest they may have a mental health problem
  • the person has a chronic physical health problem with associated functional impairment
  • concerns have been raised by other agencies about the person's abilities to participate in the criminal justice process.
When using the CMHS-M or CMHS-W with a transgender person, use the measure that is in line with their preferred gender identity.
If there are concerns about a person's mental capacity, practitioners should:
  • perform a mental capacity assessment if they are competent to do this (or refer the person to a practitioner who is)
  • consider involving an advocate to support the person.
NICE is developing a guideline on decision-making and mental health capacity.
All practitioners should discuss rights to confidentiality with people and explain:
  • what the assessment is for, and how the outcome of the assessment may be used
  • how consent for sharing information with named family members, carers and other services should be sought
  • that the assessor may have a legal or ethical duty to disclose information relating the safety of the person or others, or to the security of the institution.
All practitioners carrying out mental health assessment should take into account the following when conducting an assessment of suspected mental health problems for people in contact with the criminal justice system:
  • the nature and severity of the presenting mental health problems (including cognitive functioning) and their development and history
  • coexisting mental health problems
  • co-existing substance misuse problems, including novel psychoactive substances
  • coexisting physical health problems
  • social and personal circumstances, including personal experience of trauma
  • social care, educational and occupational needs
  • people's strengths
  • available support networks, and the person's capacity to make use of them
  • previous care, support and treatment, including how the person responded to these
  • offending history, and how this may interact with mental health problems.
When assessing people in contact with the criminal justice system all practitioners should:
  • recognise potential barriers to accessing and engaging in interventions and methods to overcome these at the individual and service level
  • discuss mental health problems and treatment options in a way that gives rise to hope and optimism by explaining that change is possible and attainable
  • be aware that people may have negative expectations based on earlier experiences with mental health services, the criminal justice system, or other relevant services.
All practitioners should share the outcomes of a mental health assessment, in accordance with legislation and local policies, subject to permission from the person where necessary, with:
  • the person and, if possible, their family members or carers
  • all staff and agencies (for example, probation service providers and secondary care mental health services) involved in the direct development and implementation of the plan
  • other staff or agencies (as needed) not directly involved in the development and implementation of the plan who could support the effective implementation and delivery of the plan.
All practitioners should ensure mental health assessment is a collaborative process that:
  • involves negotiation with the person, as early as possible in the assessment process, about how information about them will be shared with others involved in their care
  • makes the most of the contribution of everyone involved, including the person, those providing care or legal advice and families and carers
  • engages the person in an informed discussion of treatment, support and care options
  • allows for the discussion of the person's concerns about the assessment process.
Practitioners should review and update assessments:
  • if new information is available about the person's mental health problem
  • if there are significant differences between the views of the person and the views of the family, carers or staff that cannot be resolved through discussion.
  • when major legal or life events occur
  • when the person are transferred between, or out of, criminal justice services
  • if a person experiences a significant change in care or support (for example, stopping an ACCT plan)
  • if a person disengages or does not stick to their treatment plan
  • annually or as required by local policy such as Care Programme Approach or Care Treatment Plan.
When updating mental health assessments, practitioners should consider:
  • reviewing and ensuring demographic information is accurate
  • reviewing psychological, social, safety, personal historical and criminological factors
  • assessing multiple areas of need, including social and personal circumstances, physical health, occupational rehabilitation, education and previous and current care and support
  • developing an increased understanding of the function of the offending behaviour and its relationship with mental health problems
  • covering any areas not fully explored by the initial assessment.
Perform a risk assessment for all people in contact with the criminal justice system when a mental health problem occurs or is suspected.
All practitioners should consider the following issues in risk assessments for people in contact with the criminal justice system:
  • risk to self, including self-harm, suicide, self-neglect, risk to own health and degree of vulnerability to exploitation or victimisation
  • risk to others that is linked to mental health problems, including aggression, violence, exploitation and sexual offending
  • causal and maintaining factors
  • the likelihood, imminence and severity of the risk
  • the impact of their social and physical environment
  • protective factors that may reduce risk.
During a risk assessment the practitioner doing the assessment should explain to the person that their behaviours may need to be monitored. This may include:
  • external monitoring of behaviours that may indicate a risk to self or others
  • self-monitoring of risk behaviours to help the person to identify, anticipate and prevent high-risk situations.
If indicated by their risk assessment, the practitioner doing the assessment should develop a risk management plan for a person. This should:
  • integrate with or be consistent with the mental health assessment and plan
  • take an individualised approach to each person and recognise that risk levels may change over time
  • set out the interventions to reduce risk at the individual, service or environmental level
  • take into account any legal or statutory responsibilities which apply in the setting in which they are used
  • be shared with the person (and their family members or carers if appropriate) and relevant agencies and services subject to permission from the person where necessary
  • be reviewed regularly by those responsible for implementing the plan and adjusted if risk levels change.
All practitioners should ensure that any risk management plan is:
  • informed by the assessments and interventions in relevant NICE guidance for the relevant mental health disorders, including NICE's recommendations on self-harm)
  • implemented in line with agreed protocols for safeguarding vulnerable people and the provision of appropriate adults
  • implemented in line with agreed protocols in police custody, prisoner escort services, prison, community settings and probation service providers.
Ensure that the risk management plan is integrated with, and recorded in, the relevant information systems; for example, the ACCT procedure in prisons, the Offender Assessment System (OASys) and SystmOne and Multi-Agency Risk Assessment Conference (MARAC) and Multi-Agency Public Protection Arrangements (MAPPA).
Develop a mental health care plan in collaboration with the person and, when possible, their family, carers and advocates. All practitioners developing the plan should ensure it is integrated with care plans from other services, and includes:
  • a profile of the person's needs (including physical health needs), identifying agreed goals and the means to progress towards them
  • identification of the roles and responsibilities of those practitioners involved in delivering the care plan
  • the implications of any mandated treatment programmes, post-release licences and transfer between institutions or agencies, in particular release from prison
  • a clear strategy to access all identified interventions and services
  • agreed outcome measures and timescale to evaluate and review the plan
  • a risk management plan and a crisis plan if developed
  • an agreed process for communicating the care plan (such as the Care Programme Approach or Care Treatment Plan) to all relevant agencies, the person, and their families and carers, subject to permission from the person where necessary.
When developing or implementing a mental health care plan all practitioners should take into account:
  • the ability of the person to take in and remember information
  • the need to provide extra information and support to help with the understanding and implementation of the care plan
  • the need for any adjustment to the social or physical environment
  • the need to adjust the structure, content, duration or frequency of any intervention
  • the need for any prompts or cognitive aids to help with delivery of the intervention.

Glossary

Assessment, Care in Custody and Teamwork: a prisoner-centred, flexible care-planning system which, when used effectively, can reduce risk, primarily of self-harm. The ACCT process is necessarily prescriptive and it is vital that all stages are followed in the timescales prescribed
any cognitive impairment that develops after birth, including traumatic brain injury, stroke, and neurodegenerative disorders such as dementia
responsible for protecting (or 'safeguarding') the rights and welfare of a child or 'mentally vulnerable' adult who is either detained by police or is interviewed under caution voluntarily – the role was created alongside the Police and Criminal Evidence Act (PACE) 1984
a diagram of the body on which physical injuries can be recorded
a person who provides unpaid support to someone who is ill, having trouble coping or who has disabilities
provide unpaid support to someone who is ill, having trouble coping or who has disabilities
a set of techniques that focus on the use of reinforcement to change certain specified behaviours. These may include promoting abstinence from drugs (for example, cocaine), reduction in drug misuse (for example, illicit drug use by people receiving methadone maintenance treatment), and improving adherence to interventions that can improve physical health outcomes
a screening tool that measures acute mental health issues present in people in prison. Questions are answered in a yes-no format, and then rated on a Likert-scale from 1 (low risk or need) to 5 (high risk or need), depending on severity
the transfer of any prescription medicines from the individual person for whom they were prescribed to another person for misuse
a prescription form – people who are released from prison unexpectedly can take an FP10 to a community pharmacy to receive their medicines free of charge until they can arrange to see their GP or register with a new GP
medical emergency bags containing equipment and medication for dealing with common medical emergencies – the equipment may include dressings, automated external defibrillator, and oxygen; it may also include medicine, for example for treating allergic reactions (anaphylaxis)
medicine is said to be held in-possession if a person (usually in a prison or other secure setting) is responsible for holding and taking it themselves
learned, knowledgeable work depending on experience and fine judgements in a prison setting – often learned by new staff working in prisons through shadowing and being mentored by experienced staff
a service that aims to identify people who have mental health problems who come into contact with the criminal justice system before they enter prison. They may be able to liaise and refer people they identify with mental health problems to local services or divert someone out of the criminal justice system, for example by arranging a Mental Health Act assessment. A liaison and diversion service may be in the form of a street triage service or they can be based in police custody suites or the court cells
the process of identifying an accurate list of a person's current medicines and comparing them with the current list in use, recognising any discrepancies, and documenting any changes, thereby resulting in a complete list of medicines, accurately communicated (adapted from definition by the Institute for Healthcare Improvement)
arrangements designed to protect the public, including previous victims of crime, from serious harm by sexual and violent offenders. They require the local criminal justice agencies and other bodies dealing with offenders to work together in partnership in dealing with these offenders
a monthly meeting where professionals across criminal justice agencies and other bodies dealing with offenders share information on high risk cases of domestic violence and abuse and put in place a risk management plan
a group of professionals from different disciplines who each provide specific support to a person, working as a team – in prison settings, a multidisciplinary team may include physical and mental health professionals, prison staff, National Probation Service and/or community rehabilitation company (CRC) representatives, chaplains, and staff from other agencies, such as immigration services and social care staff
a risk and needs assessment tool that identifies and classifies offending related needs, such as a lack of accommodation, poor educational and employment skills, substance misuse, relationship problems, and problems with thinking and attitudes and the risk of harm offenders pose to themselves and others.
substances taken for a non-medical purpose (for example, mood-altering, stimulant or sedative effects)
schemes involving mental health professionals providing on-the-spot support to police officers who are dealing with people with possible mental health problems
a clinical computer system used widely by healthcare professionals in the UK to manage electronic patient records; SystmOne is the standard system currently used in prisons in England and Wales

Paths in this pathway

Pathway created: November 2016 Last updated: May 2017

© NICE 2017

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