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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

6 September 2017 Physical health of people in prisons (NICE quality standard 156) added.
20 March 2017 Mental health of adults in contact with the criminal justice system (NICE guideline NG66) added.

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.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services 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 guideline should be interpreted in a way that would be inconsistent with complying 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.

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

6 September 2017 Physical health of people in prisons (NICE quality standard 156) added.
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

Physical health of people in prisons

These quality statements are taken from the physical health of people in prisons quality standard. The quality standard defines clinical best practice for physical health of people in prisons and should be read in full.

Quality statements

Medicines reconciliation

This quality statement is taken from the physical health of people in prisons. The quality standard defines clinical best practice for physical health of people in prisons and should be read in full.

Quality statement

People entering or transferring between prisons have a medicines reconciliation carried out before their second-stage health assessment.

Rationale

Medicines reconciliation helps ensure that people continue to receive the medicines they need and reduces the risk of harm caused by delayed or inappropriate medication. This is done within 7 days of arrival in a prison to ensure parity with primary care in the community, as outlined in the NICE guideline on medicines optimisation. This is particularly important for people who receive regular medication for long-term conditions.

Quality measures

Structure
a) Evidence of local arrangements to ensure that an accurate list of a person’s current medicines is obtained from the person’s GP, other healthcare professionals and, where appropriate, the transferring prison healthcare team.
Data source: Local data collection including local data sharing agreements and prison transfer protocols.
b) Evidence of local arrangements to ensure that a list of the medicines currently being taken by a person is obtained from them.
Data source: Local data collection including first-stage health assessment documentation.
c) Evidence of local arrangements to ensure that medicines reconciliation is carried out before the second-stage health assessment.
Data source: Local data collection including medicines pathways.
Process
Proportion of second-stage health assessments for people entering or transferring between prisons where medicines reconciliation has already been carried out.
Numerator – the number in the denominator where a medicines reconciliation was carried out before the second-stage health assessment.
Denominator – the number of second-stage health assessments for people entering or transferring between prisons.
Data source: The NHS England health and justice indicators of performance include data on medicines reconciliation being completed within 72 hours of entering prison.
Outcome
a) Number of adverse medication events in prison.
Data source: Local data collection including healthcare records (SystmOne).
b) Number of hospital admissions of people in prison because of adverse medication events.
Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on escorts and bedwatches for urgent care.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for a medicines reconciliation to be carried out before the second-stage health assessment so that the outcome of the medicines reconciliation can be acted on at the assessment. This includes having arrangements in place with GPs, other healthcare providers and prisons to share medicines information to ensure they can collate an accurate list of the medicines a person should be receiving.
Healthcare professionals (GPs, pharmacists, pharmacy technicians and nurses in prisons) carry out a medicines reconciliation before the second-stage health assessment and act on the outcome to ensure that the person is receiving the correct medicines. This can include checking that the person is taking the medicines, and ensuring that they have not had an adverse reaction to medicines they are taking and have no relevant known allergies.
Commissioners (NHS England) ensure that their contracts and monitoring arrangements include the requirement for prison healthcare services to carry out a medicines reconciliation before the second-stage health assessment. They should also include the requirement for integrated working between prisons, GPs and other healthcare providers.
People in prison have an accurate list of their medicines prepared for them before they have their second health assessment in prison. This means their healthcare professional can make sure they get the medicines they need while they are in prison.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendation 1.1.8

Definitions of terms used in this quality statement

Medicines reconciliation
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.
[NICE’s guideline on physical health of people in prison]
Second-stage health assessment
A health assessment carried out within 7 days of a person’s first-stage assessment which takes place upon entry into prison. This assessment includes, as a minimum;
  • reviewing the actions and outcomes from the first-stage health assessment
  • asking the person about:
    • any previous misuse of alcohol, use of drugs or improper use of prescription medicine
    • if they have ever had a head injury or lost consciousness, and if so:
      - how many times this has happened
      - whether they have ever been unconscious for more than 20 minutes
      - whether they have any problems with their memory or concentration
    • smoking history
    • the date of their last sexual health screen
    • any history of serious illness in their family (for example, heart disease, diabetes, epilepsy, cancer or chronic conditions)
    • their expected release date (if less than 1 month a pre-release health assessment should be planned)
    • whether they have ever had a screening test (for example, a cervical screening test or mammogram)
    • whether they have, or have had, any gynaecological problems
  • measuring and recording the person's height, weight, pulse, blood pressure and temperature, and carrying out a urinalysis.
[Adapted from NICE’s guideline on physical health of people in prison, recommendation 1.1.13]

Second-stage health assessment

This quality statement is taken from the physical health of people in prisons. The quality standard defines clinical best practice for physical health of people in prisons and should be read in full.

Quality statement

People entering or transferring between prisons have a second-stage health assessment within 7 days.

Rationale

Carrying out a second-stage health assessment within 7 days of entering a prison means people’s health problems can be explored in more detail than during the initial health assessment and they can receive the necessary treatment and support. During the assessment appropriate testing can be discussed and if the person is due to undergo any routine health screening this can be arranged. For people with multimorbidities or long-term conditions, this is an opportunity to discuss their conditions and ensure that the correct care and treatment are provided.

Quality measures

Structure
Evidence of local arrangements to ensure that prison healthcare services are available to carry out a second-stage health assessment within 7 days of people entering or transferring between prisons.
Data source: Local data collection including assessment protocols and audits.
Process
Proportion of prison stays where a second-stage health assessment takes place within 7 days of arrival in prison.
Numerator – the number in the denominator where a second-stage health assessment takes place within 7 days.
Denominator – the number of prison stays which last for more than 7 days.
Data source: Local data collection including healthcare records and audits.
Outcome
a) Uptake rates of national screening programmes in prison (for example retinal screening, breast, cervical and bowel cancer screening).
Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on the uptake of cancer and non-cancer screening.
b) Number of deaths in prisons.
Data source: Local data collection. The Ministry of Justice safety in custody statistics include data on deaths in prisons.
c) Number of people in prison engaging with healthcare services.
Data source: Local data collection including healthcare records.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for people to have a second-stage health assessment within 7 days of entering prison, including people who are transferred between prisons. This should include having staff available to carry out the assessments within this period, having a medicines reconciliation completed before the assessment takes place and, if appropriate, having already obtained relevant medical records or information.
Healthcare professionals (such as GPs, nurses and mental health and substance misuse practitioners in prisons) ensure that they carry out a second-stage health assessment within 7 days for people entering prison, including people who are transferred between prisons. During this assessment they can offer or refer people for treatment and support for identified health problems and identify any screening that is due. They can also provide information and support to maintain and improve health, including where people can obtain additional information.
Commissioners (NHS England) ensure that contracts with prison healthcare services include providing people with a second-stage health assessment within 7 days of entering prison, including people who are transferred between prisons. This can be monitored through contract management.
People going into prison or moving to a new prison have a second health assessment within 7 days of arriving at the prison. At this assessment they can discuss their existing health conditions and have tests for other conditions they might have. They can also find out about ways to improve their health, for example through diet, exercise and stopping smoking, and where they can get extra information about staying healthy.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendation 1.1.13

Definitions of terms used in this quality statement

Second-stage health assessment
A health assessment carried out within 7 days of a person’s first-stage assessment (which takes place upon entry into prison). This assessment includes, as a minimum:
  • reviewing the actions and outcomes from the first-stage health assessment
  • asking the person about:
    • any previous misuse of alcohol, use of drugs or improper use of prescription medicine
    • if they have ever had a head injury or lost consciousness, and if so:
      - how many times this has happened
      - whether they have ever been unconscious for more than 20 minutes
      - whether they have any problems with their memory or concentration
    • smoking history
    • the date of their last sexual health screen
    • any history of serious illness in their family (for example, heart disease, diabetes, epilepsy, cancer or chronic conditions)
    • their expected release date (if less than 1 month a pre-release health assessment should be planned)
    • whether they have ever had a screening test (for example, a cervical screening test or mammogram)
    • whether they have, or have had, any gynaecological problems
  • measuring and recording the person's height, weight, pulse, blood pressure and temperature, and carrying out a urinalysis.
[Adapted from NICE’s guideline on physical health of people in prison, recommendation 1.1.13]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health services. Information should be in a format that suits their needs and preferences. It should accessible to people who do not speak or read English, and should be culturally appropriate. People should have access to an interpreter or advocate if needed.
Mental health should be considered during the assessment and support and treatment should be provided to people with mental health problems.
The clinical needs of older people in prison, particularly the possibility of chronic illness or deterioration of health, should be considered during the assessment.
The clinical needs of people in prison who are undergoing or have undergone gender re-assignment, particularly medicines continuity and specialist support, should be considered during the assessment.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.

Blood-borne viruses and sexually transmitted infections

This quality statement is taken from the physical health of people in prisons. The quality standard defines clinical best practice for physical health of people in prisons and should be read in full.

Quality statement

People entering or transferring between prisons are tested for blood-borne viruses and assessed for risk of sexually transmitted infections.

Rationale

There are higher rates of blood-borne viruses and sexually transmitted infections in the prison population. Carrying out blood-borne virus testing when people enter or transfer between prisons, in line with Public Health England’s blood-borne virus opt-out policy, means that if they do have a blood-borne virus they can receive support and treatment. In addition, they can also receive support for any underlying causes such as intravenous drug use. Assessing a person’s risk of sexually transmitted infections, based on their sexual history, means they can receive necessary testing and treatment.

Quality measures

Structure
a) Evidence of local arrangements to test for blood-borne viruses when people enter or are transferred between prisons.
Data source: Local data collection including blood-borne virus testing protocols. The NHS England health and justice indicators of performance include data on the uptake of hepatitis B and C screening, and HIV testing.
b) Evidence of local arrangements to ensure that people entering or transferring between prisons are assessed for the risk of sexually transmitted infections.
Data source: Local data collection including sexual health policies.
Process
a) Proportion of second-stage health assessments for people entering or transferring between prisons where testing for blood-borne viruses takes place or has already been completed.
Numerator – the number in the denominator where testing for blood-borne viruses take place or has already been completed.
Denominator – the number of second-stage health assessments for people entering or transferring between prisons.
Data source: Local data collection including health records. The NHS England health and justice indicators of performance include data on the uptake of hepatitis B and C screening, and HIV testing.
b) Proportion of second-stage health assessments for people entering or transferring between prisons where assessment for the risk of sexually transmitted infections takes place or has already been completed.
Numerator – the number in the denominator where assessment for the risk of sexually transmitted infections takes place or has already been completed.
Denominator – the number of second-stage health assessments for people entering or transferring between prisons.
Data source: Local data collection including health records.
Outcome
a) The number of people diagnosed and treated for blood-borne viruses in prisons.
Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on people diagnosed with hepatitis B or C being referred to a specialised service and receiving treatment within 18 weeks. They also include data on the number of people who are HIV positive who are seen by secondary care within 2 weeks.
b) The number of people diagnosed and treated for sexually transmitted infections in prisons.
Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on the uptake of chlamydia screening.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for people entering and transferring between prisons to have blood-borne virus testing in line with Public Health England’s blood-borne virus opt-out policy and assessment for the risk of sexually transmitted infections at the second-stage health assessment. If people in prison are diagnosed with a blood-borne virus or sexually transmitted infection, they should ensure that systems are in place to provide treatment and support, including specialist referral.
Healthcare professionals (GPs, nurses and healthcare assistants in prisons) test people entering and transferring between prisons for blood-borne viruses and assess them for the risk of sexually transmitted infections based on their sexual history. They encourage people to discuss their possible risk factors and make them feel comfortable to do so.
Commissioners (NHS England) ensure that prison healthcare services have systems in place for people entering and transferring between prisons to have blood-borne virus testing in line with Public Health England’s blood-borne virus opt-out policy and assessment for the risk of sexually transmitted infections at the second-stage health assessment. Specialist treatment and support services should be available to people in prison who are diagnosed with a blood-borne virus or sexually transmitted infection.
People going into prison or moving to a new prison have tests for HIV, hepatitis B and hepatitis C within 7 days of arriving at the prison. They also have their risk of sexually transmitted infections such as chlamydia or gonorrhoea assessed, based on the information they give about their sexual history. If, after testing, they are diagnosed with one of these viruses or infections they can be offered specialist referral, treatment and support.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendations 1.1.23, 1.1.24 and 1.1.29

Definitions of terms used in this quality statement

Blood-borne virus testing
These are blood tests to identify whether a person has a blood-borne virus. The most common examples of blood-borne viruses are HIV, hepatitis B and hepatitis C.
[NICE guideline on physical health of people in prison, full guideline and expert opinion]
Assessment for the risk of sexually transmitted infections
This is done by using the person’s sexual history and can be carried out at the second-stage health assessment.
[Adapted from NICE’s guideline on physical health of people in prison, recommendation 1.1.29 and expert opinion]
Sexually transmitted infections (STIs)
Infections that are acquired through sexual contact, including chlamydia, genital warts, genital herpes, gonorrhoea and syphilis.
[NICE guideline on physical health of people in prison, full guideline and expert opinion]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.
Some people who are at risk of sexually transmitted infections based on their sexual history may be vulnerable for example, because of abuse, or drug or alcohol dependency. Healthcare professionals should discuss the risk of sexually transmitted infections sensitively and in a supportive, non-judgemental way.

Lead care coordinator

This quality statement is taken from the physical health of people in prisons. The quality standard defines clinical best practice for physical health of people in prisons and should be read in full.

Quality statement

People in prison who have complex health and social care needs have a lead care coordinator.

Rationale

Having a lead care coordinator in place for people in prison who are receiving care from different teams means that they can receive joined-up care. The lead care coordinator can ensure good communication within the multidisciplinary team, which can include health, social care and custodial teams. By working with the multidisciplinary team the lead care coordinator can help to ensure that people in prison receive help and support to manage their health and social care needs. In addition, people in prison can receive help to reduce avoidable exacerbations of their physical and mental health conditions, reducing the risk of unplanned hospital admissions.

Quality measures

Structure
Evidence of local arrangements to ensure that a lead care coordinator is available for people in prison who are being cared for by different prison teams.
Data source: Local data collection including job descriptions.
Process
Proportion of people in prison who have complex health and social care needs who have a lead care coordinator.
Numerator – the number in the denominator who have a lead care coordinator.
Denominator – the number of people in prison with complex health and social care needs.
Data source: Local data collection and audits.
Outcome
a) Number of unplanned hospital admissions of people in prison.
Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on escorts and bedwatches for urgent care.
b) Number of care plans jointly developed and shared on transfer between prisons or release from prison.
Data source: Local data collection including healthcare records.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for people in prison with complex health and social care needs to have a lead care coordinator to manage their care. This will include liaison with the multidisciplinary team to coordinate care and ensure it is provided as needed while the person is in prison, during transfers and when the person is leaving prison.
Healthcare professionals (such as GPs and nurses in prisons) ensure that people in prison with complex health and social care needs have a lead care coordinator. The person should know who their lead care coordinator is and this should also be communicated to the prison staff. The lead care coordinator will liaise with the multidisciplinary team to ensure that care is coordinated and provided as needed while the person is in prison, during transfers and when the person is leaving prison.
Commissioners (NHS England) ensure that they commission prison healthcare services that identify lead care coordinators for people with complex health and social care needs.
People in prison who are cared for by different teams (for example a GP, social worker, mental health team or substance misuse team) have a lead care coordinator who is responsible for their care. They will know who their lead coordinator is. The lead care coordinator will work with everyone involved in their care to make sure they receive the care and support they need while they are in prison, being transferred or leaving prison.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendation 1.2.3

Definitions of terms used in this quality statement

Complex health and social care needs
People in prison being cared for by multiple teams in and beyond the prison system (for example primary care, mental health, substance misuse or social care) on an ongoing basis. This could be for a number of reasons, for example a learning or physical disability with substance misuse, mental health or vulnerability issues.
[Expert opinion]
Lead care coordinator
This is a named professional who is responsible for managing a person’s care when they are in prison, during transfers and when they are leaving prison. They liaise with other healthcare staff involved in the person’s care (for example, ensuring follow-up on diagnostic tests) and ensure relevant information is shared between primary and secondary care teams, and other social care, probation and community service providers if necessary.
[NICE guideline on physical health of people in prison, full guideline and expert opinion]

Equality and diversity considerations

Barriers to communication can hinder people’s understanding of how they can be involved in their care, particularly if they have complex health and social care needs. These barriers could include: mental health problems, learning or cognitive difficulties; physical, sight, speech or hearing difficulties; or difficulties with reading, understanding or speaking English. Adjustments should be made to ensure that all people in prison with complex health and social care needs can work with their lead care coordinator to plan their care, with access to an advocate if needed.

Medicines on transfer or discharge

This quality statement is taken from the physical health of people in prisons. The quality standard defines clinical best practice for physical health of people in prisons and should be read in full.

Quality statement

People being transferred or discharged from prison are given a minimum of 7 days’ prescribed medicines or an FP10 prescription.

Rationale

Continuation of medication is important to maximise benefits and reduce the risk of harm. Transferring people between prisons with a minimum of 7 days’ prescribed medicines (excluding opioid substitution therapy, which is available from stock at all prisons) ensures that they have an adequate supply of medicines until they can get more at the prison they are transferred to. Discharging people from prison with a minimum of 7 days’ prescribed medicines or an FP10 prescription to obtain medicines from a community pharmacy ensures that they have an adequate supply of medicines until they can get the next prescription after their release.

Quality measures

Structure
a) Evidence of local arrangements to ensure that a minimum of 7 days’ prescribed medicines is transferred with the property of people moving to another prison.
Data source: Local data collection including medication protocols and working agreements with other prisons.
b) Evidence of local arrangements to ensure that, based on a risk assessment, a minimum of 7 days’ prescribed medicines or an FP10 prescription is provided to people leaving prison.
Data source: Local data collection including medication protocols and risk assessments.
Process
a) Proportion of transfers between prison settings where a minimum of 7 days’ prescribed medicines is provided.
Numerator – the number in the denominator where a minimum of 7 days’ prescribed medicines is provided.
Denominator – the number of transfers between prison settings where the person is currently receiving prescribed medicines.
Data source: Local data collection including healthcare records and audits. The NHS England health and justice indicators of performance include data on the number of people transferred who are received into prison with 7 days’ medication.
b) Proportion of prison discharges where a minimum of 7 days’ prescribed medicines or an FP10 prescription are provided.
Numerator – the number in the denominator who receive a minimum of 7 days’ prescribed medicines or an FP10 prescription.
Denominator – the number of discharges from prison where the person is receiving prescribed medicines.
Data source: Local data collection including healthcare records and audits. The NHS England health and justice indicators of performance include data on the number of people discharged from prison who are supplied with 7 days’ medication or an FP10 prescription.
Outcome
a) Rates of medication continuity when people are transferred between prisons.
Data source: Local data collection including healthcare records.
b) Rates of medication continuity when people are discharged from prison.
Data source: Local data collection including healthcare records.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place, including risk assessment, for people to receive a minimum of 7 days’ prescribed medicines or an FP10 prescription when they are transferred or discharged from prison. This should include ensuring that there is a process for people to receive a supply of their medicines or an FP10 prescription if they are transferred or discharged from prison at short notice.
Healthcare professionals (GPs, nurses, lead care coordinators and pharmacists in prisons) ensure that when people are being discharged or transferred from prison they are given a minimum of 7 days’ prescribed medicines or an FP10 prescription. A risk assessment should be carried out to establish whether medicines or an FP10 prescription should be provided, or if neither should be provided because there is a risk of harm if medicines are supplied before a clinical assessment has been done.
Commissioners (NHS England) ensure that they commission prison healthcare services that discharge or transfer people from prison with a minimum of 7 days’ prescribed medicines or an FP10 prescription, based on a risk assessment. This can be monitored through contract management.
People who are leaving prison or moving to a new prison are given a 7-day supply of any prescribed medicines they are taking, or, if leaving the prison, a prescription so that they can collect a temporary supply from a community pharmacy free of charge. After this they will be able to get their medicines by seeing a doctor, either in the new prison or in the community if they have left prison.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendation 1.7.14

Definitions of terms used in this quality statement

FP10 prescription
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.
[NICE’s guideline on physical health of people in prison]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health services. Information should be in a format that suits their needs and preferences. It should accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.
If people are being released from prison into homelessness or temporary accommodation, or they are likely to have difficulty getting their medicines, for example if they are part of a traveller community, their lead care coordinator, if applicable, and the multidisciplinary team should work together to ensure continued access to medication.
If people need specialist medicines or critical medications, for example antiretrovirals, mental health medications or hormone treatment, or if they have substance misuse problems, their lead care coordinator and the multidisciplinary team should work together to ensure continued access to medication.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

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.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services 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 guideline should be interpreted in a way that would be inconsistent with complying 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.

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: September 2017

© NICE 2017. All rights reserved. Subject to Notice of rights.

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