Intended for healthcare professionals

Practice Guidelines

The health of prisoners: summary of NICE guidance

BMJ 2017; 356 doi: (Published 27 March 2017) Cite this as: BMJ 2017;356:j1378
  1. Richard Bradshaw, guideline chair, NICE physical health of people in prison guideline1,
  2. Ben A J Pordes, senior project manager2,
  3. Hannah Trippier, senior research fellow2,
  4. Nick Kosky, guideline chair, NICE mental health of adults in contact with the criminal justice system guideline3,
  5. Steve Pilling, clinical advisor4,
  6. Fionnuala O’Brien, project manager5
  7. On behalf of the Guideline Committee for the NICE guideline on physical health of people in prisons and the NICE guideline on mental health of adults in contact with the criminal justice system
  1. 1former director of Offender Health, Department of Health and National Offender Management Service, UK
  2. 2National Guideline Centre, London W1W 5QZ, UK
  3. 3Dorset Healthcare University Foundation Trust, Forston Clinic, UK
  4. 4Department of Clinical, Education and Health Psychology, University College London, London WC1E 6BT, UK
  5. 5National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  1. Correspondence to: N Kosky Nick.Kosky{at}

What you need to know

  • People in custodial settings are entitled to the same level and quality of physical and mental health services as NHS patients in the community without restrictions

  • Perform comprehensive extended physical and mental health assessment on entry into and release from custodial settings

  • Monitor and treat chronic health conditions for those serving custodial sentences, offer testing for infectious diseases, and explore the possibility of mental health conditions

  • The prevalence of mental health problems among people in prison is about 10 times higher than in the general population

  • On a person’s release from a custodial sentence, primary care services should receive a structured handover of new and ongoing health problems, which can guide them as they reassume responsibility for coordinating care

Compared with the general population, adults in contact with the criminal justice system have higher rates of mental and physical health problems. Such people include those under arrest, in prison, on license, or serving a community sentence. Most live in the community or serve short custodial sentences,1 and will feature on the patient list of most general practices. Care for these people should be equivalent to that of people without a history of contact with the criminal justice system. There is little to suggest that, for most people, treatments that are effective in a non-criminal justice setting are not effective in the criminal justice setting.

Some of the most prevalent problems include substance misuse, personality disorder, depression, anxiety, respiratory disease, diabetes, and other chronic health conditions. Being held in prison is associated with increased suicide rates and high levels of mental health problems. People in contact with the criminal justice system should have the same access to NHS treatment as the general population at all stages. Lack of access to healthcare can exacerbate existing problems and affect reintegration to society …

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