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What families think about prison healthcare
Pact report finds families are too often locked out of a prison healthcare system that doesn’t value their role as carers.

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Nobody's listening

A new (3 February 2023) report from the charity Pact (Prison Advice and Care Trust) called “Nobody’s Listening” finds that involving families more proactively in prisoners’ healthcare would reduce deaths in custody, relieve pressure on the NHS and the criminal justice system, and cut crime.

Pact  spoke to families caught up in the criminal justice system, asking them to discuss their experience of trying to support their loved-ones in prison.  

The report finds that when the system works well, it can have a positive impact on people’s health, allowing prisoners to access previously unavailable support.   

 However, it concludes that families and significant others are too often locked out of a system that doesn’t value their role as carers. This stores up a range of problems, the ripple effects of which are felt well beyond the prison gates. 


Pact spoke to 33 members of prisoners’ families for this report and their messages are divided into four main sections in the report which I summarise briefly below. People in prison in this report are referred to as patients.

Families’ experiences

Many of the families consulted felt that their loved ones’ involvement in the criminal justice system was as a result of persistent, systemic failure of services (education, social care, health and/or criminal justice) to meet their needs. Almost a third of families described their loved one as having an acute mental health crisis immediately prior to their contact with the criminal justice system. 

While families acknowledged patients had committed a criminal offence, many felt that the  system had failed to effectively consider alternative diversionary treatment appropriate to the patients’ needs.

While some family members reported positive experiences of prison healthcare, the majority witnessed a significant decline in their loved ones’ mental and physical health during their custodial sentence. They attributed this to numerous and inter-related systemic factors including: the prison environment, lack of joined up working, delays in healthcare provision, lack of health promotion, a security rather than wellbeing-led regime, staff skills, knowledge and experience, and limited opportunities for patients’ or families’ voices to be heard.

Recognising the role of families

Families rarely felt that their role (as carers, advocates, sources of information or vital support) was valued or understood by the criminal justice and health systems, and reported a lack of recognition for the role they had played prior to their loved ones’ incarceration, particularly where the patient was a young adult, neurodiverse or had chronic mental or physical health needs.

They identified numerous challenges in supporting loved ones’ health and wellbeing in custody with ‘lack of communication’ underpinning them all.

‘He has been traumatised by his time in prison… he went in a handsome young man and now he looks like he’s been at war.’

Opportunities for families to support health

Families’ experiences demonstrate that once a patient moves into the criminal justice system their ability to be heard and play a role in supporting the health and wellbeing of their loved one is often severely restricted. Patients lose access to ‘relationships’ as a tool in promoting good health at a point at which they are often at their most vulnerable, and families are locked out at a time when they too are often at their most anxious.

Families asked for justice and healthcare staff to pro-actively involve them at key points: at arrest and in police custody, during the judicial process, at point of reception or early days in custody, pre and/or post prison transfer, when a patient’s health needs changed and at the point of release and during resettlement.

They were particularly concerned to be asked to contribute to the ACCT assessment process (only one of out of 11 families had even been informed that their loved on had been put on an ACCT).

Families asked for improved communications and a single point of contact for families and patients.

Supporting families to support patients

Family members described the far-reaching impact of supporting a patient in custody including: a loss of trust in services and systems, the loss of agency or role (as a carer, partner or parent), the impact on time and resources and the impact on their own health and wellbeing – both physically and mentally.

 Almost a quarter of families had not received any support during their loved one’s journey through the criminal justice system. Where support was received, it tended to be accessed when someone was in prison (typically from a family support charity), rather than earlier in the criminal justice journey. Many family members had accessed support for their own mental health as a result of their loved ones’ imprisonment.

Conclusions and recommendations

The report makes a series of ten recommendations but the main three areas of support which families wanted throughout the criminal justice journey were:

  1. proactive provision of accurate information about prison life and how to support a loved one in custody; 
  2. information and guidance about how to support their loved ones’ health and wellbeing needs; 
  3. family-friendly, inclusive, non-judgemental, informed and empathetic support.

Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here

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