Health of People in The Criminal Justice System Assessing Physical and Mental Health of People in Prisons and Young Offender Institutions

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physical
ysical and mental health of people in
prisons and yyoung
oung offender institutions
NICE Pathways bring together everything NICE says on a topic in an interactive

flowchart. NICE Pathways are interactive and designed to be used online.
They are updated regularly as new NICE guidance is published. To view the latest
version of this NICE Pathway see:
http://pathways.nice.org.uk/pathways/health-of-people-in-the-criminal-justice-system
NICE Pathway last updated: 10 September 2018
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associated recommendations.
Health of people in the criminal justice system Page 1 of 24

© NICE 2018. All rights reserved. Subject to Notice of rights.
Assessing ph
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oung offender NICE Pathways
institutions

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1 Person aged 18 or over in prison or young offender institution
No additional information
2 First-stage assessment
Health assessment at first reception into prison
At first reception into prison a healthcare professional (or trained healthcare assistant under the
supervision of a registered nurse) should carry out a health assessment for every person. Do
this before the person is allocated to their cell. As part of the assessment, identify:
any issues that may affect the person's immediate health and safety before the second-
stage health assessment
priority health needs to be addressed at the next clinical opportunity.
Ensure continuity of care for people transferring from one custodial setting to another (including
court, the receiving prison or during escort periods) by, for example:
accessing relevant information from the patient clinical record, prisoner escort record and
cell sharing risk assessment
checking medicines and any outstanding medical appointments.
Take into account any communication needs or difficulties the person has (including reading and
writing ability), and follow the principles in NICE's recommendations on patient experience in
adult NHS services.
The first-stage health assessment should include the questions and actions in questions for
first-stage health assessment [See page 12]. It should cover:
physical health
alcohol use (see what NICE says on alcohol use disorders)
substance misuse (see criminal justice system in NICE's recommendations on Drug misuse
management in over 16s and also NICE's recommendations on coexisting severe mental
illness and substance misuse: assessment and management in healthcare settings)
mental health
self-harm and suicide risk (see what NICE says on self-harm and suicide prevention).
Give the person advice about how to contact prison health services and book GP appointments

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in the future.
Ask the person for consent to transfer their medical records from their GP to the prison
healthcare service (see coordination between prison and healthcare services.
Identifying mental health problems
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.
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.

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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.
Record keeping and medicines reconciliation
Enter in the person's medical record:
all answers to the reception health assessment questions

health-related observations, including those about behaviour and mental state (including
eye contact, body language, rapid, slow or strange speech, poor hygiene, strange thoughts)
details of any action taken.
Carry out a medicines reconciliation (in line with NICE's recommendations on medicines
optimisation) before the second-stage health assessment. See also access to medicines for
recommendations on risk assessments for in-possession medicines and ensuring continuity of
medicine.
Quality standards
The following quality statements are relevant to this part of the interactive flowchart.
Physical health of people in prisons
1. Medicines reconciliation
Mental health of adults in contact with the criminal justice system
2. Mental health assessment
3 Screen for TB within 48 hours of arrival
Healthcare professionals in prisons should ensure people coming into prison are screened for
TB within 48 hours of arrival.
Report all suspected and confirmed TB cases to the local multidisciplinary TB team within 1

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working day.
If a case of active TB is confirmed:
Arrange for the local multidisciplinary TB team to visit within 5 working days
Contact the local Public Health England unit and multidisciplinary TB team to arrange a
contact investigations exercise. They should also consider using mobile X-ray to check for
further cases.
Put contingency, liaison and handover plans in place to ensure continuity of care before a
person being treated for TB is transferred between prisons or released. Any other agencies
working with the person should also be involved in this planning.
For further guidance on the assessment and management of TB, see what NICE says on
tuberculosis in prisons or immigration removal centres.
4 Second-stage assessment within 7 days
Physical health and substance misuse
A health professional (for example a registered general nurse) should carry out a second-stage
health assessment for every person in prison. Do this within 7 days of the first-stage health
assessment and include 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 suffered a head injury or lost consciousness, and if so:
how many times this has happened
whether they 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 and if less than one month plan pre-release health
assessment (see below)

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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.
Review the person's first- and second-stage health assessment records, medical history, GP
and vaccination records and:
Refer the person to the GP or a relevant clinic if further assessment is needed. See for
example identifying people for full formal risk assessment for cardiovascular disease and
risk assessment for type 2 diabetes.
Arrange a follow-up appointment if needed.
Mental health
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 is other evidence supporting the likelihood of mental health problems, or a man scores 6
or more on the CMHS-M, or a woman scores 4 or more on the CMHS-W:
a practitioner who is trained to perform an assessment of mental health problems should

conduct further assessment or
a practitioner who is not trained to perform an assessment of mental health problems
should refer the person to an appropriately trained professional for further assessment.
See further mental health assessment and care planning.

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Record keeping and review
Enter in the person's medical record:
all answers to the second-stage health assessment questions

health-related observations
details of any action taken.
Plan a follow-up healthcare review at a suitable time based on clinical judgement, taking into
account the age of the person and length of their sentence. For people who may be in prison for
less than 1 month see below.
People who may be in prison less than 1 month
For people who may be in prison for less than 1 month, plan pre-release health assessments
during the second-stage health assessment.
Quality standards
The following quality statements are relevant to this part of the interactive flowchart.
2. Second-stage health assessment
Mental health of adults in contact with the criminal justice system
2. Mental health assessment
5 Offer tailored advice and support
Offer people tailored health advice based on their responses to the assessment questions. This
should be in a variety of formats (including face-to-face). It should include advice on:
alcohol (see assessment for harmful drinking and alcohol dependence in NICE's
recommendations on alcohol use disorders)
substance misuse (see psychosocial interventions for drug misuse in people over 16 in
NICE's recommendations on drug misuse)
exercise

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diet
stopping smoking
sexual health.
Offer the person advice, with supporting literature if appropriate, on:
how to contact prison health services and book GP appointments or other clinics for
example, dental, optician, chiropodist, substance misuse and recovery services
where to find health information that is accessible and understandable
how to attend or get a referral to attend any health-promoting activities in the future (see
promoting health and wellbeing).
medicines adherence (see increasing patient involvement in decision-making in NICE's
recommendations on medicines optimisation).
6 Specific health checks and screening
Ensure that there is a system and processes in place to carry out and refer to other
assessments in line with NICE recommendations.
Hepatitis B and C
Prison healthcare services (working with the NHS lead for hepatitis) should ensure that:
all people are offered a hepatitis B vaccination when entering prison (for the vaccination
schedule, refer to the Green Book)
all people are offered access to confidential testing for hepatitis B and C when entering
prison and during their detention
people who test for hepatitis B or C receive the results of the test, regardless of their
location when they become available
results from hepatitis B and C testing are provided to the person's community-based GP, if
consent is given.
See also what NICE says on testing for hepatitis B and C in prisons and immigration removal
centres.
HIV
Offer all people HIV testing when entering prison.
Primary care providers should ensure annual HIV testing is part of the integrated healthcare

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offered to men who are known to have sex with men.
Provide information on HIV testing and discuss why it is recommended (including to those who
indicate that they may wish to decline the test).
Conduct post-test discussions, including giving positive test results and delivering post-test and
general health promotion interventions.
Recognise illnesses that may signify primary HIV infection and clinical indicator diseases that
often coexist with HIV.
See also what NICE says on HIV testing and prevention.
Sexually transmitted infections
Identify people at high risk of STIs using their sexual history. Opportunities for risk assessment
may arise during consultations on contraception, pregnancy or abortion, and when carrying out
a cervical smear test or offering an STI test. Risk assessment could also be carried out during
routine care or when a new patient registers.
Have structured, one-to-one discussions with people at high risk of STIs (if trained in sexual
health), or arrange for these discussions to take place with a trained practitioner.
See also what NICE says on preventing sexually transmitted infections and under-18
conceptions.
Quality standards
The following quality statement is relevant to this part of the interactive flowchart.
3. Blood-borne viruses and sexually transmitted infections
7 Managing physical health
See Health of people in the criminal justice system / Managing the physical health of people in
prisons and young offender institutions

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8 Further mental health assessment and care planning
See Health of people in the criminal justice system / Further mental health assessment and care
planning for people in prisons and young offender institutions
9 Managing mental health
See Health of people in the criminal justice system / Managing the mental health of people in
the criminal justice system

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Questions for first-stage health assessment
Topic questions Actions
Prison sentence
Yes: refer the person for urgent mental health

1. Has the person committed murder, assessment by the prison `mental health in-
manslaughter or another offence with a reach team if necessary.
long sentence?
No: record no action required.
Prescribed medicines
Yes: document any current medicines being

taken and generate a medicine chart.
Refer the person to the prescriber for

2. Is the person taking any prescribed appropriate medicines to be prescribed, to
medicines (for example, insulin) or over- ensure continuity of medicines.
the-counter medicines (such as creams or
drops)? If so: If medicines are being taken ensure that the
next dose has been provided (see access to
what are they? medicines).
what are they for?
Let the person know that medicines
how do they take them?
reconciliation will take place before the second-
stage health assessment.
Physical injuries
3. Has the person received any physical Yes: assess severity of injury, any treatment

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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,

injuries over the past few days, and if so: the person may need to be transferred to an
external hospital. Liaise with prison staff to
what were they?
transfer the person to the hospital emergency
how were they treated?
department by ambulance.
If the person has made any allegations of

assault, record negative observations as well
(for example, 'no physical evidence of injury').
Other health conditions
4. Does the person have any of the

following: Ask about each condition listed.
allergies, asthma, diabetes, epilepsy or Yes: make short notes on any details of the
history of seizures
person's condition or management. For
chest pain, heart disease example, 'Asthma – on Ventolin 1 puff daily'.
chronic obstructive pulmonary disease
tuberculosis, sickle cell disease Make appointments with relevant clinics or
hepatitis B or C virus, HIV, other specialist nurses if specific needs have been
sexually transmitted infections identified.
learning disabilities
neurodevelopmental disorders
physical disabilities?
5. Are there any other health problems the Yes: record the details and check with the

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person that no other physical health complaint

person is aware of, that have not been has been overlooked.
reported?
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,
6. Are there any other concerns about the
jaundice, gait or frailty).
person's physical health?
Refer the person to the GP or relevant clinic.
No: note 'Nil'.
Additional questions for women
If the woman is pregnant, refer to the GP and

midwife.
If there is reason to think the woman is

7. Does the woman have reason to think
pregnant, or she would like a pregnancy test:
she is pregnant, or would she like a
provide a pregnancy test. Record the outcome
pregnancy test?
and if positive make an appointment for the
woman to see the GP and midwife.
No: record response.
Living arrangements, mobility and diet
Yes: note any needs. Liaise with the prison

8. Does the person need help to live disability lead in reception about:
independently?
the location of the person's cell
further disability assessments the prison

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may need to carry out.
Yes: remind prison staff that all special

9. Do they use any equipment or aids (for
equipment and aids the person uses should
example, walking stick, hearing aid,
follow them from reception to their cell.
glasses, dentures, continence aids or
stoma)?
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
10. Do they need a special medical diet?
clinic for ongoing monitoring.
Past or future medical appointments
Yes: note details of any recent medical contact.

Arrange a contact letter to get further
information from the person's doctor or
Has the person seen a doctor or other specialist clinic. Note any ongoing treatment the
healthcare professional in the past few person needs and make appointments with
months? If so, what was this for? relevant clinics, specialist nurses, GP or other
healthcare staff.
Yes: note future appointment dates. Ask

12. Does the person have any outstanding healthcare administrative staff to manage these
medical appointments? If so, who are they appointments or arrange for new dates and
with, and when? referral letters to be sent if the person's current
hospital is out of the local area.

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Alcohol and substance misuse
Urgently refer the person to the GP or an

alternative suitable healthcare professional if:
13. Does the person drink alcohol, and if
so: they drink more than 15 units of alcohol
daily or
how much do they normally drink?
they are showing signs of withdrawal or
* how much did they drink in the week they have been given medication for
before coming into custody? withdrawal in police or court cells.
Yes: refer the person to substance misuse

services if there are concerns about their
14. Has the person used street drugs in the
immediate clinical management and they need
last month? If yes, how frequently?
immediate support. Take into account if:
When did they last use:
they have taken drugs intravenously
heroin they have a positive urine test for drugs
methadone their answers suggest that they use drugs
more than once a week
benzodiazepines
they have been given medication for
amphetamine withdrawal in police or court cells.
cocaine or crack
If the person has used intravenous drugs, check
novel psychoactive substances
them for injection sites. Refer them to substance
cannabis misuse services if there are concerns about their
anabolic steroids immediate clinical management and they need
performance and image enhancing immediate support.
drugs?
Problematic use of prescription medicines

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15. Has the person used prescription or

over-the-counter medicines in the past
Yes: refer the person to substance misuse
month that:
services if there are concerns about their
were not prescribed or recommended immediate clinical management and they need
for them or immediate support.
for purposes or at doses that were not
prescribed? No: record response.
If so, what was the medicine and how
did they use it (frequency and dose)?
Mental health
16. Has the person ever seen a health

professional or service about a mental
health problem (including a psychiatrist, Yes: refer the person for a mental health
GP, psychologist, counsellor, community assessment if they have previously seen a
mental health services, alcohol or mental health professional in any service
substance misuse services or learning setting.
disability services)?
If so, who did they see and what was the
nature of the problem?
17. Has the person ever been admitted to a

psychiatric hospital and if so: Yes: refer the person for a mental health
assessment.
when was their most recent discharge?
what is the name of the hospital? No: record response.
what is the name of their consultant?
18. Has the person ever been prescribed Yes: refer the person for a mental health
medicine for any mental health problems? assessment if they have taken medicine for
If so: mental health problems.
what was the medicine No: record response.

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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?
Self-harm and suicide risk
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
19. Is the person:
the person has a history of previous suicide
feeling hopeless, or attempts.
currently thinking about or planning to Be aware and record details of the impact of the
harm themselves or attempt suicide? 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).
20. Has the person ever tried to harm

themselves and if so: Yes: refer the person for a mental health
assessment if they have ever tried to harm
do they have a history of suicide
attempts? themselves.
was this inside or outside of prison?

when was the most recent incident?
what was the most serious incident

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Glossary
ACCT
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
acquired cognitive impairment
any cognitive impairment that develops after birth, including traumatic brain injury, stroke, and
neurodegenerative disorders such as dementia
appropriate adults
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
body map
a diagram of the body on which physical injuries can be recorded
carer
a person who provides unpaid support to someone who is ill, having trouble coping or who has
disabilities
carers
provide unpaid support to someone who is ill, having trouble coping or who has disabilities
contingency management
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

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Correctional Mental Health Screen for men (CMHS-M) or women (CMHS-W)
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
diversion
the transfer of any prescription medicines from the individual person for whom they were
prescribed to another person for misuse
FP10
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
grab bags
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)
in-possession
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
jail craft
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
liaison and diversion
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

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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
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 (adapted from
definition by the Institute for Healthcare Improvement)
Multi-Agency Public Protection Arrangements (MAPPA)
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
Multi-Agency Risk Assessment Conference (MARAC)
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
multidisciplinary team
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
Offender Assessment System (OASys)
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.

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street drugs
substances taken for a non-medical purpose (for example, mood-altering, stimulant or sedative
effects)
street triage
schemes involving mental health professionals providing on-the-spot support to police officers
who are dealing with people with possible mental health problems
SystmOne
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
Sources
Mental health of adults in contact with the criminal justice system (2017) NICE guideline NG66
Physical health of people in prison (2016) NICE guideline NG57
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

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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.

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

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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.



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Assessing ph

NICE Pathways bring together everything NICE says on a topic in an interactive

Health of people in the criminal justice system Page 1 of 24

Health of people in the criminal justice system Page 2 of 24

1 Person aged 18 or over in prison or young offender institution

Health assessment at first reception into prison

Health of people in the criminal justice system Page 3 of 24

Identifying mental health problems

the person's wishes

Carry out assessments:

in a suitable environment that is safe and private

person escort record (PER)

Health of people in the criminal justice system Page 4 of 24

Record keeping and medicines reconciliation

Enter in the person's medical record:

all answers to the reception health assessment questions

Physical health of people in prisons

Mental health of adults in contact with the criminal justice system

2. Mental health assessment

3 Screen for TB within 48 hours of arrival

Health of people in the criminal justice system Page 5 of 24

If a case of active TB is confirmed:

4 Second-stage assessment within 7 days

Physical health and substance misuse

Health of people in the criminal justice system Page 6 of 24

a practitioner who is trained to perform an assessment of mental health problems should

See further mental health assessment and care planning.

Health of people in the criminal justice system Page 7 of 24

Record keeping and review

Enter in the person's medical record:

all answers to the second-stage health assessment questions

People who may be in prison less than 1 month

Physical health of people in prisons

2. Second-stage health assessment

Mental health of adults in contact with the criminal justice system

2. Mental health assessment

5 Offer tailored advice and support

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Offer the person advice, with supporting literature if appropriate, on:

6 Specific health checks and screening

Offer all people HIV testing when entering prison.

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offered to men who are known to have sex with men.

See also what NICE says on HIV testing and prevention.

Sexually transmitted infections

Physical health of people in prisons

3. Blood-borne viruses and sexually transmitted infections

7 Managing physical health

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8 Further mental health assessment and care planning

9 Managing mental health

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Questions for first-stage health assessment

Topic questions Actions

Yes: refer the person for urgent mental health

Yes: document any current medicines being

Refer the person to the prescriber for

No: record no action required.

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received and record any significant head,

Document any bruises or lacerations observed

In very severe cases, or after GP assessment,

If the person has made any allegations of