In this post, our expert Dr Stephen Attard talks about what it is like to work as a prison psychiatrist.

With the media spotlight very much on mental health in prisons, we speak to one of our experts about his own experiences working as a prison psychiatrist. Dr Attard leads the prison mental health in-reach service at HMP Woodhill. After spending several years working in secure mental health units including Broadmoor Hospital and St Andrew’s Hospital, Dr Attard talks to us about his role and what it entails.

How long have you been a prison psychiatrist?

I have been in prison psychiatry since August 2018 although I have extensive previous experience of visiting prisons in my capacity as a consultant forensic psychiatrist. Working solely within the prison estate gives me a unique experience into the procedures, practice and challenges of prison psychiatry.

What do you enjoy most about being a prison psychiatrist?

Perhaps the most enjoyable aspect of prison psychiatry is the ability to work within what is a rapidly developing and surprisingly new sub-speciality of forensic psychiatry. I am continually surprised by the variety of work and enjoy the challenge presented by what is a broad and complex range of psychopathologies in this patient group. I currently work in a local remand prison with a Category A function and two of only five Close Supervision Centres in the country. This means that, daily, I could be working with inmates who may have committed the most minor offences and are experiencing mild symptoms of mental ill-health or some of the riskiest men in the country with a number of complex co-morbid mental disorders.

Does being a prison psychiatrist help you in your role as an expert witness?

Understanding the prison environment is of great help with my expert witness work, not only in terms of helping the interview and assessment process but also because it allows me the opportunity to follow up many individuals from the moment they are remanded into custody to the end of the court process and, often beyond.

If you could change one thing about prison mental health care, what would it be?

As any prison psychiatrist will attest, there are several challenges when working in a custodial setting. These challenges include the politics of multiple agencies working under the same roof and the competing priorities of healthcare recommendations and the prison regime. If I were gifted the power to change one thing about male prisons, I would replicate the focus on a trauma-informed and psychologically-minded approach which is often seen in female prisons.

Do you work with other people in prison?

Most prisons will have a prison mental health inreach team.  From 1990 the idea of “equivalence” became recognsied in government policy and advocates that prisoners should receive the same stadanard or delivery of care as they would have had were they not in prison.  Community psychiatry is not delivered by psychiatrists alone.  Therefore, prison psychiatrists do not work in silo either.  In my role at HMP Woodhill, I work alongside a team of experienced community psychiatric nurses.  Together we work collaboratively with the prison GPs, primary care nurses, pharmacists, and prison staff to deliver a rounded and holistic model of care.  The quality of our service is regulated and we participate in peer review.

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