A disproportionate number of women in prison have mental health problems and they are nine times more likely to die from suicide than women in the general population. They have insufficient access to help both inside where the focus has largely been on men, and outside where they often lack suitable help and support on release. For many women, improsionment is a tragedy that damages them, their families and the next generation, some of whom are born in prison, where giving birth can be particularly traumatic and potentially lethal. And men cannot be forgotten by women who are in prison, because many of them are in prison because of the actions of a man. However, it is crucial not to assume that ‘trauma’ explains all of their problems, particularly some kinds of violent behaviour. We need to keep many more women out of prison and try to help women much earlier along their life paths, long before they go to prison. Mental health care provides too little, too late. We must challenge our own stigmatising attitudes towards women in prison, support those NGOs who work tirelessly with women in the criminal justice system and advocate much more powerfully for women in prison.

This chapter seeks to provide clinicians with a better understanding of prisons and overcome many of the myths and misconceptions, with the objective of making the environment more attractive and interesting for future psychiatrists. In addition to a wide need and a rich variety of conditions, the psychiatrist in prison must contend with barriers to care such as working without a mental health act and, when a patient needs to be transferred and treated outside of prison, navigating complicated pathways to care. Mental disorder is prevalent in all prison systems. Pathways into prison may be related to general factors, specific factors such as delusions and comorbidities and complications of mental illness such as homelessness and breakdown of relationships, as well as service provision issues. The prevailing policy has been to divert prisoners in need of hospital care out of prisons. Court diversion models can focus on any point in the pathway from community to the criminal justice system. In prison, specialist mental health services are needed to address the high levels of morbidity due to self-harm, drug use, suicide and self-harm, hunger strikes and many other manifestations of developmental problems and traumatic experiences.