Health in prison

Drugs and alcohol

The government commissioned independent review of drugs by Dame Carol Black, published in 2020–21, estimated that people with a serious drug addiction occupy one third of prison places. They are generally serving very short sentences, have an extensive offending history and reoffend in the future. The review concluded that drug prevention, treatment and recovery across all public services (including prisons) was “not fit for purpose and urgently needs repair.” It recommended an additional £552m of investment over the next five years, including funding to improve quality of in-prison treatment, increased diversion from custody to community services, and seamless post-release support for addiction recovery, including coordinated service provision, and welfare support from day one of release.¹

In December 2021, the government published its 10-year strategy to tackle drugs and address the recommendations in Dame Black’s review. It promised to invest £780m in a “world class treatment and recovery system”.²

Since then, the prison service has expanded its efforts to reduce demand and support recovery. There are now Incentivised Substance Free Living (ISFL) units in 85 prisons,³ up from 25 in 2022,⁴ and six Drug Recovery Wings (DRWs).⁵ ISFL units offer additional support, drug testing and incentives, and are open to any prisoner who wants to live in a drug-free environment (including people who have not used drugs). DRWs are abstinence-based regimes for people recovering from dependency.

However, drug supply remains a critical issue. Drones are becoming a significant problem for prisons, and inspectors have raised concerns above a wave of “uncontrolled criminality”.⁶

Substance use and supply in prison

Almost one in three women (30%) and almost two in five men (39%) report that it is easy to get illicit drugs in their prison.⁷

More than a quarter of men (28%) said that it was easy to get alcohol in their prison—more than double the level amongst women in prison (11%).⁸

Nearly one in five women (19%) and more than one in 10 men (11%) surveyed by inspectors reported that they had developed a drug or alcohol problem since they had arrived at prison.⁹

Drugs were seized on 26,348 occasions last year, an increase of 25% on the previous year. Where drugs were found, the percentage of finds where the exact substance was unknown accounted for the largest category (32%), followed by psychoactive substances (26%), then cannabis (25%).¹⁰

1,155 staff were investigated for supplying drugs to prisons in 2023. In the same year, 47 staff were arrested for drug conveyance, and 56 were charged.¹¹

Substance-related needs upon entry to prison

Just under one in seven people (13%) serving a sentence in prison are there for drug offences, down from 17% in the previous year.¹²

In 2023, three in five prisoners serving less than 12 months (60%) had an identified substance misuse need, and two in five (39%) had an identified alcohol misuse need.¹³

Two-thirds of women (66%) and nearly two in five men in prison (38%) report committing offences to get money to buy drugs. More than two-thirds of women (68%) and over half of men (55%) said they were under the influence of drugs when they offended.¹⁴

Nearly half of women in prison (48%) report having committed offences to support someone else’s drug use.¹⁵

Seven in 10 people in prison with a self-identified alcohol problem (70%) said they had been drinking when they committed the offence for which they were in prison.¹⁶

Substance misuse monitoring and support

48,848 people received drug and alcohol treatment in prison during 2023–24, an increase of 7% from the previous year. Almost half (48%) were receiving treatment for opiate use.¹⁷

In 2024–25, just over half of adults (57%) identified as needing substance misuse treatment after prison were successfully engaged within 21 days—a four percentage point increase from the previous year, and a 27 percentage point increase from when records were first published in 2015–16 (30%).¹⁸

Mental health

The last few years have seen efforts to update mental health law, including for prisoners and forensic patients. In 2018, an independent review of the Mental Health Act urged ending the use of prisons as a place of safety; introducing time limits for transferring mentally ill prisoners to hospital; and that transfer decisions should be overseen by an independent role.¹⁹

The Mental Health Act 2025 introduced a 28-day statutory time limit on transfers from prison to hospital. It also restricts the use of prisons as a place of safety and the use of remand solely for mental health concerns.²⁰ However, concerns have been raised over adequate resourcing of alternative places of safety, and the government has promised to publish an annual review.²¹

In 2024–25, prison inspectors continued to raise concerns about stubbornly high delays to transfers, and the continued detention of severely mentally ill women in prison due to a lack of options in the community.²²

Mental ill health among people in prison in England is estimated to cost £2.1bn annually, including £400m from avoidable prison sentences linked to mental health issues. However, much of the best-quality data on the prevalence of mental health conditions in adults in prison is outdated, making it difficult to accurately calculate the true cost.²³

Over half of surveyed men (56%) and almost three-quarters of women in prison (74%) say they have mental health problems.²⁴

A 2023 survey of mental health caseloads in three-quarters of English prisons found anxiety and depression to be the most common primary issue (29% of patients), followed by psychosis (22%) and personality disorders (17%).²⁵ In London, where there are more local prisons with short-term and remand populations, the prevalence of psychosis was nearly double the national rate.²⁶

Estimated prevalence of clinical syndromes in the prison population

Source: Tyler, N. et al. (2019) An updated picture of the mental health needs of male and female prisoners in the UK: prevalence, comorbidity, and gender differences, Social Psychiatry and Psychiatric Epidemiology, 54, 1143-1152.

Many prisoners with mental health conditions have other factors that increase risk to their life. In surveyed prisons, more than half of patients had previously self-harmed (54%); two in five had attempted suicide (40%); and a similar proportion had a history of substance misuse alongside poor mental health (39%).²⁷

People entering prison are screened for mental health needs. But only one in seven surveyed prisons (14%) reported that initial screenings were conducted by someone with a mental health qualification, and only one in five prisons (21%) said the same for secondary screenings.²⁸

In 2021, the Justice Committee found that around 10% of those in prison were receiving treatment for mental illness, with some prisons estimating as much as 70% of the population having some form of mental health need at any one time. It expressed surprise that none of the relevant bodies knew the extent of need for mental healthcare services in prisons.²⁹

In 2024–25, inspectors raised concerns about the continued difficulties in accessing mental health services in adult prisons, owing to chronic recruitment and retention issues with mental healthcare staff.³⁰

1,094 people were transferred from prison to a secure hospital in 2024—a 3% increase since 2015.³¹

Just over one in seven sampled patients (15%) were transferred within the recommended 28 days, according to a 2022–23 review by prison inspectors. The average waiting time was 85 days. They found that the process was not centred on patient need, and driven by a lack of available beds in secure facilities.³²

4,880 mental health treatment requirements (MHTRs) were included in a community or suspended sentence order in 2024—a 40% increase compared with the year before. MHTRs were included in 2.8% of all orders, up from 0.3% in 2013.³³

People who received mental health treatment requirements had a reoffending rate nine percentage points lower than those given short custodial sentences, reoffended less often and less seriously.³⁴

Disability, health and social care

In 2025, the Chief Medical Officer for England undertook a major review of the health of people in prison and the care they receive. While it concluded that the last three decades have seen considerable improvements in care, the health of people in prison remains much worse than in the community, and prisons themselves make the treatment and prevention of disease more difficult. The review highlighted how the ageing prison estate and the tension between care and security considerations can negatively affect healthcare, as well as the vulnerability of people transitioning into, between, and out of prison, where poor information sharing means their care is disrupted and their health not well understood.

56% of surveyed women, 46% of men and 33% of children in prison report having a disability. All groups reported feeling less safe in prison than non-disabled prisoners.³⁵ ³⁶ ³⁷

People with disabilities report more negatively about key aspects of prison life, including less access to clean clothing that fits, less time out of cell at weekends, and complaints not being fairly dealt with.³⁸ ³⁹

Inspectors have highlighted that the continuing shortage of staff in prisons was creating risks for prisoners’ healthcare.⁴⁰ Less than a third of men (30%) and only one in six women (16%) said it was easy to see a doctor in prison. One in five men (21%) and one in seven women (13%) said it was easy to see a dentist.⁴¹

The number of people granted compassionate release for health reasons is low—between 2012 and 2024, only 120 people were released. Numbers have dropped in the recent years. In 2014, the three-year rolling average was 10 people a year. In 2024 it was five people.⁴²

The Prisons and Probation Ombudsman found that risk assessments for compassionate or temporary release were frequently determined by the risk a person would have posed when healthy — not the actual risk they pose based on their current health condition.⁴³

196 pregnant women were held in prison at some point during 2024–25—19 fewer than the previous year—with an average of 49 imprisoned at any one time.⁴⁴

42 babies were born in prison in 2024–25, compared to 53 in the previous year.⁴⁵ HMPPS does not record how many women experience miscarriage in prison.⁴⁶

42 women and 41 babies were received into Mother & Baby Units (MBUs) in 2024–25.⁴⁷ MBUs have an upper child age limit of 18 months, which may be extended in exceptional cases where separation is considered detrimental to the interests of the child.⁴⁸

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