Rates of mental ill health are far higher in prison than in the general population—with around 9 in 10 people in prison experiencing a mental health or substance-related need. Conditions often worsen in custody, with inspectors warning of rising self-harm and declining wellbeing.
In the last year alone, there were more than 72,000 incidents of self-harm in prisons in England and Wales—around one every seven minutes.
But there is a powerful, underused safeguard already within reach:
Families.
Allison's story
Allison did everything she could to protect her son. He was living with paranoid schizophrenia when he entered prison. From the outside, Allison tried to help staff understand his needs—his history, his medication, his risks. She wrote letter after letter.
She was not listened to. Instead, she was dismissed as “the problem”.
As her son’s mental health deteriorated, her warnings went unheard—until the worst happened. He attempted to take his own life. Only then was he transferred to hospital, where he finally received the care he needed.
Today, he is rebuilding his life—working, in stable housing, with a partner and young child.
This is a success story. But it should never have taken a life-threatening crisis – and a mother’s battle – to get there.
Why families matter
Families and loved ones often know the person best. They can:
- Spot early warning signs before anyone else
- Share vital mental health history
- Help ensure the right care and medication
- Provide stability, connection, and hope
Yet despite this, families are rarely meaningfully involved—particularly in the ACCT process, the prison system’s main tool for managing risk of suicide and self-harm.
This is a missed opportunity to save lives.
What needs to change
The guidance is clear: families should be involved in safeguarding processes like ACCT wherever possible. But in practice, this is inconsistent—and often absent.
That needs to change.
- Prisons must actively involve families in ACCT processes
- HMPPS and policymakers must ensure this happens consistently
- Commissioners must recognise families as a core part of effective mental healthcare
Our work on prison healthcare
Pact makes prisons safer and healthier by ensuring families' insights influence healthcare practice and by strengthening supportive relationships around people in custody. We help families navigate prison healthcare systems and advocate for their loved ones.
Through our Listen to Families initiative we gather the experiences of families dealing with health needs in custody, and use these to influence practice and policy for a more responsive system that utilises the knowledge, care and expertise of the loved ones of people in prison.
