Listen to families: the missing piece in prison mental health care

By Andy Keen Downs, CEO

Mental ill health in prisons is not a new problem—but it is an urgent one.

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.

There is no single solution to this. But there is one clear, practical step that could make a meaningful difference: listen to families—and involve them properly.

An overlooked safeguard

The prison system already has a framework designed to protect people in crisis: the Assessment, Care in Custody and Teamwork (ACCT) process.

ACCT is intended to identify risk, bring together relevant information, and coordinate care for people at risk of suicide or self-harm. In principle, it is built on collaboration. In practice, one key group is too often missing: families.

This is despite clear guidance issued to all prisons that families should be involved wherever appropriate. Inspections have repeatedly found that family involvement is rarely considered, and seldom recorded. That represents a serious gap in safeguarding.

What families bring

Families are not an optional extra in care. They are often the people who:

• Recognise subtle changes in behaviour early
• Understand long-term patterns of mental ill health
• Know what treatments and approaches have worked—or failed—before
• Can provide continuity between custody and the community

In other words, they hold information that no file or short assessment can fully capture.
Ignoring that information is not neutral—it is a lost opportunity to prevent harm.

Allison’s experience

Allison’s story shows what happens when families are not heard. 

Her son, living with paranoid schizophrenia, was sent to prison. From the beginning, she tried to share what she knew: his diagnosis, his history, his needs, the importance of the right medication.

She wrote repeatedly. She pushed to be taken seriously. She described herself, with some frustration, as “prisonzilla”. Her involvement was not welcomed. She was told her son was fine. She was treated as a problem to be managed, rather than a resource to be used.

Meanwhile, her son was moved over 300 miles away. His condition deteriorated.

Eventually, he attempted to take his own life, causing extensive injuries. Only after this crisis was he transferred to hospital, where he finally received appropriate care.

Today, his situation is very different. He is out of prison, working, living independently, with a partner and a young child.

Allison calls herself a success story. But their positive ending came only after months of avoidable suffering on both sides of the prison walls – and nearly led to her son’s death.

Watch Allison's story.

A system issue, not a one-off

This is not about one prison or one case. It reflects a broader pattern in which families are too often:

• Not contacted
• Not invited into ACCT discussions
• Not recognised as partners in care

The result is a system that works with incomplete information, increasing the risk of harm.

What needs to change

The solution is not complicated—but it does require consistency and commitment. 

Prisons should:

• Proactively identify and contact families where appropriate. This means gaining the consent from the person in prison as early as possible, and understanding whether a family can offer support
• Involve them meaningfully in ACCT processes
• Record and act on the information they provide

HMPPS and policymakers should:

• Strengthen expectations around family involvement
• Provide guidance, training, and demand accountability
• Recognise family engagement as a core part of safer custody as well as the most effective way of reducing re-offending

Commissioners should:

• Treat family involvement as an indicator of quality mental health care
• Support services that build and maintain these relationships

Listening saves lives

Family involvement will not solve every problem in prison mental health care. But it can:

• Provide insight to improve decision-making
• Strengthen care planning
• Reduce risk
• Reduce the burden on prison healthcare and officers
• Support recovery

In some cases, it can be the difference between life and death.

A shared responsibility

This Mental Health Awareness Week, the message is simple: families are already part of the solution. The system needs to treat them that way.

Take action

If you work in prisons or criminal justice: involve families in ACCT processes

If you shape policy or commission services: make family involvement standard, not optional

If you support this cause, share this message: #ListenToFamilies

Find out more.