Experiences of Prisoners Living With Mental Health Conditions and Seeking or Receiving Mental Health Support in Prisons: An Integrative Review

BACKGROUND: Prisoners experience poor mental health and well-being in prison, including severe mental illnesses. However, access to mental health support and treatment in prison is limited. We conducted an integrative review to synthesise prisoners' experiences of living with mental ill health and/or seeking or receiving mental health support in prisons. METHODS: A systematic search of peer-reviewed empirical studies published from 2014 to 2024 was conducted following PRISMA guidelines. Databases searched included Medline, PsycINFO and CINAHL. We included studies of adult prisoners (aged ≥ 18 years) experiencing poor mental health who sought or received help. We were inclusive in our definitions of "poor mental health" and "support" to capture papers where prisoners may not have a formal diagnosis and where support may have been pastoral or delivered by healthcare practitioners. RESULTS: Nineteen studies met the inclusion criteria. Four main themes emerged. The first encompassed the range of emotions and feelings experienced, predominantly negative. The second was about the accessibility of mental health services, evidenced not only by limited availability but also by a general lack of support, service providers being described as lacking empathy and coercion to take medication. The third theme was of more internalised barriers to help-seeking, including a sense of stigma and concerns about confidentiality. The fourth theme was about coping strategies, including support from peers, family and religious practices but also maladaptive coping strategies such as self-harm. CONCLUSIONS: Prisoners experienced unmet mental health needs. Poor service experiences added to the burden, only partly met through constructive alternatives. Serious, sometimes dangerous maladaptive coping suggests that current access to and suitability of formal healthcare services should be reconsidered within the context of wider methods of pastoral support. Future research on the role of the wider prison community in providing mental health and well-being support is needed. TRIAL REGISTRATION: The protocol for this review is registered on PROSPERO CRD42024581279. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024581279.