Prisoners with mental health problems will often also have several other vulnerabilities, including substance dependencies, poor life skills, histories of trauma, unstable housing and limited experience of employment. Mental health and drug use There are many associations between mental health and drug use, which prison staff should be aware of. Drug use (or drug withdrawal) may mirror some of the symptoms of mental ill-health or can exacerbate symptoms. Use of substances may be a sign of mental ill-health and people with mental health conditions may be more likely to use drugs, in some cases to alleviate the symptoms of mental ill-health. Sudden or significant changes cause or exacerbate mental health conditions Mental ill-health can be triggered by sudden or significant changes in a person’s life. These could include receiving a prison sentence, outcomes from court hearings, family breakdown or the death of a family member. Separation from children and the loss of child custody particularly impact women in prison.13 Mental health of women in prison Widespread domestic violence against women and sexual abuse prior to imprisonment have been documented in countries worldwide. Women who are admitted to prison are more likely than men to have existing mental healthcare needs, often as a result of domestic violence and physical and sexual abuse. Furthermore, most women who are admitted to prison are mothers, and the separation from their children, as well as from the rest of their family, can have a severely negative impact on their mental well-being. (Bangkok Rules 12 and 13) HIV and mental health in prisons People in prison are five times more likely to be living with HIV than adults in the general population and studies have shown that rates of mental illness are exceptionally elevated among this population.14 There are also higher rates of substance use, anxiety and PTSD among prisoners living with HIV. 12