Monitoring risk factors Prisoners with certain backgrounds are also at risk of mental ill-health, including people who have experienced abuse and trauma. Be alert to situations of heightened risk Those with primary care responsibilities for family members are more likely to experience anxiety about the situation of their family, including their children – this commonly affects female prisoners. Research has highlighted that mothers separated from their infants are at high risk of mental health difficulties, particularly following recent childbirth.19 There are particular times or situations when prisoners with mental ill-health might experience a deterioration in their condition, including the possibility of self-harm or suicide. Staff should be aware of these situations and put precautions in place as necessary. Factors that could result in a deterioration in a prisoner’s mental well-being could include: Communication and culture Personal factors Illness or death of family/friends; marital and other family breakdown; significant family events; major public or religious holidays; news related to physical health; financial worries/debts; withdrawal from substances; and the end of support programmes. Positive communication and interaction with prisoners Isolation and a lack of mental stimulation or communication with others are common factors which contribute to mental ill-health in prisons. Positive staff attitudes and interactions are therefore critical to the well-being and rehabilitation of prisoners. Staff can offset the negative psychological impact of imprisonment, and ward off common reactions, such as depression and anxiety. Criminal justice-related factors Pre-trial detention, sentencing, court and parole hearings/ decisions; decisions on prison transfers/allocation; and the period leading up to release. Relating to detention conditions Staff who communicate positively with prisoners, using dynamic security approaches, may also be able to identify warning signs and potential triggers for mental health decline. Periods of isolation, particularly solitary confinement; the imposition of disciplinary measures and the use of restraints or force; periods of inactivity or over-activity; deterioration of physical conditions of detention; incidents of bullying, harassment or violence, including sexual abuse. Dynamic security Dynamic security combines positive staff-prisoner relationships with fair treatment and purposeful activities that contribute to effective rehabilitation and reintegration to society. Be aware of at-risk individuals Whilst everyone in prison is at risk of mental ill-health, it is important for prison staff to be aware of particular groups or individuals who may (but not necessarily) be more at risk, including: women; children/young people; foreign nationals; lesbian, gay, bisexual, transgender and intersex (LGBTI) prisoners; the elderly; and prisoners with physical disabilities. Prisoners who have been sentenced to death or those with uncertain or indeterminate sentences, including pre-trial detainees, are often affected by mental ill-health, as are segregated prisoners. 20 21