Prison regime Staff should also be aware that those with existing mental health conditions may face barriers to getting involved with physical or educational activities, which may be due to a lack of confidence, anxiety, or fatigue. Promote physical health • Support the development of prisoner-led activities and promote programmes throughout the prison. Poor physical health can increase the risk of developing mental health conditions, and vice versa – poor mental health can negatively impact physical health. • Talk to prisoners about available activities, including work, training, sports and recreation and their potential participation in such programmes. • Talk to prisoners about their health and any problems they are facing. • Encourage prisoners to participate in physical activities. • Try to understand and address any barriers to participating in activities faced by prisoners. • Ensure that all prisoners have access to prison health facilities and that they are able to request and attend medical appointments. • Ensure that activities are tailored to a range of interests, abilities and confidence levels. • Ensure that all prisoners have access to adequate food and water. Promising practice: Prisoners raise awareness of mental health In Ireland, under a partnership between the Red Cross, the prison service and the country’s education training agency, a group of prisoners in each prison attended a weekly training session on health, for between four to six months. Following completion of the course, the prisoners were supported by staff to work on a peer-to-peer basis, raising awareness and implementing projects to improve the overall health and well-being of prisoners in their community, including on mental health and self-harm/suicide prevention. Almost 800 Irish Red Cross volunteer prisoners have been recruited since 2009 and roughly half of these have completed the full course and graduated.23 Promising practice: Yoga and t’ai chi In Thailand, yoga and t’ai chi practices were used in two projects that aimed to improve the health of women prisoners. Ten women prisoners from Ratchaburi Central Prison became instructors and travelled to Koh Samui women’s prison to teach yoga. The project also boosted the morale of the prison staff and built better relationships between prisoners themselves and between prisoners and staff.21 Promote meaningful activities Prisoners can develop mental ill-health due to a lack of physical activity and mental stimulation. On the other hand, prisoners who are able to participate, on a voluntary basis, in different aspects of prison life will be less isolated and more engaged. In well-functioning systems, prisoners can play an active role in improving prison life. Consider physical conditions of detention Conditions of detention and levels of overcrowding can have a significant impact on mental health and well-being. Contributing factors include silence, constant noise or specific noises like doors banging, smells, temperature and ventilation. Hygiene levels and access to toilets/showers, sleeping arrangements, and a lack of privacy also impact mental well-being. Prisoners who are engaged in physical and intellectual activities generally have improved moods and self-esteem, as well as reduced levels of stress and anxiety.22 24 25