The role of primary care in supporting imprisoned women with mental illness.

People with severe mental illness (SMI) have a life expectancy that is reduced by up to 20 years compared with the general population, and primary care has a key role in reducing this mortality gap.1 Providing primary care in the prison setting requires special consideration. People in prison have multiple complex health and social care needs.2 There are up to 80 000 people in prison in England and Wales at any one time, and imprisoned women make up around 5% of this population.3 Women in prison often have disproportionately higher levels of serious SMI, substance use disorders (SUD), and self-harm compared with men in prison.4 Complicating these high rates is the high comorbidity and complex needs arising from experiences such as Adverse Childhood Experiences (ACEs), trauma, abuse, being separated from their children and family, homelessness and unemployment, and a relatively high proportion have a history of substance and alcohol misuse.5 According to the Prison Reform Trust, 25% of women in prison reported symptoms indicative of psychosis. The rate among the general population is about 4%.5 There are no reliable data reporting whether women with SMI in prison access primary care services pertaining to their physical healthcare needs (such as cardiometabolic problems, and access to screening services including cervical and breast screening) and whether these physical health needs are being adequately met. It is likely that these will differ between different female prisons in England. Since 1999 there have been several policies that aim to improve the way in which health care is provided in prisons. Initiatives are guided by the principle of ‘equivalence of care’, that is, prisoners have the right to the same standard and range of physical and mental health services as they would have in the community.6 …