The briefing – drawing on research and insights from academics at The University of Manchester– finds that healthcare in prisons is fragmented across the health and justice departments, with responsibility split between multiple agencies and service providers and no single body in charge. Poor coordination between the Department of Health and Social Care, the Ministry of Justice and healthcare providers continues to undermine the quality and continuity of care available to prisoners.

This lack of joined-up working is compounded by severe pressures in the prison system itself. Overcrowding, staff shortages and an ageing, crumbling prison estate are making it harder to deliver basic healthcare and are contributing to poor health outcomes among prisoners. On average, people in prison have a life expectancy more than 20 years lower than the general population. While around 70% of prisoners are estimated to need mental health support, only around 10% are recorded as receiving treatment.[1]

Supporting people’s underlying health needs has been identified as a critical component of reducing reoffending. Chief Medical Officer for England, Professor Chris Whitty, highlighted offending and reoffending are strongly linked to health, with the greatest risks occur at moments of transition: entry into prison, transfers between facilities, and after release.[2]

The pressures within the system are only set to get worse, due to an ageing prison population. Nearly 1 in 4 prisoners is now aged 50 or over, a group with complex and chronic health needs that prisons were never designed to meet.[3] Deaths from natural causes among older prisoners have increased over the past decades, yet access to appropriate care, including palliative and end-of-life support, remains inconsistent.

The SMF warns that without reform, the prison health system will continue to miss the chance to break cycles of ill health, disadvantage and crime.

To address these challenges, the Social Market Foundation sets out four key priorities for government, including:

• establishing a sustainable, long-term funding settlement for prison healthcare;
• improving coordination and integration between health services, justice agencies and service providers;
• prioritising prevention and early intervention; and
• strengthening cross-government oversight of prisoner health.

Jake Shepherd, Senior Researcher at the Social Market Foundation, said: "Healthcare is a human right – that includes people in prison. Many prisoners enter custody in poor health, and weaknesses in the system mean health outcomes in prison are consistently worse than in the wider population. While investing in prison health may not be politically popular, it brings wider public health benefits and can help reduce reoffending, leading to long-term savings. Prison health is therefore not just a moral issue, but a practical one”.

“The Government should start by investing more, focusing on prevention, and improving how organisations work together on prisoner healthcare, to make prisons safer places that support healthy lives and rehabilitation.”

, Senior Research Fellow in Social Care and Society at The University of Manchester said: “This report from Policy@91ֱ�� and the Social Market Foundation identifies the systemic barriers that prevent people living in prison from accessing the health and social care they need. Health and social care in prisons should be on an equivalent footing to services provided in the community, but research at The University of Manchester shows this is consistently not the case. 

“Poor health amongst people living in prison is the product of overstretched systems, deteriorating environments, and long‑standing inequalities that follow people into prison. Crucially, this work highlights the growing health needs of older people and women of all ages living in prison. Addressing these issues will deliver benefits far beyond the prison walls, and policymakers should act on the evidence-led recommendations this report provides.” 

• The SMF report will be published at   

[1] Mental Health in Prison.

[2] The Health of People in Prison, on Probation, and in the Secure NHS Estate in England (Department of Health and Social Care and Ministry of Justice, 2025).

[3] ^cx The Health of People in Prison, on Probation, and in the Secure NHS Estate in England.

The team of clinicians, academics, researchers, service users and carers will study the effects of Cognitive Behavioural Suicide Prevention therapy within prisons.

Suicide is the leading cause of preventable death in prisons in England and Wales with 86 prisoner deaths and 52,000 episodes of self-injury in 2021 alone, leaving prisoners five times more likely to take their own lives than the general population.

The Prevention of Suicide in Prisons: Enhancing Access to Therapy (PROSPECT) programme is a collaboration between , the University of Manchester, the , and

It is funded by the (NIHR), the research partner of the NHS, public health and social care.

If proven to be effective, the promising new therapy could offer hope to those currently living in prison and also to the families, friends and professionals who care for them.

Cognitive Behavioural Suicide Prevention is a talking therapy delivered in once or twice weekly 1:1 sessions, each lasting 30-60 minutes with up to 20 sessions in total.

The therapy supports patients to develop a personalised understanding of the reasons for suicide.

It aims to provide short term, immediate benefit while also working towards longer-term gains through development of resilience to future suicidal episodes.

Dr Tim Kirkpatrick, a Research Fellow from The University of Manchester, said: “Suicide in male prisons is a serious problem and there is a great need to prevent it.

“The PROSPECT programme aims to improve treatments by promoting access to a promising new therapy: Cognitive Behavioural Suicide Prevention (CBSP) within prisons.

“If successful, the PROSPECT programme will help to reduce the personal, economic, and social costs of prison suicide.”

The trial will aim to test the CBSP therapy with men in four prisons from across the North of England, who have had recent difficulties with suicidal thoughts or behaviour.

91ֱ�� participants will be randomly allocated to either receive the CBSP therapy in addition to their regular treatment offered to prisoners thought to be at risk of self-harm or suicide, or to receive regular treatment alone.

Alongside the trial, researchers will be conducting an evaluation of how the CBSP therapy is carried out in the prison environment, to better understand factors that help or hinder successful implementation in this specific context.

Dr Daniel Pratt, a Clinical Senior Lecturer in Psychology at the University of Manchester and Chief Investigator for the PROSPECT project, said: “This is the first prison-based trial in England that has sought to improve access to a psychological talking therapy for suicidal thoughts and acts.

“If this study proves the therapy to be effective, then we could see significant reductions in the number of suicide attempts and related deaths in prisons as well as improvements in prisoner mental health services.”

Dave Honeywell, an ex-prisoner who is now a lecturer at Arden University, said: “I was made blatantly aware there was a mental health crisis in prisons from my very first experience of prison in the early 1980s. It almost seemed an accepted part of prison life and certainly not taken seriously by the staff.

“When I returned to prison in the 1990s it really stood out how much things had worsened and clearly exacerbated by drug use. The availability of therapy in prison could at least give prisoners hope and options which was something I was never offered.

“My mental health suffered immensely in prison and if therapy was available, I was not aware of it because I would have been very eager to receive it. Not only would the availability of therapy be hugely important but all prisoners must be made aware that there is therapy available!”

You can find out more about PROSPECT