Delivering flexibility within a rigid system: The challenges and achievements of a values-led clinical psychology service within a remand prison setting

Prison environments present a unique challenge to psychologists in being able to deliver therapeutic care and support whilst restricted by physical and procedural security alongside a culture of ‘order and discipline’. The clinical psychology service within the mental health team at HMP Birmingham adapted our way of working to try and navigate these challenges. These were exacerbated by the Covid-19 pandemic which served as a catalyst to how we provided effective care that was evidence-based and values-led, whilst modelling against a community clinical psychology model of care. The efficacy of the team was evidenced through reduced waiting times, improvements in outcome measures for general wellbeing and trauma symptomology and positive feedback from service users. Key reflections on what worked included being flexible; utilising joint working with colleagues; providing individualised care; and having clear roles and values as a team. Some areas for further improvement have been identified including delivering more training, consultation and joint working to colleagues; offering more group interventions and involving service users in the production and delivery of resources and interventions; and adding to the literature base regarding mental health support within custodial environments.