Prison mental health — reception crisis and care pathway (MEQ)

(i) Reception priorities. Treat reception as urgent clinical triage under equivalence of care. In the first hours: (1) medical stability and withdrawal risk (stimulant crash; possible opioid withdrawal given missed methadone); (2) suicide/self-harm screen with history of scars and current ideation; (3) psychosis assessment given untreated schizophrenia and overdue LAI; (4) medication continuity plan for antipsychotic and opioid agonist therapy per local policy; (5) vulnerability (first night, remand uncertainty). Obtain community notes, last LAI date, methadone programme confirmation, and custody observations. Do not invent local regulation section numbers.^[1][2][7]

(ii) Suicide and self-harm tonight. Early remand / first night is a recognised high-risk window. Risk profile: current ideation, prior self-harm scars, psychiatric illness, possible single-cell isolation, substance use, legal stress.^[2][3] Conduct full risk interview (ideation, intent, plan, means, protective factors), MSE, and collaborative safety plan. Recommend enhanced or constant observation as indicated; ligature-aware placement; meaningful staff engagement, not checkbox watches alone. Self-harm is a clinical signal associated with later suicide — not a pure discipline issue.^[3] Review overnight and after court news.

(iii) Substances and dual diagnosis. SUD is highly prevalent in prisons; concurrent (not sequential) care is required.^[4][1] Manage stimulant-related crash and screen for other depressants. For missed methadone, arrange urgent medical review for opioid withdrawal and continuity/re-induction of OAT according to local prison health policy. Restart antipsychotic pathway for schizophrenia (consider LAI after acute assessment and consent/lawful authority). Integrated plan: mental illness + SUD + custody supports.

(iv) Segregation response and stepped care. Decline segregation as "treatment." Solitary/segregation associates with adverse psychological effects and high distress; it is not psychiatric care and may worsen psychosis and self-harm risk.^[5][8] Prefer healthcare wing / enhanced observation with increased mental health input. Stepped ladder: primary/in-reach → enhanced observation → external hospital transfer if needs exceed prison capacity (severe psychosis + high suicide risk, need for intensive nursing). Transfer statutes are jurisdiction-specific — state principles only.

(v) Release-transition principles (even if not imminent). Teach that early post-release is another extreme suicide-risk window; planning must start early: scripts, appointments, OAT continuity, housing/support, crisis contacts, family engagement where safe.^[6][1] Document that throughcare is suicide prevention.