prison visit support

Prison Fellowship

How to Prepare for a Prison Visit

Visiting a family member in prison presents its own bundle of challenges. Just knowing what to expect can reduce stress. Being prepared can raise the bar for positive visitation experiences, possibly snowballing into more visits, and hopefully, improved relationships.

Since studies point to lower recidivism rates for prisoners who stay connected to supportive family members, positive prison visits end up benefiting everyone: prisoners, families, and the community. For the 1.5 million children and youth who have at least one incarcerated parent, visiting their parent(s) can strengthen family bonds.

To be prepared, consider the following information the first time visiting someone in prison. Please keep in mind that rules vary among prisons.

BEFORE VISITING PRISON

Be approved.

Be sure your name is on the prisoner's pre-approved visiting list for people age 18 and older. Information on the form allows officials to do background checks to approve or deny visitation. Most facilities require this form, but verify with the facility to be sure. Some facilities also require an authorization form for children.

Check the facility's visitation hours, which are typically weekends and holidays, and possibly additional days depending on the facility and security level. Visit the Federal Bureau of Prisons'  website to see a list of federal prisons; for state or private prisons, directly contact the facility.

BE AWARE OF WHAT YOU CAN BRING

Check the facility's policy for what is allowed in the visiting room. Generally, visitors can only bring in identification (such as a driver's license), a single car key, eyeglasses, small bills, or change for vending machines (if applicable) in visitation rooms.

No medications, tobacco products, or any illegal substances are allowed. Cell phones or other electronic devices are also not permitted.

Other restrictions might include rules about bringing in food or gifts.

DURING THE PRISON VISIT

Dress appropriately.

Wear appropriate clothing. Avoid provocative, revealing items and anything similar to prison clothing such as khaki or green military-type. Visitors may be denied access if dress code policies are violated.

ARRIVE EARLY

Give yourself an extra 15-20 minutes to fill out paperwork. Be prepared to be searched before being admitted into the visiting room. Searches may include a pat down by an officer of the same gender and a pass through a metal detector. All visitors must be searched, including children.

Before bringing children, consider visiting alone first so you can explain what to expect.

BE RESPECTFUL

Show courtesy to all correctional staff, other visitors, and prisoners to ensure a positive visiting experience for everyone.

SHOW AFFECTION IN MODERATION

Handshakes, hugs, and affection (in good taste) are usually allowed at the beginning and end of a visit.

To keep the visiting area orderly and to prevent the distribution of contraband, security staff may limit physical contact.

SUPERVISE CHILDREN

Be aware of you and your children's behavior to avoid the risk of losing visiting privileges.

BE A GOOD LISTENER

Extend a listening ear to the prisoner you are visiting. A little understanding can go a long way.

AFTER THE PRISON VISIT

Mail a letter to the prisoner to continue building the relationship. Be sure to check with the facility first to ensure permission.

Encourage the prisoner to get involved in prison programs to cope with prison life and to take reentry classes for a successful reentry plan. Prison Fellowship ® offers several in-prison programs —ranging from faith-based seminars to life-skills classes—in prisons across the country.

GET INVOLVED

Explore involvement in a local church that provides support for prisoners, former prisoners, and their families. Check out Prison Fellowship's efforts in reentry , church and community engagement, and Angel Tree ® .

Consider involvement in Celebrate Recovery , a nationwide Christ-centered recovery program that is forward-looking and emphasizes personal responsibility and spiritual growth.

Or check out an online support group such as DailyStrenth that is dedicated to families impacted by incarceration, or the National Association for Christian Recovery that provides resources and free online training in topics including 12-step recovery, parenting addicted children, recovering from childhood trauma, etc.

Finally, be a part of Prison Fellowship's Second Prison Project™ . Find out how you can help your loved one and others with reentry and adjusting to life with a criminal record.

FOR MORE INFORMATION

Visiting loved ones in prison can lead to stronger relationships and help beat the odds of someone returning to prison. And that's definitely raising the bar for good.

Other helpful websites include Assisting Families of Inmates and PrisonPro.com .

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A Volunteer Visitation Program to Federal and Military Prisoners Throughout the United States

Our visitors.

PVS volunteer visitors are at the heart of our organization, as they further our mission each day in prisons across the country. By giving just one day a month to their work with PVS, they offer the invaluable gift of human contact to those left isolated by the prison system.

PVS visitors are as unique as they are diverse ; there is no one type of person who is drawn to the work of our organization. Visitors represent all age groups, professions, as well as educational, religious, and socioeconomic backgrounds. Although sponsored by many religious groups, PVS visitors do not impose a particular religion or philosophy on prisoners. For many, their only common bond is the service that they provide to prisoners across the country, but this simple act unites them with a network of visitors; past, present, and future .

In addition to making monthly visits, our visitors also have the opportunity to connect with one another through their correspondence with our national office, meeting with other visitors in their geographical area, and participating in our annual training conferences. Through this interaction  visitors support one another, share experiences, and offer guidance.

By becoming a visitor, you too can share in the unique mission of PVS and join our network of over 300 other individuals that make prison visitation a priority in their lives . 

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How to visit or send money to a prisoner

If you know someone who is in prison, you may be able to support them by visiting or sending them money. Find out how to support someone in federal or state prison.

Visit or send money to someone in state or local prison

Options for visiting or sending money to inmates in state and local prisons vary. Contact the state or local corrections department for more information.

Send money to someone in federal prison

People in federal prison have bank-type accounts that they can use to buy things from the prison commissary. You can deposit money into a federal inmate's account electronically or through a postal money order by mail.

Learn more about depositing money into a federal prisoner’s account .

Visit someone in federal prison

The Bureau of Prisons (BOP) recommends completing these four steps before visiting someone in federal prison:

Find out which prison the person you are visiting is in.

Get approval from the prison to visit.

Review the prison’s rules and regulations before visiting.

View the prison’s visiting schedule and find out how to get there.

Learn more from BOP about each step before planning your visit.

LAST UPDATED: January 31, 2024

Have a question?

Ask a real person any government-related question for free. They will get you the answer or let you know where to find it.

• Prisoner Resources
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Prisoner Visitation and Support

Prisoner Visitation and Support (PVS) is a volunteer visitation program for federal and military prisoners across the U.S., with special priority given to those on death row, in solitary confinement, serving long sentences, or not receiving regular visits.  PVS volunteers visit once a month, with no religious or political agenda, to provide a listening ear to those who need one.  Limited visiting for Spanish speaking prisoners. Serves federal and military prisoners only. 

Directory Category

Mailing address.

Bringing families together

We help the families and friends of incarcerated people organize a visit to prisons in any US State.

Improve the wellbeing of society by maintaining relationships between incarcerated people and their loved ones, enabling successful reintegration into society after release.

Connecting families

We have already helped more than 150 people visit their loved ones.

Distance is not a problem

We organize visits between family members in all 50 states.

Apply quickly

Fill out our questionnaire in just a few minutes to determine if we can organize your visit together.

Our founders know incarceration firsthand. While they spent months to years in the prison system, when they were released they were able to return home to their families and support networks. Their lives mostly went back to normal. They could put their mistakes behind them and move on. But several of the people they served time with, who did not have the same level of privilege and support, were not as lucky. PVF was created to give others the same opportunity to stay close to their loved ones while serving a prison sentence.

Research Analyst

Makeda Telesford

Makeda is a Research Analyst at Dutchess Management and is currently pursuing a bachelor’s degree in Communication and Speech Disorders at Brooklyn College.

Bill Baroni

Bill brings more than 20 years of governmental and non-profit experience to Dutchess, where he is involved in identifying solutions to some of the most complex problems that face our diverse clientele.

Investment Analyst

At Dutchess, he helps manage operations for our software incubator partners and conducts preliminary research on new ventures for the company and its clients.

Chief Operating Officer

Anna has been the COO at Dutchess Management since March of 2020.  Prior to that she worked as the Private Equity Practice Coordinator at Willkie Farr & Gallagher.

Two-and-a-half million people in the United States wake up every morning in a prison. The US incarcerates a larger share of its population than any other country on earth. 95% of all presently incarcerated people will be released at some point.² But unfortunately, just three years later, half will be back in prison.³ Why? One reason is the loss of connection – especially to family members and other loved ones – that happens while someone is incarcerated. The average family can’t afford to take off work, travel hundreds of miles out of state, and cover lodging costs just to visit a loved one for a few limited visitation hours.⁵ So, too many families with incarcerated people disintegrate, causing drastic consequences, including substance abuse, learning and education loss, and mental illness.⁶ These issues are especially acute in the more than 50% of families with incarcerated people which have children under the age of 18.

Thankfully, simple visits between loved ones can prevent or heal much of this damage. Studies show that family visits can reduce recidivism by as much as 50%.⁷ Meaningful contact with parents also reduces behavior problems, criminal activity, and mental and physical problems in children.⁸ The benefits of increased visitation and reduced recidivism do not stop at the personal level. Maintaining connections to family members can help incarcerated people readjust and contribute to society after they’ve paid their debts to it. Lower spending on reoffenders can save states $18 billion per year.⁹ Preserving support networks for incarcerated people thus has significant advantages for everyone.  ‍

Support from A to Z

Step 1: apply.

Fill out a 5-minute form that goes directly to our application review team. We’ll be in touch shortly.

Step 2: Confirm Logistics

Our travel team will help you coordinate with the prison to confirm your visit and take care of booking travel arrangements.

Step 3: Visit!

Enjoy quality time with your loved one!

“Anyone who has a loved one in the prison system knows the mental, emotional, and financial toll it puts on the families. There have been countless times I haven’t been able to visit my loved one because I just couldn’t afford the trip.

The Prison Visitation Fund has blessed me with the gift of being able to visit my loved ones without the financial burden. This organization understands the importance of a visit for both the incarcerated and their loved ones on the outside. I’m so eternally grateful for this group and everything they have done for me and my family.”

"I received the gas cards for my trip to see my husband. My family and I had such an amazing day yesterday and it was in a large part thanks to your organization and the help you gave us.

Such an awesome day yesterday I was able to hug and kiss David for the first time since he went in and I hear that they're opening up the prisons for full contact now so when I go in October it'll be even better. Again thank you so very much for your help, I'm eternally grateful for all that you've done thank you.”

“PVF made it possible for me to see my fiancé in person for the first time. I originally heard about PVF in a prison wife group I'm a part of on Facebook.

I was planning the trip to see my fiancé at the end of July when I came across the post. Stressing about the funds to be able to see him, I figured applying would be worth a shot. The only way I have been able to see my fiancé before is through 30 min video visits that I pay for 2X a week. We have been getting by with just those for a year.

When I got the call saying I was approved, I was brought to tears. PVF helped with the funding for the gas and put me and my two children in an amazing hotel room. Making it all the more possible for me to make this trip to see my fiancé.

Thanks to PVF my children and I got to spend 2 four hour visitation days with my significant other. I couldn’t thank PVF enough for what this organization did for my family. The look of pure happiness on my children's and my fiancé's face was so worth it. Thank you PVF for making it possible for my family and me to be whole in a while.”

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Prisoner Visitation and Support

October 1, 2020

By Quaker Works

prisonervisitation.org

Cofounded by Quaker activist Fay Honey Knopp over 50 years ago, Prisoner Visitation and Support (PVS) continues to provide a supportive presence to those in prison despite the challenge presented by the pandemic.

Each month 400 PVS volunteers visit prisoners in over 100 federal and military prisons throughout the United States. With the onset of the pandemic, all prison visits were suspended indefinitely as of March. Prisoners are locked inside their cells for 23 hours a day as the virus spreads within many of the institutions. The Federal Bureau of Prisons, in recognition of years of PVS involvement, has granted PVS visitors special permission to correspond with prisoners during this period. Some of these prisoners are on death row at FCI Terre Haute and are scheduled to be executed. Prisoners are responding to their PVS visitors expressing deep appreciation for their letters, often the only contact they have with the outside world. Prisoners say that PVS is a lifeline for them, a connection that provides hope in a time of fear and desperation.

During this interim period, PVS staff are using technology to keep in touch remotely with visitors, providing support and resources. Staff are also developing new training resources for visitors to prepare them for returning to face-to-face visits with prisoners who have experienced the effects of trauma resulting from months of isolation.

• Prisoner Visitation

Quaker Works

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Prison Visits

The Department of Corrections (DOC) recognizes the vital role families play in the reentry process , and will support incarcerated individuals in maintaining ties with family, friends, and the community through personal visits and engagement with community stakeholders and partners. Reasonable efforts will be made to ensure visiting facilities are comfortable, pleasant, and permits informal communication and limited, appropriate physical contact.

Visitor Application Process

Visitor guidelines.

• Approved Visitors List

Minor Visitors

International visitors, extended family visits, professionals, general visit information.

Application Processing Time Update: The Statewide Visit Unit (SVU) is currently working on processing a very high volume of visit applications. Applications are taking approximately 40-45 business days to process (business days do not include weekends or state holidays). Submitting more than one application will cause previous applications to be voided and the process to restart. Thank you for your patience and understanding.

All visitors must complete and submit a visitor application . A separate application must be completed for each proposed visitor (minor or adult). It is recommended that applicants have all required documentation ready and available prior to filling out the online application to ensure successful completion and submission. The Department only accepts Electronic Visit Applications for prison visits at this time.

Applications are generally processed within 30 business days of receipt, though in some cases more time may be needed. Please allow a minimum of eight weeks before inquiring with the Statewide Visit Unit regarding application status. Submitting multiple applications for an individual visitor will cause a delay in processing.

See Family & Friends and Professionals for information that may be applicable to your visit. All visitation policies and forms can be found on the Resources webpage. See Prison Visits Frequently Asked Questions for more information about visiting a prison facility.

DOC 450.300 Visits for Incarcerated Individuals (pdf) is applicable to all types of prison visits. Please note visitors whom are 18 years of age and older must present a valid, current photo identification at the time of the visit (i.e., driver's license or state issued identification card, international visitors must present their passport).

The following applies to in-person visitation:

• Visits occur on a first come, first served basis. If the visit room is full, visitors may be turned away. Facility visit guidelines identify the process utilized by the facility to allow for other visitors to be afforded visit privileges. Please review the appropriate facility visitor guidelines for more information.
• Facility emergencies may affect operations. These are unforeseen and visiting may be cancelled or end early without advanced notice. Visitors are urged to check the prison facility alerts & notices and to check with the facility prior to traveling.
• For the safety of yourself and your loved ones, all persons are subject to search per DOC 420.340 Searching and Detaining Facility Visitors (pdf) .
• To protect your loved one and other individuals in the facility, please stay home if you are sick.
• Visit rooms, tables, chairs, restrooms and high-touch surface areas will be sanitized between visit sessions.

Facility Specific Information

Each facility has its own specific visitor guidelines, visiting hours, and event calendars, which can be accessed in the table below.

Prison Facility Visitor Guidelines, Visiting Hours & Event Calendars

Restrictive housing visiting.

Restricted housing will follow DOC 320.255 Restrictive Housing (pdf) policy for scheduling, hours, and will remain non-contact according to Restrictive Housing Level System Grid (Attachment 2) (pdf) .

Special Visits

Per DOC 450.300 Visits for Incarcerated Individuals (pdf) , the process for specials visits is at the discretion of the facility superintendent. Special visits may be requested utilizing the DOC 21-787 Special Visit Request (pdf) form.

Visitor Behavioral Observations

Per DOC 450.300 (pdf) , a record of each visit is entered into the statewide visit system. Visitor behavior observed by Department of Corrections’ staff may be electronically documented. Visitors may request a copy of behavior observation entries from their visitor profile in the statewide visit system via public records request .

Family & Friends

Approved visitor's list.

The visitor application approval process must be completed before an individual is placed on an incarcerated individual's Approved Visitor List.

• Individuals may only be on one incarcerated individual's Approved Visitor List, with one exception .
• When an incarcerated individual is transferred to another prison facility, his/her Approved Visitor List will remain and be available in the Statewide Visit System. Incarcerated individuals are responsible for notifying their visitors of transfers.
• Individuals denied placement on an incarcerated individual's Approved Visitor List will be informed, in writing, of the reason for denial.
• Incarcerated individuals may remove a visitor from their Approved Visitor List, or request to resume visits with the removed visitor. Visitors must submit a new application if they have been removed.
• If an individual wishes to be removed from an Approved Visitor List, they must submit their request in writing to the Statewide Visit Unit .
• A request to be removed from an incarcerated individual’s Approved Visitor’s List must be submitted prior to applying to visit another incarcerated individual. Please note, if you do not request to be removed prior to your new application being processed, you will be required to resubmit your application. This will restart the application processing time.
• An individual removed from an Approved Visitor List must wait 90 calendar days before applying to visit the same or another incarcerated individual. When the visitor is requesting to visit a different incarcerated individual, the waiting period may be waived if the visitor never visited with the individual whose list they were removed from or if they have not visited in the last 90 days. If the visitor wishes to be added back to the visit list of the same incarcerated individual, the 90 day wait will not be waived.

Minors are those individuals who are under 18 years of age. The following are required for all minors who will be visiting an incarcerated individual at a Department of Corrections (DOC) prison facility:

• Minors must be on the incarcerated individual's Approved Visitor List .
• Minors must be accompanied during the entire visit by their non-incarcerated parent/legal guardian, or a designated escort .

The following may also apply depending on the nature of the minor's visit:

• If the minor is an infant or toddler, see the visitor's guidelines of the prison facility you will be visiting for information about what items are authorized.

International visitors must provide a copy of their passport photo page and a copy of their criminal history from their local jurisdiction, or a certificate of criminal records from the local jurisdiction that outlines all criminal history, or if there is no criminal history (misdemeanor or felony).

Extended Family Visits (CY 2019)

1,231 approved efv visitors made 3,805 visits to 688 incarcerated individuals in 2019..

Extended Family Visit (EFV) processing generally takes 8-10 weeks from the time that the department receives all necessary documentation. Please allow a minimum of 12 weeks before inquiring about the status of your EFV application. For more information refer to DOC 590.100 Extended Family Visiting (pdf) and the EFV Resource Guide (pdf) .

The requirements for EFV visitors that must be met include:

• The visitors must be immediate family members who can provide legal verification of the relationship.
• All EFV participants require Superintendent/designee approval.
• If the incarcerated individual is incarcerated on a serious violent or sex offense, the EFV Review Committee must review and authorize EFV privileges.
• In addition to the forms listed, there are several criteria that must be met for family, minors and incarcerated individual to be eligible for an Extended Family Visit. Please note the EFV application process can be lengthy, and additional documentation may be requested.
• Visitors will submit applicable paperwork and documents by sending them to the address below.

Department of Corrections Attn: EFV Application Post Office Box 41118 Olympia, WA 98504-1118

• Each individual visitor must also complete the Consent to Medical Treatment and Waiver of Liability form.

• An orientation will be scheduled before your first EFV at the facility.
• Please contact your incarcerated family member to initiate the EFV scheduling process.
• If you are an approved EFV visitor and have any questions about EFV’s contact facility visit staff .
• Visitors may only bring items that are identified on the Extended Family Visit Allowable Items list .
• All policy requirements are applicable. Please take the time to review DOC 590.100 Extended Family Visiting (pdf) .
• Individuals from one EFV group may not be within 6 feet of EFV participants from other groups within the EFV area.
• If the incarcerated individual participating in the EFV is on medication/s via pill line, these medications will be brought to the EFV unit to be taken.
• If a visitor is on controlled medication/s held by the facility, this medication will be brought to the EFV unit for the visitor to take them.

See Prison Visits Frequently Asked Questions and DOC 590.100 Extended Family Visiting (pdf) for more information.

Professional visitors are processed at the prison facility where the incarcerated individual is incarcerated. Professional visitors include:

• Social Services Agency Representatives (except those identified as a visit supervisor for a minor visiting an incarcerated parent)

Professional visitors should contact the prison facility to coordinate their visit. See Prison & Video Frequently Asked Questions for more information.

Media Personnel

If media personnel would like to visit with a specific incarcerated individual, they must complete the same application process as all visitors . If media personnel would like to tour a prison facility, they should contact the Public Information Officer to coordinate a tour.

Family & Visitors

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Federal Bureau of Prisons

Bureau to resume social visitation.

Non-contact social visits to resume October 3rd

(BOP) - The BOP recognizes the importance for inmates to maintain relationships with friends and family. During modified operations in response to COVID-19, the BOP suspended social visitation, however, inmates were afforded 500 (vs. 300) telephone minutes per month at no charge to help compensate for the suspension of social visits. As a modification of the BOP's Phase Nine Action Plan, and in accordance with specific guidance designed to mitigate risks, social visits are being reinstated, where possible to maintain the safety of our staff, inmates, visitors, and communities.

Each individual institution has made plans consistent with their institutional resources (including physical space) and will continuously monitor their visiting plan, and make prompt modifications, as necessary, to effectively manage COVID-19. Such modification may include limiting or postponing visitation, providing visitation by appointment, or other adjustments as appropriate.

All visits will be non-contact and social distancing between inmates and visitors will be enforced, either via the use of plexiglass, or similar barriers, or physical distancing (i.e., 6 feet apart). Inmates in quarantine or isolation will not participate in social visiting. The number of visitors allowed in the visiting room will be based on available space when utilizing social distancing. The frequency and length of visits will be established to ensure all inmates have an opportunity to visit at least twice a month. Visitors will be symptom screened and temperature checked; visitors who are sick or symptomatic will not be allowed to visit. Both inmates and visitors must wear appropriate face coverings (e.g. no bandanas) at all times and will perform hand hygiene just before and after the visit. Tables, chairs and other high-touch surfaces will be disinfected between visitation groups; all areas, to include lobbies, will be cleaned following the completion of visiting each day.

The BOP is committed to protecting the health and welfare of those individuals entrusted to our care, as well as our staff, their families, and the communities where we live and work. It is our highest priority to continue to do everything we can to mitigate the spread of COVID-19 in our facilities; therefore, every CDC recommended precaution will be incorporated into our revised visiting procedures.

More information about each institution's revised visiting procedures and schedule will be forthcoming and posted on www.bop.gov .

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Prison Families Alliance

The heart of the prison family, main content, announcements.

• PFA CARES (Community, Advocacy, Resources, Education, Support) in person meetings in Las Vegas, NV, 6pm-7pm PST, every Thursday.  Open to adults and youth who have or had a loved one in the carceral system. Share a meal, share information, join our community.   Click here to register.
• Join us at the Connecting For Justice Conference (formerly International Prisoners’ Family Conference) March 18-20 in Ashland, Ohio
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Prison Families Alliance (PFA) is a nonprofit 501(c)3 organization that is committed to improving the lives of families and children who have or had loved ones in the criminal justice system. Visit our About page to learn about our mission, vision, and approach to supporting adults and children who have loved ones in the criminal justice system, and to find out about our co-founders and board of directors.

PROGRAMS & SUPPORT

Prison Families Alliance hosts support meetings and educational programs. These programs are desgined to inform, support, and empower a variety of audiences.

PFA hosts compassionate, supportive peer-led meetings for adults who have loved ones in the criminal justice system.

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PFA supports youth affected by a loved one’s incarceration. Our youth program provides a safe environment for youth ages 7 to 17.

PFA provides a variety of events, workshops and activities to help families understand and navigate the criminal justice system.

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Visitation Scheduling

A Safe, Secure, and Fully Automated Visitation Management Solution

The GTL visitation management solution, VisitMe Scheduler, is proven to be the most robust and configurable in the corrections market. As an integrated GTL product, the VisitMe Scheduler solution will aid in streamlining a facility’s daily operations. For example, VisitMe Scheduler can eliminate long queues in the visitation area by avoiding the chaos of having a high volume of concurrent visitors at the facility. In so doing, the system also minimizes staffing requirements.

The visitation management system also enables facilities to create a more efficient visiting process that allows them to expand their visitation schedules. This further enhances a facility’s ability to help maintain that very important service of regular communication between inmates and their friends and families. The key feature and power of the visitation management solution is the VisitMe Scheduler software, which essentially automates the entire visitation process – this truly separates the software from all other video visiting systems. Facilities will have the luxury of configuring station availability for the public or inmates, inmate quotas, and daily and weekly schedules.

The system will utilize the configurations to create a very efficient, safe and automated visitation process. The system provides a public web site to allow the public to schedule their visits to an inmate. The system then performs all automated conflict checks on the visits and connects the proper stations for the scheduled visits.

The National Leader in Active Deployments

Currently managing over 100 correctional facilities visitation programs, the VisitMe Scheduler software solution maintains the majority share of successful program implementations. In addition, this software application’s current installed base spans a range of facility sizes both large and small.

Revenue Generation Opportunities

Providing the opportunity for additional and extended visitation sessions, a facility can securely expand a service that has been proven to reduce recidivism. Utilizing the configurability of the revenue and billing application, GTL VisitMe Scheduler will allow a facility to create its own unique revenue options such as custom rate tables, varying charges for particular days and times, and refund policies.

Fully Configurable Implementation

GTL can efficiently integrate our VisitMe Scheduler with any facility’s current visitation protocol. Regardless of the specific intricacies designed to coordinate the current visitation service, VisitMe Scheduler’s configurability will adhere to all mandatory requirements while creating additional efficiencies throughout the remainder of the program.

Related Products

Video Visitation

GTL’s video visitation solution adds another way for incarcerated individuals to see their loved ones. More secure than traditional visitation, it reduces the introduction of contraband and communicable diseases into facilities. It complements other communication systems as well as traditional visitation.

• Open access
• Published: 17 April 2024

Breaking down barriers to mental healthcare access in prison: a qualitative interview study with incarcerated males in Norway

• Line Elisabeth Solbakken 1 , 2 ,
• Svein Bergvik 3 &
• Rolf Wynn 1 , 4  

BMC Psychiatry volume  24 , Article number:  292 ( 2024 ) Cite this article

440 Accesses

Metrics details

Mental health problems are highly prevalent in prison populations. Incarcerated persons generally come from disadvantaged backgrounds and are living under extraordinary conditions while in prison. Their healthcare needs are complex compared to the general population. Studies have found that incarcerated individuals are reluctant to seek help and that they experience challenges in accessing mental healthcare services. To some extent, seeking treatment depends on the degree of fit between potential users and health services, and actual use might be a better indication of accessibility than the fact that services are available. This study aimed to explore individual and systemic facilitators and barriers to accessing mental healthcare in a prison context.

An analytical approach drawing on elements of constructivist Grounded theory was the methodological basis of this study. Fifteen male participants were recruited from three prisons in Northern Norway. Data was collected through in-depth interviews on topics such as help-seeking experiences, perceived access to services and availability of health information.

We found that distrust in the system, challenges with the referral routines, worries about negative consequences, and perceived limited access to mental healthcare were barriers to help-seeking among incarcerated individuals. How prison officers, and healthcare personnel respond to incarcerated persons reporting mental distress could also be critical for their future willingness to seek help. Providing information about mental health and available services, initiating outreaching mental health services, and integrating mental health interventions into treatment programs are examples of efforts that might reduce barriers to accessing services.

Conclusions

Facilitating access to mental health services is crucial to accommodate the mental health needs of those incarcerated. This study provides insights into the complex interplay of individual, social and systemic factors that may contribute to the utilization of mental health care among incarcerated persons. We suggest that correctional and healthcare systems review their practices to facilitate access to healthcare for people in prison.

Peer Review reports

Mental health of people in prison

The rates of mental disorders are considerably higher among incarcerated individuals than in the general population [ 1 , 2 , 3 , 4 ]. Co-morbidities are common, and around 20% of incarcerated individuals have concurrent mental and substance use disorders [ 5 ]. They are at increased risk for all-cause mortality, self-harm, violence, and victimization, and suicide rates are about 3–6 times higher among incarcerated males relative to males in the broader population [ 6 ]. Adverse life experiences and disadvantaged living conditions from an early age may explain the observed accumulation of mental health problems in prison populations worldwide [ 7 , 8 ]. Genetic predispositions combined with environmental stressors are implicated in the development of mental disorders [ 9 , 10 ]. People in prison generally experience low educational achievements, low income, and unstable housing. Thus, the poor mental health of prison populations is caused by a complex interplay of social, environmental, and genetic factors [ 7 , 11 ]. In addition to the pre-existing burdens, incarcerated individuals are facing prison–specific challenges such as loss of autonomy, social isolation, bullying and violence that may exacerbate mental health issues [ 12 , 13 , 14 , 15 ]. Considering the elevated rates of mental health problems in prison, facilitating access to mental health services is crucial to accommodate the needs of those incarcerated.

Access to mental health services

The treatment gap refers to the proportion of individuals with mental health problems within a specific community that require treatment without receiving it [ 16 ]. Variable access to mental healthcare and high levels of unmet mental health needs are universal challenges in communities across the world [ 17 , 18 ]. Even when health services are available, individual and systemic barriers may hinder their use. In a narrow sense, access to healthcare may be considered equivalent to available services. However, some argue that a more meaningful way to define access is the “degree of fit” between the potential users and health services [ 19 ]. For instance, if services are accessible in terms of transportation and treatment costs and whether they are compatible with potential users’ personal attitudes, beliefs and preferences. “Having access” can be understood as the potential for using available mental health services. “Gaining access”, is the individual process of choosing to use those services [ 20 ]. Within this frame of reference, access to services is more precisely defined by the actual use of services.

Mental health help-seeking

Across settings and populations, the majority of those suffering from mental health problems do not seek treatment [ 21 , 22 , 23 ]. The literature on help-seeking gives insight into the intrapersonal factors involved in accessing mental health care. Within this context, help-seeking has been defined as: " an adaptive coping process that is the attempt to obtain external assistance to deal with a mental health concern” [ 24 ]. The process of seeking help involves becoming aware of a mental health problem that may require intervention; articulating the psychological challenges in a way that can be understood by others; awareness of help sources that are available and accessible; and a willingness to talk about the mental health problem to available help sources [ 25 ]. Throughout the help-seeking process, personal thoughts and feelings become increasingly interpersonal as an individual confides in and seeks support from others. It is not uncommon to share mental health concerns with informal sources of support such as friends and family prior to, or even instead of, seeking professional help [ 26 ]. Moreover, informal networks are found to facilitate but may also discourage professional formal help-seeking for mental health problems [ 27 , 28 ].

The theory of planned behavior (TPB), a well-known model within behavior change research, may also provide a framework for understanding how personal attitudes and social influences are implicated in accessing healthcare. Subjective norms, attitudes, and perceived behavioral control are elements of TPB that are particularly important for understanding the help-seeking process [ 29 ]. In this context, subjective norms refer to a person’s beliefs about other peoples’ practice or approval of help-seeking and are related to expectations of social support in pursuing professional help. Attitudes refer to appraisals of seeking professional mental help as beneficial or harmful and a judgement of whether help-seeking would be constructive compared to alternative behaviors. Perceived behavioral control can be divided into self-efficacy (the confidence that one can seek help), and controllability (the extent of personal control in the help-seeking process). A recent review found that attitudes and perceived behavioral control predict help-seeking intentions across different population groups and cultures [ 30 ].

Access to mental health services in prison

Equity is essential in healthcare to ensure that the health system meets the needs of different groups of people and individuals [ 20 ]. “The principle of equivalence” is a widely endorsed standard for healthcare in correctional settings [ 31 ]. This principle is laid down in the United Nations´ Nelson Mandela Rules. Rule number 24 states that: “Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status” [ 32 ] (p.8) However, some argue that equal standards are not sufficient to meet the complex needs of incarcerated individuals and that mental healthcare in prison must be more intensive and integrative than services provided in the community [ 33 , 34 , 35 ]. In reality there are several reports of shortcomings in the delivery of mental healthcare in prison in many countries across the world, as mental disorders in incarcerated persons are underdiagnosed and undertreated [ 6 , 34 ]. Studies from Canada, the US, and the UK indicate that a significant proportion of incarcerated people with mental health problems have not received adequate treatment [ 36 , 37 , 38 , 39 ]. Suggested explanations for unmet needs are underfunding, failure in screening procedures and quality at reception, demand for more mental health knowledge among prison staff, and possible underrating of the severity of mental health problems by the prison administrations to reduce treatment costs [ 36 , 37 , 38 , 39 , 40 ]. Taken together these reports suggest that mental health services do not fit the complex needs of incarcerated persons in high-income countries. There is less knowledge about the situation in low- and middle-income countries. However, the elevated rates of mental disorders in these countries suggest that unmet needs among incarcerated persons are a widespread challenge [ 1 ].

Mental health help-seeking in prison

Evidence suggests that the immense burden of mental disorders among people in prison is not matched by a proportional use of mental healthcare [ 41 ]. Several reports from various correctional settings have documented that incarcerated persons are reluctant to seek help for mental health problems [ 41 ]. Among the reported barriers to help-seeking in prison are confidentiality concerns [ 42 ], fear of stigma associated with a diagnosis [ 43 ], a preference for self-management or informal support [ 44 ], lack of knowledge of psychological services [ 42 , 44 ] and distrust in the system [ 45 ]. In addition, systemic factors may influence access to healthcare in prison. The culture in all-male prisons typically demands that those imprisoned mask their vulnerabilities by adopting a tough and dominant demeanor [ 46 ]. Experiencing mental illness and receiving professional mental health treatment is also associated with an increased risk of victimization in incarcerated individuals [ 47 ].

Mental health literacy (MHL) is a concept that includes the knowledge and attitudes that influence how people manage their mental health needs [ 48 ]. Having sufficient knowledge and access to information about mental health and mental health services can be a prerequisite for seeking professional help [ 49 ]. For people living in the community, seeking online information and advice is an important strategy for gaining knowledge about how to cope with mental health challenges [ 50 , 51 , 52 ]. For security reasons, access to the Internet is typically severely limited for those imprisoned [ 53 , 54 ]. Hence, this essential mental health information source is largely unavailable to them. Accordingly, incarcerated individuals are reliant on finding mental health information through information pamphlets, books, TV programs, newspapers or consulting healthcare professionals [ 55 ]. Some argue that limited access to online information and digital health services may have consequences for the well-being and successful rehabilitation of those incarcerated [ 53 , 56 , 57 ]. Thus, there are reasons to believe that restricted access to mental health information may also affect help-seeking and access to healthcare for incarcerated individuals.

The rationale for the current study

Fostering health-promoting environments and adequate access to mental healthcare within prisons is a public health imperative increasingly acknowledged in the literature [ 33 ]. Moreover, the mental health of incarcerated persons is a matter of public safety since untreated severe mental disorders are associated with a higher risk of recidivism [ 58 , 59 ]. People in prison retain their right to health services, and in principle, incarcerated persons have access to mental health services. A vital question, however, is how incarcerated persons experience gaining access and how this affects their actual use of services. Existing research on the provision of mental healthcare in prisons, particularly within a Scandinavian context, is sparse, leaving significant knowledge gaps. The question of access to health information for incarcerated persons is similarly understudied. This study aimed to investigate how incarcerated persons experience individual and systemic factors that facilitate or impede access to mental healthcare in prison.

The Helsinki Declaration of Medical Research involving human subjects and services laid the basis of the ethical considerations of this study [ 60 ]. The study was approved by the Data Protection Officer of the University Hospital of North Norway (No. 02415). The Norwegian Correctional system, which is responsible for the welfare of incarcerated individuals, approved of the study (Ref. 200900463-347). The Regional Health Research Ethics Committee concluded that the project was outside their mandate (Ref. 40,701).

The principles of voluntariness and informed consent are central to human subject research. Individuals in prison are considered vulnerable due to their restricted freedom and autonomy, poor health status, higher incidence of learning disabilities, and lower literacy levels. Consequently, additional precautions are required to ensure that research with incarcerated participants is conducted ethically [ 61 ]. User participation in designing research that includes vulnerable groups is crucial to achieving this objective [ 61 , 62 ]. Measures in accordance with recommendations were taken to ensure consent information that is complete, relevant, and understandable [ 63 ]. A user representative from Way-Back, an organization that supports incarcerated persons with reentry to their communities, contributed to the project’s planning. The user representative provided input on information about the study, research questions, the interview guide and how to conduct the interviews. The input was used to tailor information and for conducting the interviews in accordance with the constraints of the prison contexts and the needs of the incarcerated individuals. The choice of whether to reimburse participants in prison studies is debated. Because of the relative deprivation of prison life, some argue that even small incentives could potentially result in undue influence for participation in research [ 64 ]. For this reason, we chose to abstain from offering reimbursement for the participants in this study.

Study context

At any given time, about 3000 persons are serving a sentence in Norway, of which 5.6% are women and 26.2% are non-Norwegian citizens [ 65 ]. A recent study found that almost 60% of incarcerated persons in Norway had a diagnosed mental disorder, together with a 33% rise in the one-year prevalence of mental disorders between the years 2010–2019 [ 66 ]. Thus, the proportion of people with mental disorders entering prison has been increasing. In Norway, access to necessary healthcare is considered a basic human right and is legislated in the Patient’s Rights Act section 2 [ 67 ]. Healthcare is primarily tax-funded, with a nominal service fee and a relatively low cap on yearly individual costs [ 68 ]. Norway has committed to “the principle of equivalence” meaning that those imprisoned retain their right to healthcare equal to that of the general population [ 31 ]. Prison health services serve incarcerated persons with milder mental health problems and are accessible by self-referral through a paper-based request system. The prison health services can refer those who experience moderate to severe mental disorders to specialist mental health services, and treatment is often provided in prison by mental health professionals from local hospitals For people imprisoned in Norway, healthcare and medications are free of charge [ 69 ], eliminating one significant barrier to mental healthcare access [ 70 ]. Furthermore, as the municipalities and local hospitals provide health services - the importation of services promotes equity and that services are independent of the correctional system, thereby strengthening the rights of people in prison [ 71 ].

A study found that incarcerated persons in Norway were reluctant to seek help for mental health problems from prison health services unless they had concurrent sleep or substance use problems [ 72 ]. A survey by Bjørngaard et al. [ 73 ] found lower patient satisfaction with prison health services compared to people using community health services and that those with mental health problems were less satisfied compared to incarcerated patients with other health challenges. A survey representative of the Norwegian prison population found that 20% of incarcerated males sample reported that they had received mental health services, while 25% reported that they had been in need of mental health services in prison but had not received any [ 11 ]. More recent reports suggest that mental health services are insufficient to meet the needs of those imprisoned in Norway and that incarcerated individuals referred due to their severe mental illness may not be admitted to specialist services for in-patient assessment and treatment [ 74 , 75 ]. These reports indicate that mental health services do not fit the complex needs of incarcerated persons in Norway and that there are potential obstacles in their access to mental healthcare.

Study design

This study was underpinned by relativist epistemology which is based on the assumption of multiple individual realities that allow for different understandings of the same phenomenon [ 76 ]. The study design was suitable for exploring and explaining commonly experienced individual, social, cultural and structural factors that influence help-seeking and access to mental healthcare for incarcerated individuals. The study incorporates vital Grounded Theory (GT) components, including initial coding, categorizing data, constant comparative methods involving inductive and abductive reasoning, and memoing [ 77 ]. The use of theoretical sampling, which is rare in prison research due to ethical and practical constraints [ 78 ], was not employed in this study. Data collection concluded once additional data no longer contributed new insights or further elaborated the developed categories.

Preconceptions

The first author, a clinical community psychologist and a PhD student, worked part-time as a prison officer for two years during her psychology education. This experience gave her an insider’s view of the correctional system, inevitably influencing her initial perceptions. Before conducting the interviews, she held a somewhat optimistic view of the correctional system’s capacity to support and enhance the mental health of those incarcerated. However, this perspective was challenged through the narratives of the study participants, who conveyed powerful personal accounts that highlighted substantial barriers to obtaining mental health services within the prison environment. The other two authors, serving as supervisors, are also researchers and mental health professionals with considerable clinical experience. Their diverse backgrounds contributed to a supervisory dynamic that adresssed the research topic’s complexities. Throughout the study, the authors engaged in a process of collaborative reflection, concerned with maintaining a balance between engaging with participant stories and sustaining a critical stance towards the data. These discussions were essential in helping the first author navigate an empathetic understanding of the participant’s experiences with the necessary analytical objectivity required for rigorous qualitative research.

Participants and study settings

Fifteen males serving a prison sentence were recruited from three prisons in Northern Norway. Thirteen of the participants served a sentence at a high security level, while two served at lower security. The participants’ age ranged from the early twenties to the late sixties (M: 43.6 years). Two participants had other nationalities, while the rest were Norwegian citizens. Further details about the participants must be withheld to preserve their privacy. When citing individual participants, they are anonymized by using pseudonyms.

Recruitment

Participants were recruited through posters in the prison ward that conveyed basic information, including the fact that the interviews were confidential and would be recorded. The posters encouraged those interested in participating to approach a contact person for more information. A prison officer, a social worker or a reintegration coordinator were assigned the role as contact persons in the selected prisons. Those who actively approached the contact person were given more comprehensive written information about the study. Requiring an active choice by incarcerated individuals was done to enhance their experience of self-determination and autonomy in their decision to participate. The contact person scheduled appointments with the participants, and the interviewer had no prior knowledge of the participants other than what they presented in the interviews. One potential participant cancelled the interview appointment due to health issues on the interview day and withdrew from the study.

The first author conducted face-to-face, in-depth interviews. The interviews took place in prison visitation rooms or in an office in the health wards. Before the interview, the participants were given information about the study and their rights as research participants and signed a written consent form. The interviewer was alone with the participants during the interview and had a personal alarm as a safety precaution. The interview guide covered topics on knowledge of mental health and available services, help-seeking experiences, and access to mental health information (sample questions provided in Table  1 ). The participants were asked open-ended questions and were invited to speak freely on these topics. Thus, the order and framing of questions varied depending on where they fit into the participants’ narratives. This allowed for following up on the participants’ experiences and may have given the participants an increased sense of control in the interview. The first author who conducted the interviews was attentive to signs of emotional discomfort in participants and avoided pressure on sensitive topics. After the interviews, the participants were encouraged to ask questions and comment on their experience and reminded of their right to withdraw from the study. Nearly all the participants expressed that the experience of participating in the study was positive and that they appreciated the chance to contribute to the research project.

The first author transcribed the audio-recorded interviews in Norwegian, ensuring a verbatim account of the participants’ narratives. The initial eight interviews were transcribed before initiating data analysis. This early examination of the data facilitated a refinement of the interview guide, which was then applied to the subsequent seven interviews to deepen the inquiry. Data collection and analysis were concurrent as the study progressed from the ninth interview, which allowed for immediate integration of new data into the evolving analytical framework. The data was examined using the NVivo 12 software, which supported the systematic organization and analysis of the data. The data was analyzed line-by-line, searching for incidents in the form of recurring beliefs, actions, experiences, and explanations [ 79 ]. The constant comparison method was applied throughout the analysis. In the initial coding phase, incidents were compared to incidents, and through this process underlying recurring concepts and similarities were identified and assigned codes. Subsequently, codes were then compared to codes, and related codes were organized into conceptual categories, reflecting both common features and divergent viewpoints [ 77 ]. In the intermediate coding phase, the data was abstracted into categories which were compared to each other, and relationships between categories were developed and refined. The authors engaged in a collaborative and reflective dialogue throughout this process, meeting regularly to deliberate on preconceptions, the emerging categories and their interpretations. This dynamic exchange was informed by memos that captured analytical decisions, insights, and evolving interpretations, thus guiding the reflective process. In the last stage, advanced coding, a core category which binds the other categories and sub-categories together was developed. Through a collaborative process the categories were substantiated with representative quotes, which, upon completion of the analysis, were translated from Norwegian to English for inclusion in the report. This resulted in a nuanced understanding grounded in the participants’ experiences and the researchers’ interpretative lens.

The data analysis yielded four main categories illustrating the participants’ active engagement in identifying challenges and facilitators for mental healthcare access within the prison environment. The first category, “Mental health awareness,” captures how beliefs and knowledge concerning mental health were influenced by the experiences and constraints inherent to prison life, potentially affecting the pursuit of help and access to healthcare services. The second main category reveals how systemic sub-cultural values can obstruct healthcare access, whereas, on a personal level, fellow inmates served as vital support for obtaining mental health services. The third main category, “Access to mental health care,” examines how organizational and systemic barriers impede access to mental healthcare. The final main category, “Enhancing access to services,” delineates factors that lowered the bar for mental healthcare access. The core category, “Breaking down barriers,” encapsulates the dynamic interplay between incarcerated individuals and the contextual factors that influenced their ability and willingness to access mental healthcare in prison. This central theme also recognizes the collaborative effort between participants and researchers in identifying problem areas and solutions to mental healthcare access, thereby “breaking down barriers”. An outline of these categories is presented in Table  2 .

Mental health awareness

An information void.

Seeking information can be an essential first step for recognizing symptoms of mental illness that may require intervention. Prior to imprisonment, visiting their general practitioner or using online search engines were the preferred methods for finding health information for the participants in this study. In prison, however, access to the Internet is severely limited:

Where can we get information? We do not have access to computers or anything. So, I would have to call someone on the outside to get them to print articles and send them to me by post. So, no. We don’t know our rights, we don’t know about the services available to us, as a matter of fact we know very little. There’s an information void. Stuart

A few of the participants referred to the prison library as a source of information. Some also said that they could talk to health care professionals, correctional officers, or other staff members like the priest, to get mental health information. Fellow incarcerated individuals who had experienced mental health problems and received health services were also mentioned by some participants. The common thread in all suggestions was a dependency on others to access information about mental health. Only a couple of participants had tried to find mental health information during their time in prison. However, they found it difficult to obtain:

The only choice I have is to ask the prison officers to print it [mental health information], but sometimes they don’t want to do it because they think it’s bad. And I have tried to search for psychosis and such in school [in prison], but then the teachers ask why I would seek out such a gloomy subject. It feels a bit complicated to obtain information. Larry

Participants from all three prisons also pointed out the need for more information about mental healthcare in prison:

We have a notice board on the ward (…). The information should be hung there for people to see, that there is a psychologist here, and that you can talk to her. ‘cause I’ve seen little of that sort in here. Liam

One participant underscored that information about available mental health services is particularly important for those with no experience from such services prior to imprisonment:

It [information] must tell you about your opportunities. To normalize it [seeking help] in a way. And the threshold must be low. I think many experience that it is too high. If I hadn’t been in contact with mental health services before I came here, the threshold for seeking help would have been sky high for me as well. Neil

Awareness of mental health issues

Factors in the prison context were fundamental to the participants’ explanations of mental health problems. Many participants attributed the onset or worsening of mental health problems to the shock of imprisonment and to the continuous hardships of prison life. Understanding symptoms as primarily caused by external stressors such as prison hardship may have influenced their appraisals about the need to seek help. As Frank stated:

I’ve always had good mental health. Until I came here, inside these walls. Frank

Frank reported considerable symptoms of post-traumatic stress. Understanding his symptoms as something triggered by the prison living conditions, he did not see how seeking professional help could benefit him. Like many other participants, he insisted that the correctional system needed to change and had lost hope that he could improve his own situation.

In contrast, other participants who attributed their mental health problems to external stressors concluded that they indeed needed help to cope. The suffering they experienced during their first weeks in prison motivated them to seek formal help:

I asked to talk to a psychologist in here. ‘Cause, I felt that I needed to. ‘Cause in the beginning when I came here, it all seemed dark. No matter how hard I tried to do the right thing, there was some sort of dark force that was just pushing on, and the obstacles were piling up. Travis

For some, their main motivation for seeking help was to receive professional validation from healthcare personnel regarding the negative health consequences of their prison experiences. Some also hoped that healthcare professionals could advocate for better living conditions:

And it is good that others [psychologists] can take part in these things. So that it is manifested what prisons actually do to people. Jack

Social influences on help-seeking

Prison culture and mental health stigma.

The participants described how the culture within prison influenced their willingness to talk about mental health issues. The importance of appearing strong and dominant within the prison setting was emphasized by many. According to several participants, the talk at the wards was characterized by attempts to one-up the others’ stories about criminal activities to appear tough. Many also explained that hiding vulnerabilities was critical in the prison community, and some also underlined the potential for victimization for those who were not able to conform to the prison norms:

You are wearing a prison mask. You cannot show weakness. ‘Cause then you’ll soon be a victim, a sitting duck. I have experienced inmates that have, eh mostly stayed in their cells. They have been harassed so badly that they are sitting there crying. The prison milieu can be tough. Neil

Choosing to confide in and seek advice from peers can also have negative consequences. Several of the participants said that it was wise to be careful with who you chose to share mental health related issues with:

Let’s say you talk about your personal feelings, and about your sentence and stuff, right. They can be very nice to you there and then, before they stab you in the back later on, spreading everything you’ve said to destroy you. It is a cynical game. Bobby

Bobby went on to explain that a fellow incarcerated individual could use personal information for harassing, blackmailing and threatening the family of someone who has confided in them, if a conflict should arise. Some of the participants also addressed directly how the prison climate may influence willingness to seek mental health treatment:

They do not want to go to a psychologist and talk. Because then they are seen as weak and not able to cope. Because in prison everyone should be tough. Drug lords and such. But, on the inside they are not like that. Nicky

The role of peers in accessing mental health services

Despite the clear barriers, fellow incarcerated appeared to be an important informal help source for mental health problems. Many of the participants had observed signs of emotional distress among their incarcerated peers and described how they had given them advice and encouragement. According to several participants, those imprisoned also had an essential role in recognizing mental health problems in their peers:

There is no-one who talks to us regularly to check on how we are doing. That’s not a priority here. So, unless some of the inmates take on the role of an officer or a psychologist, then there’s no-one who reports concern (…) There are many inmates who are taking on a role as a social worker, but it’s kinda wrong. They are neither paid for it, nor qualified. They do it because no-one else does. Stuart

Although none of the participants said that they themselves had been prompted to seek help by peers, they told stories of how they had pushed their peers to seek formal help:

A fellow inmate. I could tell he was struggling because he talked to me as the only person. In a way, I was his psychologist. The days when he was down in the dumps, I tried to talk to him (…) And I said, listen up. It’s for your own good. I will write a request form, and we will arrange contact with a psychologist (…) and it will help. Nicky

Experiencing fellow incarcerated people in distress appeared to be common, and participants also explained how they reported to prison officers their concerns about peers with self-harm and suicide plans:

There was a fella’ who told me that he knew exactly how to take his own life (…). “I’ll just do it like this and this and this”. And, uhm. Then he said he was going to do it. And I thought that I would have to report it, and I did. Roy

Roy went on to describe in detail how his reported concern led to a prison officer interrupting the suicide attempt by the fellow incarcerated, thereby saving his life. Several other participants shared similar stories, indicating that peers played a significant role in recognizing and getting help for mental health related problems in prison.

Access to mental healthcare

Self-referral and disempowerment.

In order to access prison healthcare, those imprisoned must write and deliver a paper-based request form. All the participants in this study were aware that this is the way to contact prison healthcare, and most of them knew that the general practitioner working at the prison could refer them to a psychologist or to a psychiatric hospital. Unfortunately, the request form system seemed to amplify the participants’ perceptions of disempowerment. Rather than seeing themselves as agents taking charge of their own situation and health, they were left passively waiting to be contacted after filling out the forms:

You are pacified when you must write a request form to talk to someone. Then you don’t know when they are coming to talk to you. And then it’s like, the problem may be swept under the rug when they finally get to you. Tommy

According to the participants, many of these request forms seemed to disappear, and it could take an exceedingly long time before they got any response to their request:

Many times, when you write a request form it disappears. Nothing happens. Those request forms are worthless most of the time. Keith

There were also several participants who voiced concern over the confidentiality of the request forms even when the forms were delivered in closed envelopes:

We can see for ourselves that they [prison officers] open and read, uhm, confidential information, [lowers his voice] and to put it mildly, uhm, breaches in confidentiality are all too common. It is alarming! Neil

One of the informants also explained that incarcerated persons who had mother tongues other than Norwegian could have problems with understanding and filling out request forms to health, and that forms that were not filled out correctly were of no value. According to Roy and other participants, the correctional system did not give sufficient information and guidance about the request forms:

They might not know how to write, or understand what it [the form] says, you know? Potentially it is severe for that guy, right. It’s garbage! Garbage, that request form. They haven’t received any request from him. Roy

The perceived availability of mental healthcare

The perceptions of accessibility of mental health care varied between the participants. A few of the participants were in active treatment with a psychologist at the time of the interviews, and they had experienced the access as unproblematic. Common for some of these participants was that they had been in treatment before they entered prison:

From sending my request and to receiving an acceptance letter it took one and a half weeks. Less than three weeks later I was in treatment. It was efficient. Much quicker than I’ve ever experienced before. Neil

However, many participants said that they could not access secondary mental health services. There were two notable sub-groups among the participants who perceived that access to specialized psychological treatment was limited. The first group shared stories about living unstructured lives at the edge of society. They seemed to have little confidence in health care and correctional services, and were less hopeful of their own potential of being rehabilitated:

I have tried for several years now, but I didn’t get help. They can say whatever they want about how easy it is to access a psychologist and prison healthcare and everything, but it is not true. Ronny

Two of the participants explained how they would have to take drastic measures such as performing violent acts or acting weird to get help for their mental health problems When Marlon was asked how he could access mental health services he responded:

You would have to either hurt yourself, or someone else, so that they end up in hospital. Marlon

The interviewer asked if it was possible to access mental health services by using less drastic measures, Marlon answered:

Uhm. Naaah. I don’t know. I do not think so. Not from my experience. Marlon

Another sub-group having difficulties accessing mental health services was those in prison for the first time. Most had led more typical lives with stable employment and housing conditions before imprisonment. When they sought mental health services, they were told that these adjustment problems were normal in prison:

I’ve been struggling for several periods here and have said that I wanted to talk to a nurse or a psychologist. And then I was referred to a psychologist. And the psychologist assessed me, and said that: “Nothing’s wrong with you, you are just having a hard time, I cannot help you”. So, you do not get anyone to talk to, unless you- I don’t know what you must have really, but I sure ain’t got it. The nurses say that they haven’t got the time, and the psychologist says that I am not ill. And then I am left to feel bad. In my case, there is no service really. Stuart

Prison officers’ role in mental healthcare and accessing services

Several participants stated that mental health problems and well-being were not high on the prison agenda. Many would have appreciated it if correctional officers on a more regular basis had asked how they were doing and believed that this would have facilitated them to open up and talk about mental health issues.

In my opinion, mental health is forgotten here in a way. Physical activity, movement, workouts, yes. Since I arrived here some months ago, only twice I’ve been asked: “Hi, how are you? Is there something you want to talk about?” Travis

Some also said that they knew people in prison who were unaware of their own need for mental health care or unable to access help, and argued that the correctional system should do more to help these people to access care:

You have the type where people do not get help because they themselves are not able to request help from the prison health services and the prison officers do not see to that they get the help they need. Neil

Some were concerned about how acute health problems were handled in the weekends and evenings when prison health services were unavailable. In these situations, prison officers were left to decide whether or not to contact emergency healthcare services. Several of the participants were not satisfied by this arrangement:

(…) they think that they can make a doctor’s judgement. That they can decide that it is not that important. It is rude. It is trespassing norms. Jack

Some participants told stories of how their peers in prison did not seem to get the help they needed even though it was apparent that they were in a bad state mentally:

I have reported concern about people, before they started cutting themselves and f***ing themselves up. But what worries me, is that even though I voiced my concern to both prison health services and prison officers, no measures were taken. Before it was too late. Stuart

Asking for help from correctional officers could also have consequences. Ronny served at a lower security level. He experienced that his requests to see a psychologist were met by suggestions of transferring him to a higher security level:

I have written request forms: “I need to speak to a psychologist. Immediately”. And then they [the prison officers] are threatening me by saying that they are going to transfer me to a higher security level. They ask if I am going to hurt myself. No, I tell them. I’m not going to hurt myself. I just need to talk to a psychologist. Ronny

Another participant described how he had sometimes cut himself by shards from plates and drinking glass to suppress mental suffering. He explained how he on one occasion used the intercom to notify the officers that they needed to come and pick up a glass that was triggering an urge to self-harm. The participant said that initially a single officer came to his cell to pick up the glass:

A few minutes later there were four officers, and they unlocked the cell door, and there were a lot of questions. I guess they were worried about my mental state, and I said that I appreciated the concern. Then I reminded them that I had asked them to pick up the glass so I would NOT cut myself, so if they were to use that against me, it would be unfair. Tommy

He reassured that the situation had been resolved with the conversation. However, he had the impression that disclosing mental distress to officers could increase the risk for being transferred to a higher security level, or to a security cell.

Enhancing access to services

The perceived advantages of seeking professional help.

There were some commonly experienced benefits of seeking mental healthcare among the participants. Coming off drugs and living under stable conditions in prison provided some participants an opportunity to reflect on their lives and to gather motivation to work on their addiction and mental health problems:

I have been thinking a lot about treatment in an institution. I know how it went the last few times I got out [of prison]. Within half an hour I was sitting there with the needle. And if I don’t do anything before I get out, the same will happen again. I’m trying to prevent it (…) I’ve had treatment for drug and alcohol use before. And back then there was a psychologist who said that, once you’ve been clean for a year, then the brain is back to normal. I can feel it, like, my mindset is already changing . Kurt

For about half of the participants, seeking professional help was related to their motivation for living a law-abiding life after prison. The participants linked substance use to both mental health problems and a criminal lifestyle, and getting treatment was seen as essential for preventing recidivism:

I have lived a rough life, and I have no-one, NO-ONE. How long am I going to live? One doesn’t know. But I’ll be fifty soon. So, I must make it now. I really have to make it now [his voice bursts]. And it depends on many psychological factors. So, I’m choosing to use all the things that I have access to in prison, like treatment for drug addiction. Roy

Although many had previous experience of treatment for their substance use, they still had hopes that treatment could help them. Liam had previously experienced that consultations with a psychologist brought up subjects that was difficult for him to talk about:

I regret that I quit, because it could have done me good. But I guess it got too personal, and it stirred up things. Liam

He also explained that at the time he was more interested in doing drugs than going to therapy. However, he still believed that treatment could help him:

I will probably contact a psychologist, now that I’m about to get treatment for my addictions. It is easier to open up when there are no substances involved. Liam

In summary, seeking professional help for mental health problems was perceived to promote in-prison coping, rehabilitation, and preparation for life outside of prison for most of the participants.

Lowering the bar for accessing mental health services .

Many of the participants expressed skepticism towards ‘the system’. They described how they had been let down and disappointed by the child welfare services, the criminal justice system, and healthcare professionals. Experiences from childhood to adult life had led to a lack of confidence that healthcare personnel and the correctional system and society had their best interest at heart. For them, it was important that healthcare professionals were perceived as genuine and “on their side”:

The experience of being believed and listened to… They do not have to relate, to say that they understand so damn much, ‘cause that’s not really important. Marlon

Several participants said that barriers for talking about mental health were reduced when healthcare personnel reached out in the prison ward. One of the prisoners described two nurses who used to visit the prison wing every day at lunch-hour. He appreciated that it was possible to request a private conversation in the cell, and that he was taken seriously:

They were highly skilled. And they listened. They listened to what you had to say, and they understood you. Tommy

Having previous positive experiences of mental health treatment and knowledge of what to expect from mental health services also seemed to reduce barriers for in-prison help-seeking from some of the participants:

I saw a psychologist on a regular basis, once a week (…). And after six consultations I was past the worst in some sense. I was provided with the tools I needed to cope. Bobby .

This participant had experience with psychological treatment outside of prison and had tried to access mental health services for months in prison. However, he believed his challenges were too mild to get help from a psychologist. He emphasized the need for available low-threshold services for those who suffer from milder mental health problems:

It should be available for everyone who wants it. It should not be embarrassing, it should not be taboo, it should be… A natural part of it, really. Bobby

In addition, when services were provided as standard procedure and a natural part of rehabilitation, they were perceived as less stigmatizing. Nicky described how he was placed on a prison ward that was specialized in substance use treatment:

And when you are placed in that ward, then you are automatically assigned to a psychologist from the substance use clinic, that you can have weekly consultations with. Nicky .

Some also suggested that the systematic screening and assessment of health and social problems also could facilitate access to mental health services and this was suggested as an integral part of healthcare and rehabilitation in prison by some of the participants. Ronny underscored the importance of proper assessment:

What is this person’s problem? Why did he come back? Is there something happening to him on the outside? Could he need help with anything? Maybe someone should ask him? Ronny

Ronny went on describing the nice brochures of the correctional system, with promises of assessment of strengths and needs of individuals, but he claimed that this did not happen in reality. This view was shared by several of the other participants, as they called for more assessment to benefit the mental health and rehabilitation of incarcerated individuals.

Mental health support from different sources

The participants had different preferences regarding where to get help. Support from friends and family was seen as important for most of the participants. However, health professionals could sometimes be preferred over informal or semi-formal sources because of their role in advocating for better living conditions in prison:

I get visits from my family, but I’d like to talk to someone here in prison, so that they could gain awareness of the actual problem. If I’m spitting venom to some random lady that is here as a volunteer with the Red Cross, it’s useless, I think. If I talk to a nurse who works here at this establishment, she could perhaps do something about some of our challenges. Stuart

The cultural competency of health care personnel could also be a key factor in promoting help-seeking and forming a therapeutic alliance with people in prison. Many incarcerated individuals have lived on the edge of society, while most health care personnel, and particularly doctors and psychologists, are from the upper middle class. These cultural differences may form an abyss between the incarcerated individuals and mental healthcare personnel:

A psychologist does not have a criminal record. Now I’m generalizing. But they have performed well in school. Have passed through the system. Highly educated. Their lives have been smooth sailing (…) They have not experienced the shadow side of life. Tommy

This participant had one prior positive experience with a psychologist, but his general impression of psychologists was that they were of no help. He did not feel a connection with any of the others and had written them off completely. He preferred talking to a representative from a user organization who have led a similar life to himself:

I know that they know exactly how I’m feeling. They have served a prison sentence. And they… They have lived experience, and then it’s much easier to listen to what they have to say, because I know it’s not knowledge that they have acquired through reading. Tommy

Prison officers can also be of help to incarcerated people who experience mental health problems. Nicky said that while he was at a lower security level, he had been to a sports event outside prison with an officer and some fellow incarcerated. He had a panic attack because of all the people who kept arriving at the venue and he had to go outside for some fresh air. The prison officer followed him and was understanding, and told Nicky that he had seen many incarcerated people with similar reactions:

He was understanding and said: It will be OK. After that day at the match, coincidently, he ended up being my primary contact officer. And to socialize me back to society he fixed it so that every weekend he was working we could go to a shopping mall, to try. Little by little, by little. (…) It helped. It did. Yes. Nicky

Although Nicky had no plan to seek help for his anxiety symptoms, he appreciated the support he received from his primary contact officer.

Bobby, on the other hand, had some informal support from fellow incarcerated and had also talked with a priest. He said that he often ruminated when he had time alone in his cell and emphasized his need for sharing his thoughts with others and receiving advice. He explained why he preferred to get help from formal sources:

So, to have someone who is an outsider. Who’s not an inmate. Who has got a sensible outlook on life, that can guide you– I think that’s important. (…) Because when you talk to a fellow inmate, then… It can go in the opposite direction, right. Because many have been through major crises, they have lost friends, they have lost family, maybe they have lost their girlfriend and wife, their children won’t speak to them, right? Bobby

Most participants also held the prison priests in high regard and appreciated the availability of the service. However, talking with a priest was not seen as a replacement for a consultation with a psychologist:

It was peculiar, when I asked for someone to talk with, the priest was offered first. For me it is alright, I go to church. But I’m thinking, if someone is not a Christian. I’m like: a priest? Or if you’re not religious. A session with the priest is more like a consultation towards God and his will. He can be a good listener [the priest], but you might not get the help you need in a mental sense. So, a psychologist, a “talking person” in prison is necessary. That could check on you sometimes.

This study’s findings demonstrate that many of the factors deciding access to mental healthcare are firmly rooted at the organizational level of the correctional and healthcare systems. Prisons in the Scandinavian countries, including Norway, are presumptuously humane compared to harsher correctional settings in other parts of the world. One could assume that these favorable conditions would be more conducive to mental healthcare access. However, the systemic barriers we found largely overlapped with challenges reported in other countries [ 42 , 43 , 44 ]. In addition, we found that individual beliefs, attitudes and aspirations also influence willingness to seek mental healthcare. Interestingly, most of these intrapersonal factors are tightly interwoven with the participant’s appraisals of how the prison conditions influence their mental health. This study also addresses an important knowledge gap in the literature, namely how restrictions on access to mental health information could influence mental health help-seeking for people in prison. The identified core category, “Breaking down barriers”, reflects an overarching focus on solutions to improving mental healthcare access based on the experiences of the participants in this study.

Access to health information

Knowledge of available services and how to access them is a prerequisite for mental health help-seeking [ 80 ]. The participants in our study claimed that information about mental health services was unsatisfactory, and lack of such information has also been noted as a barrier to help-seeking in other prison-based studies [ 44 ]. Moreover, sufficient levels of mental health literacy are positively associated with increased intentions for help-seeking from both informal and formal sources [ 81 ]. The participants in our study reported severely restricted access to their preferred sources of health information and a dependency on others to obtain such information. Since information seeking may occur before individuals are ready to share their health concerns with others, having to rely on others for accessing information is a potential barrier for recognizing mental health problems [ 25 ]. Thus, it is likely that the limited access to mental health information negatively impacts incarcerated persons capacity to manage their own mental health needs. The potential consequences of restrictions on access to health information among people in prison need more research attention. However, findings from other populations suggest that closing the apparent health information gap could be an important intervention for improving help-seeking for mental health problems [ 82 , 83 ].

The social influences on accessing mental healthcare

The participants reported that prison culture reduced their willingness to seek support from fellow incarcerated and the use of professional help for mental health problems. The TBP element “subjective norms” posits that beliefs about the opinions of others may influence the willingness to seek help [ 29 ]. Attributing mental health problems to personal weakness may reflect a stereotyped attitude involved in stigmatizing mental disorders [ 84 ]. Stigma may lead to concerns about what others might think if one were to seek help, and may delay or hinder help-seeking efforts [ 80 , 85 ]. It also seemed to be an important constraint to mental healthcare access in our study. This corresponds with findings from other studies [ 45 , 46 , 47 ] and suggests that fear of appearing weak is also a significant barrier to help-seeking in a Scandinavian prison context. Based on our findings and recommendations, we advise that focus on health education and normalization of mental health problems are measures that could decrease stigma [ 86 ], and increase willingness to seek mental health support and treatment among people in prison.

Although the culture among those incarcerated was perceived to discourage seeking support for mental health problems, fellow incarcerated also played a key role in supporting those who experienced mental health problems. They were more available than other help sources and had lived experience with distress related to imprisonment. Since information about available services was insufficient, fellow incarcerated were also perceived as an important source of information. Thus, naturally occurring peer support seemed to normalize mental health problems, possibly reducing stigma and lowering the threshold for mental health help-seeking. From the literature, we know that peer-based health interventions is effective in correctional settings [ 87 ], and formalizing peer-based health information and support could be beneficial in interventions aiming to increase the use of mental health services.

Beliefs and motivations for help-seeking

The prison environment was embedded in the participants’ beliefs: attributing the onset and worsening of mental health problems to the prison conditions was common among the participants. According to the Theory of Planned Behavior (TPB), attitudes about the potential benefits of help-seeking and alignment with individual goals affect the readiness and willingness to seek professional help [ 29 ]. Our data supported this notion. Some participants abstained from seeking professional help as they did not see how it might benefit them in their goal of improving their living conditions. For others, a prominent motive for seeking professional help was to receive validation and help managing their challenging life situations and the everyday stressors of prison life. A few participants also framed mental health help-seeking as a mission to document the consequences of imprisonment. By sharing their experiences with professionals, they hoped healthcare personnel could help them advocate for better conditions in prison. Obtaining sufficient knowledge about essential aspects of prison life is essential for health professionals working in a prison setting [ 88 ]. Based on our findings we propose that the ability of healthcare staff to communicate their understanding of the influence of prison living conditions on mental health is crucial for gaining trust and building an alliance with their incarcerated patients.

Another important motivator for many participants seeking help was their aspirations to live a law-abiding life after being released. It has been increasingly recognized that the relationship between mental disorders and criminal activity is complex and that integrated treatment that addresses both criminogenic factors (i.e. antisocial attitudes and behavior, substance use, criminal network, family issues and low educational/vocational engagement) and mental health issues is a must to prevent recidivism [ 89 ]. This view corresponds with the beliefs and preferences for rehabilitation and healthcare of several participants in our study. They were worried about their reintegration into society, which motivated them to seek professional help. Substance use treatment, in particular, was seen as essential to attaining rehabilitative goals. However, some participants who had served multiple sentences were less positive towards help-seeking. They had more negative experiences and seemed less hopeful that mental healthcare could improve their situation. Their low expectations for potential gain combined with a perceived lack of personal control in the help-seeking process, appeared to stall help-seeking for these participants. We suggest that implementing health services with a concurrent focus on addressing both criminogenic needs and mental disorders could be especially important for fostering healthcare utilization for people with a history of reoffending.

Organizational barriers to accessing mental healthcare

The perceived challenges with the paper-based request system were considered a significant barrier to healthcare access. TPB postulates that behavioral control and self-efficacy are important in help-seeking [ 29 ]. In a system where autonomy is limited, one could assume that a self-referral system can be empowering for those seeking help. However, the participants seemed to experience the opposite as they were left passively waiting for an answer to their request. Some also expressed confidentiality concerns, as they believed that prison officers read the request notes. Thus, the process of accessing health services seemed to diminish, rather than enhance their notions of control and self-efficacy. Improving the reliability of responses to requests and ensuring confidentiality could increase the experience of control in the self-referral process and may also empower imprisoned persons to seek help.

A barrier rooted in the interactions between the individual and the helping services was found in various expressions of skepticism towards “the system” by many participants. Earlier studies have also reported distrust in the system as a barrier to help-seeking [ 41 , 44 ]. Our results elaborate on these findings as the participants spoke of how suicides and severe self-harm by fellow incarcerated people contributed to diminished faith in the system. Some had voiced concern over the health and welfare of peers and had experienced that they were not listened to by the prison officers. According to the participants, many of their fellow incarcerated people had more severe symptoms of mental health problems and did not seem to have access to the help they needed. This confirmed their beliefs that the system took little interest in their mental health, and for some of them this led to a growing feeling of hopelessness and resentment. In addition, the high prevalence of mental disorders in prison implies that incarcerated persons witness people in severe distress regularly and for prolonged periods. This issue is largely unexplored and unrecognized in prison research, and the impact of these experiences on mental well-being and recovery should be investigated further.

Participants who experienced mental distress and adjustment problems had difficulties in accessing mental health services. They needed someone to talk to about their situation that could give them advice on how to cope, however they did not fulfil the criteria for secondary mental health services. Minor mental health problems in Norwegian prisons are to be handled by the prison healthcare services. However, according to the participants their capacity is very limited. This finding corresponds to other studies [ 90 ] documenting that access to integrated mental health services was limited for those with milder mental health problems. In the community, the establishment of low threshold services for people with mental health problems has been an important commitment as early intervention can prevent the development of more serious conditions. This may be even more important for those imprisoned, since coping strategies such as physical activity and seeking social support are less accessible [ 91 ].

Prison officer’s influence on access to mental healthcare

Prison officers were perceived to have a key role as gatekeepers to healthcare. Officers can facilitate access to healthcare by encouraging help-seeking or directly contacting healthcare services based on observations and conversations with incarcerated individuals [ 39 , 41 , 92 ]. The participants in our study pointed out the need for prison officers to take their health concerns more seriously, and that the threshold for contacting healthcare services by their request was too high. In addition, being asked directly about their psychological state by staff members was seen to ease talks about mental health by the participants. Our results support the notion that prison officers that are responsive to the mental healthcare needs of incarcerated persons could build confidence that these needs would be attended to when required [ 92 ]. Thus, ensuring sufficient mental health knowledge and awareness among prison officers of their role in mental healthcare access is an essential task for correctional systems.

Previous studies have found that the correctional systems´ procedures for managing suicidal risk is a potential obstacle for help-seeking. The fear of being moved or placed in a safety cell without personal belongings was identified as a barrier to disclosing suicidal thoughts [ 39 , 93 ]. In Norway, the risk of self-harm and suicide is ideally handled by increasing social contact, activities, monitoring and healthcare. However, in the face of acute mental crisis and severe suicide risk, placing persons in solitary confinement is not an uncommon practice [ 94 ]. Challenges with having incarcerated persons admitted and treated in specialized health care institutions, understaffing, and a lack of central guidelines for handling suicide risk may contribute to the use of solitary confinement for incarcerated persons in acute mental distress in the Norwegian correctional system [ 94 ]. The Norwegian Parliamentary Ombudsman reports that fear of solitary confinement and being placed in a security cell is a barrier to seeking help for suicidal ideations and plans [ 95 ]. In our study, participants who had asked for help when they were in acute distress experienced that the officers assumed that they intended to harm themselves. They were faced with the potential of being transferred to a higher security level or being placed in solitary confinement. Thus, how prison officers respond to incarcerated persons’ reports of acute mental distress could be of critical importance for their willingness to seek help for mental health issues in the future. However, more research on the perceived and actual consequences of disclosing mental distress and suicidal ideations in prison is needed to inform interventions to promote help-seeking.

Enhancing access to mental healthcare in prison

The participants underscore some conditions that may lower the bar mental healthcare utilization. Earlier positive experiences with mental healthcare in the community was mentioned by participants as important for their willingness to seek such services in prison, which also corresponds with findings in earlier studies [ 42 , 96 ]. In addition, the participants saw mental health services that were outreaching and integrated as positive. A few participants also highlighted mental health screening at reception to discover mental disorders that may need intervention. Screening at intake, and outreaching and integrated services are also recommended in the prison research literature [ 88 ]. Our findings show that these recommended measures may also make intuitive sense to incarcerated persons - common for all of them are that they seem to reduce stigma related to utilizing mental healthcare.

Our results indicate that incarcerated persons with both milder and more severe mental disorders experience barriers to accessing mental healthcare. These results are in line with studies from other correctional settings reporting unmet needs due to challenges with access and delivery of mental healthcare [ 37 , 38 , 39 ]. The underutilization of mental health services by incarcerated persons suggests that the ‘degree of fit’ between their needs and the available mental healthcare requires improvement. The World Health Organization (WHO) advocates for correctional systems with health and well-being as an integrated part of their core business and culture [ 33 ]. Along these lines, we found that participants called for a correctional system with mental health higher on the agenda. Some also preferred to seek help for mental health problems from other sources than mental health professionals. This finding supports the recommendation of the WHO that it is important to build mental health competency in all staff members in contact with those imprisoned. As many of the barriers to mental healthcare utilization are rooted in the wider correctional setting, we also suggest that the correctional and healthcare systems, in collaboration, should review their practices to enhance perceived efficacy in accessing healthcare.

Limitations

The data in this study are based on interviews with fifteen participants from three prisons. The participants were self-selected and may have had more knowledge, interest, and willingness to talk about mental health issues than the average person in prison. We cannot claim that the results represent a complete account of access to mental healthcare and help-seeking among incarcerated persons in Norway. However, our findings were consistent with findings from other studies from Norway and correctional settings in some other countries. We have presented details about the participants, method, data, and context to allow others to consider the potential transferability of the results. We hope our findings encourage further research on access to mental healthcare for people in prison.

Mental healthcare that is outreaching and integrated is perceived to facilitate access and decrease stigma. The correctional system should address access to health information, the referral system, and their responses to incarcerated persons who disclose distress to facilitate access to healthcare. Our results also indicate that mental healthcare extends beyond the scope of health services, suggesting that sufficient mental health knowledge and agency is needed at all levels of the correctional system.

Data availability

The data produced in the course of this research is not openly accessible owing to considerations regarding privacy. However, they can be obtained from the corresponding author upon a reasonable request.

Abbreviations

Theory of planned behavior

Mental health literacy

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Acknowledgements

The authors thank the study participants and the correctional facilities for their cooperation.

Open access funding provided by UiT The Arctic University of Norway (incl University Hospital of North Norway). The study was supported by a grant from the North Norway Regional Health Authority (Helse Nord RHF). The funding body had no role in study design, data collection, analysis, or writing of the manuscript. The study was supported by the Publication Fund of UiT The Arctic University of Norway.

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All authors contributed to the conception and design of the study. LES conducted the interviews and their transcription. All authors analyzed the data. LES drafted the manuscript. All authors participated in revising the manuscript and approved the final version.

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Solbakken, L.E., Bergvik, S. & Wynn, R. Breaking down barriers to mental healthcare access in prison: a qualitative interview study with incarcerated males in Norway. BMC Psychiatry 24 , 292 (2024). https://doi.org/10.1186/s12888-024-05736-w

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DOI : https://doi.org/10.1186/s12888-024-05736-w

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Biden to speak about abortion in Tampa. Everything to know about Florida’s abortion laws

President Joe Biden will be in Tampa on Tuesday, April 23, to talk about the increasingly restrictive abortion bans in Florida and other GOP-led states. Meanwhile, his opponent in this year's presidential race is on trial in a New York City courtroom over whether he falsified business records to hide a hush money payment to porn star  Stormy Daniels  ahead of the 2016 election.

Biden's campaign, coming to former President Donald Trump's backyard this way, may be taking advantage of a perceived weakness in Trump's attempt to regularly take credit at his rallies for Roe v. Wade getting struck down while trying to avoid the backlash to abortion bans that GOP candidates have received in races since then. But he'll also be taking on Gov. Ron DeSantis.

DeSantis signed Florida's 15-week abortion ban in 2022. Then, while it was challenged and ultimately pushed to the state Supreme Court for a decision, he signed a 6-week ban passed by the Florida Legislature last year.

When the Florida Supreme Court ruled the 15-week ban was constitutional , overruling 34 years of precedent that had held that a privacy provision in the state constitution protected a woman’s right to terminate a pregnancy, the more restrictive 6-week ban was triggered.

"When Florida’s ban takes effect, it will severely restrict reproductive health care access across the entire Southeastern United States, including neighboring battlegrounds of Georgia and North Carolina," Biden Campaign Manager Julie Chavez Rodriguez wrote in a memo released Tuesday, adding: "Many women in the Southeast desperately in need of care will have to drive for a day or more to reach the closest clinic."

Prep for the polls: See who is running for president and compare where they stand on key issues in our Voter Guide

When the 6-week ban goes into effect, nearly all abortions after six weeks will be illegal in Florida. But, six months later, voters will have the chance to vote on a constitutional amendment to bring Florida's abortion laws back closer to what they were when Roe v. Wade was still in force.

Florida abortion rulings: A win for both sides, but voters have last say with Amendment 4

What were Florida's abortion laws before?

Before the 15-week ban, the Roe v. Wade standard had applied across the country for decades. Abortions were legal:

• To the end of the first trimester (up to 12 weeks) for any reason
• During the second trimester (up to 24 weeks) to protect the health of the pregnant person
• During the third trimester if necessary to preserve the pregnant person's life or health

A full-term pregnancy is considered to be 39-40 weeks.

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What abortions are legal in Florida now?

At the moment, abortions are legal in Florida up to 15 weeks and illegal after that .

The only exceptions are if carrying the pregnancy to term would result in serious injury or death for the pregnant person or if the fetus has a fatal abnormality. Two physicians must certify, in writing, that one of those conditions warrants the procedure. The physicians risk penalties for doing so. There are no exceptions for rape, incest, trafficking or mental health .

The 2022 law also redefined "gestation" from "between fertilization and birth" to "as calculated from the first day of the pregnant woman's last menstrual period."

Abortions in Florida: Now that Roe v. Wade is gone, here's what's legal and what's not

How many people got abortions in 2023? New report finds increase despite bans

Does Florida have a waiting period for abortions?

Yes. As of April 2022 , the state requires anyone seeking an abortion to wait 24 hours after an initial doctor’s visit before returning to undergo the procedure.

What does the Florida 6-week abortion ban do?

Under the new law, all abortions (with a few exceptions) would be illegal in the state of Florida after a "physician determines the gestational age of the fetus is more than 6 weeks," a time when many pregnant people don't yet know they're pregnant. People may have as little as two weeks after missing a period to find out and get both appointments at the state's overworked clinics, which leaves an extremely narrow window for a pregnant person in a potentially traumatic situation to take action.

However, while the law reduces the amount of time pregnant people have to get an abortion, it does provide some exemptions for rape and incest that the 15-week ban lacked, something that drew criticism even from some supporters.

When do most people find out they're pregnant?

According to a  2021 study from ANSIRH  (Advancing New Standards in Reproductive Health) at the University of California San Francisco, about one in three people confirm their pregnancies after six weeks, and one in five after seven weeks.

"Later confirmation of pregnancy is even higher among young people, people of color, and those living with food insecurity," the study's summary said, "suggesting that gestational bans on abortion in the first trimester will disproportionally hurt these populations."

Does Florida's 6-week abortion law include exemptions for danger to the mother?

Yes, but only for extreme cases. Two physicians must certify, in writing, that in their judgment an abortion is necessary "to save the pregnant woman’s life or avert a serious risk of substantial and irreversible physical impairment of a major bodily function." One physician may certify it if another is unavailable at the time.

This requires physicians willing to risk possible fines, loss of license and even imprisonment to go on record against oversight committees and the state. Attempts by Democrats to  clarify the conditions  under which a physician may make that call without risking their medical license were struck down.

Does the 6-week abortion ban in Florida include exemptions for a fetus that has died or is going to die?

Yes. If two physicians have certified in writing that in reasonable medical judgment, the fetus has a fatal fetal abnormality, the pregnancy may be terminated. However, the bill included new language requiring that the pregnancy must not have "progressed to the third trimester," which could be interpreted to mean that abortions for fatal fetal abnormalities are banned after 27 weeks.

Does the 6-week abortion ban in Florida include exemptions for rape or incest?

Abortions are permitted in the case of rape, incest or human trafficking but only up to 15 weeks, and only if the pregnant person has copies of "a restraining order, police report, medical record, or other court order or documentation" to provide evidence that they are a victim of rape or incest.

If the pregnant person is a minor, the physician must report the incident of rape or incest to the central abuse hotline.

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Does the 6-week abortion ban in Florida ban abortion pills?

For anyone except licensed doctors administering them to you in person, yes.

So-called "abortion pills" — actually two pills, mifepristone and misoprostol , taken up to 48 hours apart — which cause a person’s cervix to dilate and their uterus to contract, emptying the embryo from the person’s uterus, have dramatically risen in popularity in the last few years both for the relative convenience compared to surgical abortions and to get around abortion bans. Access to them has been challenged and will be decided by the U.S. Supreme Court .

The 6-week abortion law clearly states that abortions may only be performed by a physician in the same room.  Telehealth sessions are specifically banned.

Can I go to jail for getting an abortion after 6 weeks in Florida?

Anyone willfully performing or actively helping someone get an abortion outside of the restrictions will be committing a third-degree felony, punishable by fines and imprisonment of five years. It is unclear if the pregnant person is also liable.

When does Florida's 6-week abortion ban go into effect?

May 1, 2024, 30 days after the Florida Supreme Court's ruling.

What would Amendment 4, Florida's abortion amendment do?

The proposed amendment submitted by Floridians Protecting Freedom that will appear on November's ballot reads:

“No law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider. This amendment does not change the Legislature’s constitutional authority to require notification to a parent or guardian before a minor has an abortion.”

Fetal viability has been put at about 24 weeks.

For the amendment to pass it must win by a supermajority, or at least 60% of the vote. According to an exclusive USA TODAY/Ipsos poll of more than 1,000 Floridians, half said they would vote in favor.