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

This article focuses on the adaptation and evaluation of the clinical psychology service within the mental health team at HMP Birmingham, a Category B prison housing predominantly remand adult males. The service, embedded in the Birmingham and Solihull Mental Health NHS Foundation Trust, restructured its delivery during the Covid-19 pandemic to provide flexible, evidence-based, and values-led psychological care despite challenges posed by the prison environment, culture, and high turnover of remand prisoners. Key adaptations included streamlining referrals, using a needs-focused stepped-care model, integrating Acceptance and Commitment Therapy (ACT), and enhancing joint working with mental health nursing staff. Service evaluation from April 2023 to March 2024 demonstrated reduced waiting times, significant improvements in wellbeing and trauma symptoms, and positive user feedback, while identifying areas for further development such as expanded staff training, group interventions, increased service user involvement, and research engagement within custodial mental health care.