I never expected to end up behind bars. One day in 2009 while working as a salaried GP, an email came round from the practice manager. Our large practice had got a contract at a medium-secure forensic psychiatric hospital, and they needed a GP to do a couple of physical health clinics per week to help support the psychiatrists. I'd never heard of such a thing, and it sounded mysterious and intriguing; I thought everyone in the practice would want to do it, and the sessions would go to someone more senior than me, but I replied anyway. It turned out I was the only one interested, so off I went.
It was fascinating. Patients were detained under the Mental Health Act, usually for committing crimes influenced by their schizophrenia, learning disability, or personality disorder. Whilst in secure psychiatric care, which is much like a prison, they not only had to deal with loss of liberty and their mental health conditions, but often fairly simple physical healthcare needs, which turned into significant logistical challenges, or simply went undertreated. Every clinic had its own interesting challenges, with the need for lateral thinking and careful negotiation with patients or hospital staff in order to achieve the desired outcome, or often a strategic compromise.
After doing that for a time, my wife Rachael saw an advert in the BMJ for a prison GP in South Yorkshire. I enquired and went for an informal interview. Turns out I was the only person in the country who responded to the advert (are you noticing a pattern?), so… you guessed it… I was in.
never a dull day
Since then, I've worked in more than 15 different prisons in Yorkshire and the South East over nearly ten years. I've worked with many dedicated and inspiring colleagues, many of them Christians. I've helped Rachael as she's set up and developed Integritas Healthcare, a Christian faith-inspired healthcare organisation with a heart to focus on detainees, both in the UK and abroad. 
Every prison has its own flavour — from high secure to open, male or female, remand or sentenced — and each day in prison medicine has its own interesting challenges:
- Does this hand injury need to go out to A&E tonight for an X-ray, or can it safely wait until the radiographer comes into the prison on Friday?
- Are this person's threats to kill themselves genuine, or just a manipulative attempt to get their TV back and avoid loss of privileges?
- Is this particular addictive medication really the only thing that works for their 'seizures', and have they ever actually been properly diagnosed with epilepsy?
Working in prison can certainly be challenging and stressful, and it can be easy to see the negatives. I always like to see opportunities and help others see them too. Sometimes I will greet colleagues in the morning with something like, 'Are we all ready to rebuild some broken lives today?' — trust me, it sounds less cheesy in real life…but there's no doubt that it's absolutely true.People don't end up as prisoners unless something has gone badly wrong, and often it's simply the end result of a long run of poor choices (by them or other people) and tough situations. Many prisoners have grown up surrounded by a toxic mix of crime, unemployment, addiction, abuse, mental health problems, poverty, and poor education. They may have done stupid things, or horrible things to end up in prison, but when you hear the backstories, it's often not hard to see how they've got there; it also makes me constantly grateful for the love, stability, and security that I grew up with. 'There, but for the grace of God, go I' is a phrase I'm often reminded of.
And it's that grace of God that we have the amazing opportunity to bring to people at such dark points of their life. It starts with showing them basic respect and taking the time to explain things carefully, which they might not be used to. It might mean going the extra logistical mile to get that operation that's previously been prevented by years of chaos and disruption. It might mean forgiving them and picking up where you left off after the last time, when they lost their temper and swore at you as they stormed out of clinic. Surprisingly often, it's in the unexpected answers to that great question, 'Do you have any faith that helps you when you're struggling like this?'
Recently I met a Christian medical student who was doing her elective in prison medicine with Integritas.  At age 14, she felt the Lord was telling her to work in prison, so after a little searching, she came across an article on prison medicine that I wrote for Triple Helix.  That helped her to see that it could be possible, and she hasn't been put off yet! It also reminded me that we never know how God will use our words to inspire others.>
The main routes into prison medicine for doctors are as GPs or psychiatrists (forensic or addiction). There are also plenty of opportunities for prison nurses, dentists, and physios, to name a few. Most of you will at some point come across prisoners in hospitals, or ex-prisoners in GP practices, and it can be a great opportunity to demonstrate a little care and compassion in challenging situations. There are a number of ways you could explore an interest further:
- Do an elective or student-selected component in prison medicine or forensic psychiatry
- Consider getting some prison experience as part of a GP or psychiatry training rotation
- Do the CMF / Integritas Health & Justice Track — a great introduction to the issues of healthcare for vulnerable groups, including detainees 
Mark Pickering is CMF Chief Executive and a prison GP in London