The Offender Personality Disorder Pathway in Wales identified a need for those leaving custody in England and returning to communities in Wales. The disconnection between English custodial services and Welsh community services has meant that many offenders left prison without follow-on support identified. Links between criminal justice services and health or third-sector services are not well established, and it is often challenging for those responsible for people leaving custody to access necessary services.

To address these issues, a mental health transitional support and liaison service was piloted in South Wales. With no female prisons in Wales, all Welsh women convicted and sentenced to prison must serve their sentences in prisons in England, so this pilot began by addressing women’s services. The service has since expanded to address the absence of mental health support available for men transitioning from custodial settings to the community.

This article outlines the implementation of the transitional support service and details its care pathway, which involves: identification of service users; information gathering and formulation; establishing the functions of subsequent transitional support nurse work; and phasing out services. It presents case studies to provide context to the support offered and discusses details of the continuing service expansion.