Concerns have been raised about failings in the care provided to vulnerable inmates at Northern Ireland's top security prison.
Key lessons have still not been learned, despite a series of critical reports into deaths in custody and incidents of self-harming, inspectors said.
A report by Criminal Justice Inspection Northern Ireland (CJINI) calls for greater efforts to improve the needs of at-risk prisoners.
Brendan McGuigan, chief inspector of Criminal Justice in Northern Ireland, said: "Despite a reduction in the overall number of men self-harming within the prison, inspectors had significant concerns around the management and care of men who had or were at risk of self-harming.
"I am concerned that despite the critical reports into deaths in custody and serious self-harm, some important lessons have not been learned, even though a single over-arching death in custody action plan had been developed by the Northern Ireland Prison Service."
Fourteen deaths have taken place at Maghaberry Prison since 2012.
Last September staff were strongly criticised after failing to intervene as a mentally ill prisoner blinded himself and injured his groin area.
Sean Lynch (23) inflicted "extreme and shocking" self-harm over three days, a previous report concluded.
Today's publication is the latest in a series of inspection reports on Maghaberry.
It found that while management are continuing to work to improve the prison's performance, shortcomings have been found in care and support for the most vulnerable prisoners.
The report follows an unannounced review by a team of experienced inspectors from CJINI, Her Majesty's Inspectorate of Prisons in England and Wales, the Regulation and Quality Improvement Authority and the Education and Training Inspectorate.
It was a continuation of follow-up work after an inspection report in May 2015.
Mr McGuigan added: "I welcome the drive, determination, innovation and creativity shown by the leadership team and staff to stabilise the prison, to improve outcomes for those committed to their care and implement the nine recommendations made two years ago.
"However, this positive work and the desire to deliver a more stable, safe environment for prisoners and staff must ensure the needs of vulnerable prisoners are addressed."
Mr McGuigan said the continued lack of a safer custody strategy at Maghaberry remained an issue for the inspection team.
He added that further work was required by the wider criminal justice and healthcare systems to provide alternatives to custody for highly vulnerable prisoners.
"Maghaberry prison does not provide a therapeutic environment," he said.
"We were therefore concerned to find the prison was being used as a safe place by the courts while mental health assessments took place.
"In our view this is inappropriate and we have recommended the Departments of Justice and Health should develop an agreed pathway to prevent individuals being admitted to prison for an emergency mental health assessment."
Mr McGuigan said the day-to-day regime at Maghaberry was more stable and reliable with fewer restrictions around movement and activity occurring.
Progress was also found in relation to education and healthcare.
Mr McGuigan also voiced his support for the work ongoing to stem the flow of illegal drugs into Maghaberry.
However, the report notes that the misuse of prescription medication and the tendency of some prisoners to experiment with any substance available to get a 'high' remains an issue.
Mr McGuigan added: "It is essential that the leadership team within the prison and senior managers within the Northern Ireland Prison Service continue to maintain a focus on delivering improvement at the facility.
"They must make every effort to address the concerns raised in this inspection and maintain the momentum towards positive change."
Ronnie Armour, the head of the Northern Ireland Prison Service, said: "There has been significant progress made at Maghaberry over the past two years achieved as a result of a positive determination by the leadership team and staff to deliver on improvements at the facility."
He added: "This is a timely report by inspectors who acknowledge that the needs of prisoners are complex and vulnerable prisoners especially present a real challenge.
"There is also now a wider recognition in judiciary and inspectorate that the criminal justice system is not equipped to deal with people who suffer mental health difficulties.
"This is not an issue which the Prison Service can resolve alone but we can and will contribute to work as recommended by the inspectors."