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The purpose of this study is to investigate the experiences of adult male prisoners presenting with personality difficulties in an open (Category D) prison in the UK and their experience of a pilot offender personality disorder (OPD) pathway Psychologically Enhanced Resettlement Service (PERS) in the prison.

Thirteen participants who had engaged with PERS were interviewed about their experiences of open conditions and the service. The interviews were transcribed verbatim and analysed using thematic analysis.

Two superordinate themes were identified relating to participants’ experience of open conditions, highlighting the challenges they faced. These were “the impact of institutionalization” and “relational barriers”. Two superordinate themes were identified relating to participants’ experiences of PERS; these were “relationships with staff” and “service structure”. Each superordinate theme had subordinate themes.

Analysis is based on a small number of interviews in one male prison, and only qualitative data were collected. A mixed-methods approach would enable the triangulation of results.

Clinical importance for the pilot service is established, and there should be consideration for the rollout of PERS to other open establishments.

To the best of the authors’ knowledge, this study is the first to explore the experiences of Category D prisoners within the open estate engaging with a pilot OPD pathway service. Findings illustrate the difficulties OPD service users encounter managing the transition into open prison conditions and highlight elements of the PERS model that can support this process. Clinical and research implications are identified.

Prison social environments play an important role in the health of prisoners. How they respond to imprisonment is partially dependent upon how effectively they integrate into an institution’s social structure, learn to fit in with others and adapt to and cope with becoming detached from society, community and family ‐ hence, how they personally manage the transition from free society to a closed carceral community. This paper reports on findings of an ethnography conducted in an adult male training prison in England, which used participant observation, group interviewing, and one‐to‐one semi‐structured interviews with prisoners and prison officers. The research explored participants’ perceptions of imprisonment, particularly with regard to how they learned to adapt to and ‘survive’ in prison and their perceptions of how prison affected their mental, social and physical well‐being. It revealed that the social world of prison and a prisoner’s dislocation from society constitute two key areas of ‘deprivation’ that can have important health impacts.

The purpose of this paper is to explore the perspectives of prisoners and prison staff in relation to mental wellbeing and the negotiation of barriers to accessing and providing support. This small-scale study includes the experiences of 11 prison staff and 9 prisoners within a Category D male prison.

A focus group was conducted with the prisoners and interviews with prison staff. Thematic analysis identified three core themes: “context enabling factors”, “barriers to accessing support for mental wellbeing” and “peer support roles”.

Prisoners conveyed a reluctance in reporting mental health issues due to the fear of being transferred to closed conditions. All staff indicated the benefits of peer support roles.

Further research is required on a wider scale, as it is acknowledged that the findings of this study are from one prison and may not apply to other settings. Although there are barriers that may impact the reporting of mental wellbeing issues, there may be small relational steps that can be taken to address these.

Few studies exist that explore the nuances and barriers within open prisons, perhaps due to the overwhelming need within closed conditions. A context-specific approach considering early prevention strategies to support a safer prison system and successful rehabilitation is explored. The combination of prisoner and staff experiences is of value to both academia and policymakers.

Research has consistently shown that staff working with people who self‐harm tend to experience a range of anxieties and negative emotions. Very little has been written on the particular issues and needs of staff in prisons, where rates of self‐harm are high. The current study gathered information about existing sources of support for staff dealing with prisoners who self‐harm, and identified positive practice examples. A postal survey was sent out to the Suicide Prevention Team Leaders from every HM Prison Service Establishment in England and Wales (139 in total). Fifty‐four surveys (38.8%) were completed and returned. Findings indicate that staff support services were reportedly in place in virtually all 54 establishments. However, the data suggest that even when present, provisions may not have adequately met the needs of staff working with prisoners who self‐harm, particularly when dealing with ‘repetitive’ self‐harming behaviours. These findings are discussed in relation to organizational health literature. Their practical and theoretical implications are considered, together with directions for further studies in this under‐researched area.

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug overall. Yet little is known regarding how illicit buprenorphine is obtained in prison and what influences prisoners to use it. Qualitative research was used to explore prison drug using practices. Thirty men who were former prisoners with a history of injecting drug use were interviewed in depth about their illicit prison drug use, including buprenorphine. Interviews were conducted over 18 months, from August 2006 to January 2008 and were analysed using Framework. The misuse of Subutex by snorting emerged as a significant theme. Accounts suggested that the diversion of prison prescribed Subutex was widespread and prisoners used various tactics to obtain the medication. Various complex and interlinked reasons were given to explain why Subutex was snorted in prison. The main motivation for snorting was to experience a prolonged euphoric opiate effect, believed to help to combat the boredom of being in prison. The price of illicit Subutex in prison was linked to its availability, but it was generally cheaper than heroin, thus contributing to its use. Participants’narratives identified the belief that snorting Subutex in prison was not risk free, but risks were lower than continuing to use other drugs, particularly injecting illicit opiates. The implications of prison Subutex misuse for prisoners, prison medical services, commissioners, and prescribing policy and practice are discussed.

The purpose of this paper is to present a preliminary study exploring the perception of prison officers in England and Wales regarding violence in their workplace.

Data were gathered through questionnaires administered to 152 of Her Majesty’s Prison establishments throughout England and Wales, ranging from high secure to open prisons where officers are affiliated to the Prison Officers Association. In total, 45 officers responded, seven from women’s prisons and the remainder from male adult and youth prisons. In addition, descriptive data from the Ministry of Justice statistical data set on incidents of violence are incorporated where possible.

Results indicated that violence, both prisoner on staff and prisoner-to-prisoner, is a major concern among prison officers, across all prison categories. The prison officers who took part considered there to be an absence of what they perceived to be serious measures to prevent and manage violence. Officers view the prison disciplinary system as ineffective, with reluctance for external charges to be considered against prisoners committing acts of violence within the prison.

The research is limited by a lack of external measures being obtained (e.g. observation of aggressive incidents) and the fact that the participants were self-selecting, with only a small proportion of respondents. However, it suggests a need for more detailed research into prison violence, one that integrates the views of prison staff as well as prisoners, with the former lacking in the research base to date. It also indicates a need for more focussed action from management, staff representatives and reform lobbies to explore collectively how to prevent violence in prison. Only by adopting a multidisciplinary and multifaceted approach can a comprehensive attempt at management be achieved.

Prison violence has a negative impact on correctional settings and their mission to provide a safe working environment for staff and safe environment for prisoners. Consequently, a focussed management approach on the problem is required, one that captures the view of a range of staff and prisoners. Prisoner’s violent conduct, whether assault on staff or peers, constitutes further criminal conduct. This has to be addressed through formal processes such as prison reports, police charges and potential prosecution. The latter has been under-applied. Determining the barriers to pursuing police charges and possible prosecution would be valuable to pursue. Violence against staff needs to be more thoroughly understood and not considered solely as an occupational hazard, but as a means of safe-guarding both staff and prisoners.

This study is the first that has sought to incorporate prison workforce perception on the problem of escalating levels of prison violence, using a sample from a wide set of prison environments.

This paper aims to explore the cessation of injecting amongst male drug users when in prison in England and uncovers what influenced this behaviour and why.

Qualitative interviews were conducted with 30 male drug users on release from prison to explore what happened to their injecting drug use in prison. The research was conducted from a pragmatic harm reduction approach using grounded theory.

Not injecting in prison was identified as a pertinent finding and nine overarching themes accounted for this decline. The themes often overlapped with one another, highlighting how the decision not to inject when last in prison was multi‐factorial. Running throughout the themes were participants' concerns regarding the health and social risks attributed to injecting in prison, alongside an appreciation of some of the rehabilitative measures and opportunities offered to injecting drug users when in prison.

This qualitative research offers an updated perspective on illicit drug injecting in prison in England from the view of drug users since health and prison policy changes in prescribing and practice. It contributes to evidence suggesting that prisons can be used as a time of reprieve and recovery from injecting drug use.

This paper explores absconding from a new perspective. Literature has tended to focus on the risk factors linked with absconding. This paper aims to consider desistance factors for absconding for prisoners at higher risk of absconding in open prisons.

Stage 1 used logistic regression to identify factors associated with increased risk of absconding. Stage 2 identified new receptions with increased risk and used thematic analysis to analyse interviews with prisoners that did not abscond after three months.

Stage 1 found that the total number of previous offences predicted absconding. Stage 2 found three themes linked to desistance in absconding: “support”, “ownership” and “sense of self”.

This study highlights the importance of ensuring prisoners in open prisons are offered the appropriate emotional and practical support. It also identifies the importance of hope amongst prisoners in open conditions. Future research should further explore this idea in more depth.

Previous literature has looked at absconding from a risk factor perspective. This research identifies the desistance factors associated with absconding for individuals who have been identified as high risk of absconding. Improvements in factors associated with desistance from absconding may support a reduction in absconding from open prisons.

Prisoner access to opiate-based analgesics and gabapentinoids is a concern to prisons through illicit trading. The purpose of this paper is to describe patient needs following introduction of nine pilot chronic non-cancer pain (CNCP) clinics for chronic pain in three prisons (two male and one female) in the South of England. The study evaluated the effectiveness of this model and assessed the wider practical implementation issues.

Clinical notes were reviewed for 63 consultations, anonymised and recorded for secondary analysis.

Alongside CNCP, high levels of substance misuse, physical and mental health histories were noted, especially for female patients. Amitriptyline, pregabalin, gabapentin were the main frontline analgesics prescribed prior to assessment. A total of 41 per cent of patients did not change their medication following the consultation; 25 per cent had their medication increased or reintroduced (greater for women prisoners); with one-third (33 per cent) of patients reducing the prescription of strong opioids and gabapentinoids. Significant differences were noted between male and female patients. Prisoners were amenable to changes in medication to facilitate access to work and other therapeutic interventions.

The prescribing of analgesics has largely been couched in terms of disruption to the prison regime through illicit trading. This study highlights the need to place CNCP within wider contexts of substance misuse, physical and emotional health. There is an opportunity to develop a rehabilitative rather than palliative approach to pain management. Gender specific approaches for female patients should be considered.

Few studies of CNCP have been conducted within a prison environment.

Training in the prison settings is a mandatory part of higher training in forensic psychiatry. Violence in prisons is a recognised issue, which can impact on trainee safety and overall training experience. The Royal College of Psychiatrists have produced guidelines regarding the safety of the environment in inpatient mental health settings, but there is currently no such guidance regarding the prison setting. The purpose of this paper is to report on a survey of UK-based ST4-6 trainees in forensic psychiatry regarding their training experience in prisons, focusing on supervision and safety.

The authors constructed an electronic survey which comprised of 18 items. This was sent to each UK training programme director in forensic psychiatry, who were asked to distribute the survey to trainees in their region.

There were 36 unique responses, out of an approximate total of 100 trainees. The questions fell into two broad categories: trainee safety and trainee supervision. The main themes that arose were that the majority of trainees (59 per cent) reported that they had not received a formal induction at their prison and had not received training in using the Assessment, Care in Custody and Teamwork framework (58 per cent) and serious incident review protocol (83 per cent). The vast majority (76 per cent) reported not being allocated a personal safety alarm, and 27 per cent reported having received a direct threat from a patient in prison. Responses with regards to consultant supervision were varied. The majority indicated that they received weekly supervision (62 per cent).

The findings indicate that there are a number of areas where both safety and supervision within the prison environment may be improved. This is concerning given the standards outlined by Promoting Excellence (General Medical Council), which highlights the importance of a safe and supported learning environment, and suggests the need for further analysis locally of training opportunities within prisons.