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Given epidemiological data highlighting poor health outcomes for prison staff and correctional workers, this systematic review aims to understand what health promotion interventions, delivered in prison settings, are effective for prison staff health.

A systematic review was undertaken, with search parameters encompassing papers published over a ten-year period (2013–2023). Health promotion programmes; well-being programmes; and occupational health interventions to support prison staff health as part of a targeted approach or as part of a whole-prison approach were included in the review.

The review identified 354 studies, of which 157 were duplicates and 187 did not meet the inclusion criteria. This left ten studies in the review from five countries. Reducing the impact of tobacco smoke was the commonly cited intervention, with four studies focusing on smoke-free prison legislation, but other studies focused on stress reduction for staff and supporting holistic health. The papers were of poor methodological quality, with the exception of three included studies that had robust designs. Most studies showed limited or no impact of interventions to support prison staff health, the exception being policy interventions to reduce second-hand smoke exposure.

Prison staff have poor health outcomes and yet limited attention has been paid to interventions to support their health. This review suggests a number of considerations for future policy and practice and direction for further research to improve prison staff health.

Greener on the Outside for Prisons (GOOP) is a therapeutic horticulture programme targeting the high levels of complex health and social care needs in prisons in England. The COVID-19 pandemic and resulting lockdowns led to unprecedented disruption in prisons in England. This paper examines the experiences of prisoners both during and post-lockdowns in four prisons, to understand the effects of participation in GOOP on health and wellbeing after the disruption of restrictions, and identify implications for developing this programme further.

The paper is based on original qualitative data gathered from in-depth narrative-based interviews and focus groups with prisoners and staff in four English prisons. Audio data was transcribed and subject to a thematic analysis, drawing from a realist-informed lens.

Thematic analysis revealed five key themes: reimagining the GOOP context; increasing empathy between participants; building sense of coherence; reconnecting with nature and a joined-up connection with provider services. The main arguments centre on horticulture in prisons remaining under-utilised as a means of promoting good health and wellbeing, although there is enthusiasm from staff to provide green spaces for the most vulnerable prisoners and develop a range of mechanisms to connect people in prison with nature.

This paper focuses on new knowledge arising from an unprecedented situation in English prisons, from key stakeholders on the frontline of garden activities. Accounts demonstrate the extent of the health and wellbeing benefits of participation in such activities in this challenging environment, which has implications for practice for prisons more widely.

Aboriginal and Torres Strait Islander (Aboriginal) people are overrepresented in Australian prisons, where they experience complex health needs. A model of care was designed to respond to the broad needs of the Aboriginal prisoner population within the nine adult prisons across South Australia. The purpose of this paper is to describe the methods and findings of the Model of Care for Aboriginal and Torres Strait Islander Prisoner Health and Wellbeing for South Australia.

The project used a qualitative mixed-method approach, including a rapid review of relevant literature, stakeholder consultations and key stakeholder workshop. The project was overseen by a Stakeholder Reference Group, which met monthly to ensure that the specific needs of project partners, stakeholders and Aboriginal communities were appropriately incorporated into the planning and management of the project and to facilitate access to relevant information and key informants.

The model of care for Aboriginal prisoner health and wellbeing is designed to be holistic, person-centred and underpinned by the provision of culturally appropriate care. It recognises that Aboriginal prisoners are members of communities both inside and outside of prison. It notes the unique needs of remanded and sentenced prisoners and differing needs by gender.

Supporting the health and wellbeing of Indigenous prison populations can improve health outcomes, community health and reduce recidivism.

Only one other model of care for Aboriginal prisoner health exists in Australia, an Aboriginal Community Controlled Health Organisation-initiated in-reach model of care in one prison in one jurisdiction. The South Australian model of care presents principles that are applicable across all jurisdictions and provides a framework that could be adapted to support Indigenous peoples in diverse prison settings.

In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

Health care practitioners in prison face the challenge of providing high standards of health care within the unique peculiarities and restraints of the prison environment. The strict adherence to principles of medical ethics by the prison health care staff and the knowledge and acceptance of these principles by the whole prison community not only results in ethical conduct but also yields practical professional advantages such as guidance in situations of conflict, promotion of confidence and avoidance of misunderstandings. The internationally consented conventions, declarations and recommendations relevant on medical ethics in prison are presented and their basic principles ‐ the primary task of the prison doctor, access to a doctor, equivalence of care, patient’s consent and confidentiality, preventive health care, humanitarian assistance, professional independence, professional competence ‐ are discussed. In addition, the personal obligation of the prison doctor for ethical reflection and decision making in individual ethical issues not covered by the quoted documents and in ethically controversial issues is emphasized. A training course and published guidelines for ethical conduct in prison health care are recommended.

Mental illness affects the majority of prisoners. Mental health issues are beginning to take a central position in the development of prison health services, reflecting this burden of disease. This change in focus is not before time. But prison mental health services cannot exist in isolation. Public health systems should lead provision of care for patients with acute and severe illness. A whole prison approach to health and, specifically, mental health will offer the greatest likelihood that offenders will thrive, benefit from imprisonment, and lead law‐abiding lives after release. Public awareness of the scale and commitment of prisons to mental health and illness, and understanding of prisons’ role in society, are necessary developments that would protect and enhance public mental health, as well as creating a healthier and safer society. This article draws on recent reviews, information and statements to set out a public health agenda for mental health in prisons.

In Kyrgyzstan the prevalence of injecting drug behaviour is among the highest found throughout the world. Health promotion training, improved health care and needle/syringe exchange (NSE) programmes have been shown to decrease risk behaviour among injecting drug users. In Kyrgyzstan, an intervention study with training of prison staff and prisoners was performed in one prison. Before and after the training, a random selection of the prisoners answered a questionnaire about drug use, risk behaviour and health care. The survey was carried out in both the intervention prison and in a reference prison. The number of drug users, the use of drugs and risk behaviour were improved significantly within half a year and, especially, the injection and use of drugs decreased in the intervention group. The study clearly shows that increased focus, improved healthcare and training of prisoners and staff on drug use and harm reduction can reduce both use of drugs and risk behaviour.

A cross‐section of 1980 US data on the prison population and its rate of inflow is examined. Regression analysis is used to investigate the impact of prison overcrowding, race, crime and unemployment on the above variables. Racial composition and overcrowding are found to have significant positive impacts on the numbers in prison and the rate of inflow. Unemployment does not have a significant influence, nor does the crime rate influence inflow, but it does have a significant positive correlation with the level of the prison population.

The purpose of this paper is to provide education on blood-borne viruses (BBVs) to prison staff to help reduce stigma within the prisons, improve the care prisoners receive and reduce the risk of occupational transmission.

An e-module was used to improve staff understanding of hepatitis B (HBV), hepatitis C (HCV) and HIV at a prison in Wales, UK. An assessment was used to gather data on prison staff understanding of BBVs prior to undertaking the e-module.

In total, 530/697 (76 per cent) prison staff completed the BBV e-module. Average pre- and post-course assessment scores were 8.6/11 and 10.85/11, respectively. Most staff understood the modes of hepatitis transmission, however, gaps in understanding were highlighted. In total, 22 per cent of staff believed HBV and HCV were airborne, 9 per cent believed transmission occurred through sharing cutlery. In total, 31 per cent of staff believed prisoners with hepatitis should declare their status to the prison.

The e-module significantly improved staff understanding of BBVs and should be incorporated into future prison training packages. Future education should include how BBVs are not transmitted with an emphasis on casual contact. Medical confidentiality in prisons should also be addressed. Improving understanding will help reduce the stigma of BBVs within prison and improve the multidisciplinary care the prisoner receives.

To the authors knowledge this is the first published evaluation of a BBV learning package for custodial staff. Evaluation of this educational package demonstrates a unique and valuable insight into the general understanding of BBVs by prison staff in Wales, UK.