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Article

James Woodall

There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced…

Abstract

Purpose

There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required to understand health promotion in prison. The purpose of the paper is to examine the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments.

Design/methodology/approach

Independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales, form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis.

Findings

Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data show examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change.

Practical implications

Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment.

Originality/value

This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health.

Details

International Journal of Prisoner Health, vol. 16 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

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Article

Farrukh Alam, Nat Wright, Paul Roberts, Sunny Dhadley, Joanne Townley and Russell Webster

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in…

Abstract

Purpose

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

Design/methodology/approach

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Findings

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Originality/value

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

Details

International Journal of Prisoner Health, vol. 15 no. 4
Type: Research Article
ISSN: 1744-9200

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Article

Mary Rogan

Correctional healthcare should promote the protection of human rights. The purpose of this paper is to bring a discussion of human rights into debates on how such policy…

Abstract

Purpose

Correctional healthcare should promote the protection of human rights. The purpose of this paper is to bring a discussion of human rights into debates on how such policy should be best organized.

Design/methodology/approach

The paper achieves its aim by providing an analysis of European prison law and policy in the area of prison health, through assessing decisions of the European Court of Human Rights, as well as policies created by the European Committee for the Prevention of Torture.

Findings

The paper describes the position of the European Court of Human Rights on the topics of access to healthcare, ill health and release from prison, mental illness in prison, and the duty to provide rehabilitative programming for those seeking to reduce their level of “risk.” It also argues that human rights law can be a source of practical reform, and that legal frameworks have much to offer healthcare leaders seeking to uphold the dignity of those in their care.

Originality/value

This paper will provide a rare example of the engagement of human rights law with correctional health policy. It provides practical recommendations arising out of an analysis of European human rights law in the area of prisons.

Details

International Journal of Prisoner Health, vol. 13 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Abstract

Details

International Journal of Prisoner Health, vol. 14 no. 2
Type: Research Article
ISSN: 1744-9200

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Article

P. Scraton and L Moore

Informed by primary interviews and observational research conducted by the authors with women prisoners in Northern Ireland, this article focuses on prison as an…

Abstract

Informed by primary interviews and observational research conducted by the authors with women prisoners in Northern Ireland, this article focuses on prison as an institutional manifestation of women’s powerlessness and vulnerability, particularly those enduring mental ill‐health. It contextualises their experiences within continua of violence and ‘unsafety’. It also considers official responses to critical inspection reports and those of the Northern Ireland Human Rights Commission based on the authors’ research findings. Finally, the primary research demonstrates that three decades on from publication the first critical analyses of women’s imprisonment, the conditions of gendered marginalisation, medicalisation and punishment remain. This is brought into stark relief in the punitive regimes imposed on those most vulnerable through mental ill‐health.

Details

International Journal of Prisoner Health, vol. 5 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

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Article

Graham Durcan

Prisoners are supposed to receive health care that is equivalent to that provided in the community. There is a high prevalence of mental ill health in prisons, and…

Abstract

Prisoners are supposed to receive health care that is equivalent to that provided in the community. There is a high prevalence of mental ill health in prisons, and prisoners tend to have complex needs. Prison mental health care has received only limited attention until recently. The impact of the new in ‐reach teams appears to have been positive, but primary mental health care is weak across the prison estate and the vast majority of prisoners with mental health problems still receive little or no service. The development of prison mental health care has not been evidence‐based and there has been no policy implementation guidance that compares to that provided for reforms in services for the wider community. There is no model for prison mental health care and the role of the prison mental health practitioner is not well defined, nor is the health care workforce prepared for the task.

Details

The Journal of Mental Health Training, Education and Practice, vol. 1 no. 4
Type: Research Article
ISSN: 1755-6228

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Article

Philippa Hearty, Emma Wincup and Nat M. J. Wright

Recovery is the predominant discourse within current UK drug policy, promoted as freedom from dependence. In support of such a policy driver, prison drug recovery wings…

Abstract

Purpose

Recovery is the predominant discourse within current UK drug policy, promoted as freedom from dependence. In support of such a policy driver, prison drug recovery wings have been piloted in ten prisons in England and Wales to address high drug prevalence rates in prisoner populations. The purpose of this paper is to explore the development of these specialist wings within the context of wider developments to tackle reoffending among drug-using prisoners.

Design/methodology/approach

The first part of the paper offers an analysis of the emergence of the recovery paradigm in the prison context through analysis of official policy documents. The second draws predominantly upon two process evaluations of the drug recovery wings, alongside literature on prison drug treatment.

Findings

There is limited empirical evidence to inform the debate about whether prisons can provide settings to facilitate recovery from the effects of illicit drug use. What is available suggests that effective therapeutic environments for recovering drug users could be established within prisons. Key components for these appear to be sufficient numbers of staff who are competent and confident in providing a dual role of support and discipline, and a common purpose of all prisoners committing to recovery from illicit drugs and supporting each other. Further research regarding the impact of drug recovery wings upon health, crime and wider social outcomes is needed.

Originality/value

This paper provides an updated perspective on the development of drug treatment in prisons, with a particular focus on the implications of the new recovery paradigm.

Details

Drugs and Alcohol Today, vol. 16 no. 1
Type: Research Article
ISSN: 1745-9265

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Article

Tish Lane‐Morton

The quality and relevance of what happens in prisons are measurably improved once prisons are seen, and have to act, as an integral part of society and the community. The…

Abstract

The quality and relevance of what happens in prisons are measurably improved once prisons are seen, and have to act, as an integral part of society and the community. The provision of health care has benefited a great deal from the involvement of national and local agencies whose professional expertise is in health and education. HM Inspectorate of Prisons (HMIP) has developed the World Health Organisation's concept of a ‘healthy prison’ (WHO, 1998) to judge the treatment of prisoners and the conditions in which they are held against four core criteria. Partnership working between the Prison Service and NHS was formalised in April 2000, and the majority of prisons have transferred the commissioning of health care to the NHS. This paper considers the challenges and developments of partnership working in improving health outcomes for prisoners, and identifies future improvements.

Details

The British Journal of Forensic Practice, vol. 7 no. 4
Type: Research Article
ISSN: 1463-6646

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Article

Luis Gadama, Chrissie Thakwalakwa, Chimwemwe Mula, Victor Mhango, Chikosa Banda, Stephanie Kewley, Alyson Hillis and Marie-Claire Van Hout

Sub-Saharan African prisons have seen a substantial increase in women prisoners, including those incarcerated with children. There is very little strategic literature…

Abstract

Purpose

Sub-Saharan African prisons have seen a substantial increase in women prisoners, including those incarcerated with children. There is very little strategic literature available on the health situation and needs of women prisoners and their circumstantial children in Malawi. The study aims to explore this issue.

Design/methodology/approach

A qualitative exploratory study using in-depth key informant interviews with senior correctional stakeholders (commissioner of prison farms, senior correctional management staff, senior health officials and senior officers in charge) (n =5) and focus group discussions (FGD) with women in prison of age between 18 and 45 years (n =23) and two FGD with correctional staff (n =21) was conducted in two prisons in Malawi, Chichiri and Zomba. Narratives were transcribed and analysed using thematic analysis.

Findings

Three key themes emerged and are as follows: “hygiene and sanitary situation across multiple prison levels and subsequent health implications for women”; “nutritional provision and diets of women and children in prison”; and “women’s access to prison-based and external health services”. Divergence or agreement across perspectives around sanitation and disease prevention, adequacy of nutrition for pregnant or breast-feeding women, health status and access to prison-based health care are presented.

Practical implications

Garnering a contemporary understanding of women’s situation and their health-care needs in Malawian prisons can inform policy and correctional health practice change, the adaptation of technical guidance and improve standards for women and their children incarcerated in Malawi.

Originality/value

There is a strong need for continued research to garner insight into the experiences of women prisoners and their children, with a particular emphasis on health situation.

Details

International Journal of Prisoner Health, vol. 16 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

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Article

Anita Mehay, Rosie Meek and Jane Ogden

Prisons offer a public health opportunity to access a group with multiple and complex needs and return them to the community with improved health. However, prisons are not…

Abstract

Purpose

Prisons offer a public health opportunity to access a group with multiple and complex needs and return them to the community with improved health. However, prisons are not conducive to optimal health and there are few frameworks to guide efforts. This study aims to generate insights into health literacy across a young adult prison population, specifically examining the level of limitations, barriers and characteristics associated with these limitations.

Design/methodology/approach

The study took place in a single prison in England for young adult men aged 18–21 years old. A mixed-methods design was adopted with 104 young men completing a quantitative survey and qualitative semi-structured interviews with 37 young men.

Findings

72% (n = 75) of young men scored as limited in their health literacy. Barriers included structural restrictions, limited access to formal support and social and natural disruptions. No demographic characteristics or smoking intentions/behaviours predicted limited health literacy, but characteristics of the prison were predictive. Physical problems (sleep, nausea, tiredness and headaches), mental health and well-being (anxiety, depression and affect) and somatisation problems were also predictive of limitations.

Practical implications

Prison healthcare services and commissioners should undertake regular health literacy needs assessments to support developments in reducing barriers to healthcare and increasing health improvement efforts. Action also requires greater political will and investment to consider broader action on the wider determinants of (prison) health.

Originality/value

The study provides a framework to understand and guide prison health efforts and highlights attention needed at the level of governments, prison leaders and their health systems.

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