Mental wellbeing among people in prison in Scotland: an analysis of repeat cross-sectional surveys.

Emily J Tweed,Lesley Graham,Xanthippi Gounari

doi:10.1093/pubmed/fdz106

Abstract

ABSTRACTBackgroundMental wellbeing among people in prison is poorly studied, despite featuring in many health and justice policies. We aimed to describe for the first time mental wellbeing among an unselected national prison sample.MethodsSince 2013, the Scottish Prisoner Survey—a biennial survey of people in custody in Scotland—has included the Warwick-Edinburgh mental wellbeing scale (WEMWBS), a 14-item scale with higher scores indicating greater wellbeing. We analysed data from sweeps in 2013 (n = 3158), 2015 (n = 2892) and 2017 (n = 2405) using Student’s t-test, ANOVA and multiple linear regression. We also used WEMWBS data from the Scottish Health Survey stratified by age, gender and deprivation to compare with the population at liberty.ResultsMean WEMWBS scores overall were 43.4 in 2013 (SD = 12.2), 41.8 (SD = 11.9) in 2015 and 41.2 (SD = 12.3) in 2017. Mean scores were lower among people on remand and with multiple prison episodes. Age-standardized mean scores were lower among people in prison than their peers at liberty.ConclusionsPoor mental wellbeing is an important, under-studied facet of the extreme health inequalities associated with imprisonment. These results identify that people on remand or with multiple episodes are particularly disadvantaged and provide a baseline for monitoring impacts of service or policy interventions.

Highlights

There is growing interest in the concept of mental wellbeing, as an end in itself and for its association with better physical health and longer life expectancy.[1,2,3,4] Mental wellbeing is a related but distinct concept to mental illness: people with a diagnosis of mental illness can experience positive mental wellbeing and people may have poor mental wellbeing despite the absence of mental illness.[5]
Poor mental wellbeing is an important, under-studied facet of the extreme health inequalities associated with imprisonment
These results identify that people on remand or with multiple episodes are disadvantaged and provide a baseline for monitoring impacts of service or policy interventions

Summary

Introduction

There is growing interest in the concept of mental wellbeing, as an end in itself and for its association with better physical health and longer life expectancy.[1,2,3,4] Mental wellbeing is a related but distinct concept to mental illness: people with a diagnosis of mental illness can experience positive mental wellbeing and people may have poor mental wellbeing despite the absence of mental illness.[5]. People with experience of prison are known to experience much poorer health compared to the general population,[10,11] even after accounting for socioeconomic position and other potential confounding factors.[12] There is growing concern about worsening mental health among people in prison in a number of countries, with prisons in England and Wales recording substantial increases in rates of self-harm and self-inflicted death in recent years.[13,14,15] In Scotland, an estimated 14% of people in prison have a history of psychiatric disorder and 7.3% self-harm,[16] while 78% test positive for illicit substances at reception.[17]. Mental wellbeing among people in prison is poorly studied, despite featuring in many health and justice policies. We aimed to describe for the rst time mental wellbeing among an unselected national prison sample

Objectives

Methods

Results

Discussion

Conclusion