Prisoners holding their own medications during imprisonment in England and Wales: A survey and qualitative exploration of staff and prisoners' views

Abstract

Traditionally, medication in prison has been administered in single, supervised doses. Prisons in England and Wales, however, have now been encouraged to allow prisoners to hold and manage their own medication themselves as 'in-possession' medication, in line with community practices. We aimed to examine the range of policies and practices used to manage in-possession medication in prisons, and to explore staff and patient perspectives. A mixed methods design was selected. Questionnaires were sent to all prisons throughout England and Wales in 2008, and follow-up interviews were completed with 68 staff and 24 patients at 12 prisons. In-possession medication was permitted to some degree within all prisons. Interviewees identified its principal benefit in terms of empowerment, whilst acknowledging the need to minimise health and security risks. Structured methods of risk assessment were used in 93% of establishments, although content and structure varied widely. There is still some way to go before in-possession medication policies are fully embraced in prisons. Staff and patients recognise its benefits, but some remain uneasy around the perceived risks. Risk management processes in some establishments may still require development. Prisoners and staff generally find it acceptable for prisoners to have their own medication in their possession, to manage themselves, unless individual risk assessment indicates otherwise. Achievement of the optimum balance between security, safety and empowering patients is difficult in practice. Robust, specific methods of risk management in relation to in-possession medication may help prisons move from being 'risk averse' to 'risk aware'.