The Relationships of Prison Climate to Health Service in Correctional Environments: Inmate Health Care Measurement, Satisfaction and Access in Prisons

Abstract

Abstract: Correctionalinstitutionswhicharecharacterisedbyauthoritarianorganisationmay control access to health care services through filtering requests through correctionalstaff, or conversely by using staff to identify and facilitate inmate medical care. Weinvestigated the relationship between inmate-assessed prison social climate andsatisfaction with health care in over 4,800 male and female inmates in 49 English/Welsh correctional institutions (ranging from high to low security). A single eleven-itemdimension of health care satisfaction was identified in the Measuring the Quality ofPrison Life (MQPL) instrument. Multiple regression of the dimensions of prison climateas measured by the MQPL on health care satisfaction indicated that the scales‘Relationships with staff’, ‘Safety’, ‘Feedback and care’, ‘Fairness’ and ‘Care forvulnerable’, predicted 30% of variance in health care satisfaction. Qualitative data onhealth careissues froma parallel study of twelve English/Welsh local prisons were used toexplicate the quantitative findings. Data suggest that positive prison climates facilitatedinteractions between correctional and health care staff and prisoners, while in negativeclimates correctional staff acted as a filter or barrier between inmates and health services.Further, data suggested that health care staff themselves may be influenced by prisonclimate. These findings implicate health care provision and access as an integral part ofprison climate, and suggest that inmates’ judgments on access to, and satisfaction with,prison health services are significantly associated with general, non-health related prisonclimate measures.Keywords: prison; health care; measurement; access; satisfaction; prisonclimate; EnglandHealth-related behaviours and health-seeking behaviours in correctionalenvironments are of considerable importance. First, inmate populationsare typically disadvantaged and often from the underclass in society, and,assuch,arelikelytohavepoorerhealthandinsomehealthsystems,poorer