Provision Of Health Care For Prisoners Research Articles

Healthcare governance in prisons in England: prisoners’ experiences of changes over time

ABSTRACT According to international law, prisoners should have access to healthcare on an equivalent basis to the rest of the population, and the UK Government has stated its commitment to such equivalence. Healthcare provision in English prisons has seen several reorganisations, notably in 2006 and 2013, with the stated intentions of improving healthcare provision in prisons. This article focuses on prisoners’ reported experiences over the periods of changes in healthcare governance, with the aim of identifying whether there are improvements from their perspectives. Survey data from a sample of prisoners has been collected by HM Inspectorate of Prisons for over 20 years, and these data have been used for secondary analysis of prisoners’ health needs and experiences of healthcare in English prisons. Despite the reorganisations of healthcare governance, the trends from 2003 to 2019 are of increasing health needs of prisoners and decreasing initial access, ongoing access, and quality of healthcare provision. There is little indication of any improvements experienced by prisoners from the 2006 or 2013 reorganisations. Prisoners are widely recognised as having distinct healthcare needs, but the data analysis reveals demographic differences in health needs and health access within the prison population, and an overall decline in quality and accessibility of healthcare provision in English prisons.

Exploring the challenges to safer prescribing and medication monitoring in prisons: A qualitative study with health care staff.

Research suggests that patients who are prisoners experience greater morbidity, increased health inequalities and frequent preventable harm, compared to the general population. Little is known about the process and influencing factors for safe prescribing in the unique prison environment, which may limit the development efforts to improve the quality of care in prisons. This study aimed to understand the process and challenges associated with prescribing in prisons, explore the causes and impact of these challenges, and explore approaches to improve prescribing safety in prisons. Grounded theory informed data collection and analysis of a nominal group discussion by seven participants and semi-structured telephone interviews with twenty prison healthcare staff, including GPs, pharmacists, psychiatrists and nurses. The underlying complexity of prescribing in prison settings increased the level of challenge and influenced the safety of this process. Multiple contributors to the challenges of safe prescribing were identified (comprising governance and policy; the prison structure; staff retention, training and skill mix; IT systems and interface; polypharmacy and co-morbidity; tradability and patient behaviour) with overarching constructs of variations in practice/policy and the influence of prison culture. Participants identified measures to address these challenges through multi-disciplinary collaborative working, increased consistency in processes, and the need for more innovation and education/training. Our study highlighted that healthcare provision in prisons is unique and needs to tailor the care provided to patients without enforcing a model focused on primary, secondary or tertiary care. Participants emphasised a necessary shift in workplace culture and behaviour change to support improvements. The COM-B model of behaviour change may be effectively applied to develop interventions in organisations that have in-depth understanding of their own unique challenges.

The "problem" of health: An analysis of health care provision in Canada's federal prisons.

The United Nations states that prisoners should enjoy the same standards of health care that are available in the community. Despite this, persons in prison experience barriers to care and face unique health challenges. Given the ways in which prisons shape health outcomes for incarcerated persons, it is important to interrogate how the provision of health care is governed in custodial settings. In this article, we examine one important aspect of governance: legislation governing the provision of health care in prisons. We view this issue through a critical lens, building on a body of poststructural scholarship which has illuminated how laws and policies are not merely tools of governance but also key sites for the production of meanings around social "problems," including the "problem of health." Taking Canada's Corrections and Conditional Release Act as a case example and applying Carol Bacchi's "What's the Problem Represented to Be" analytical framework, we examine how the specific representation of "health" in this legislation works to produce effects for persons in federal prison. Three key themes are formed through this analysis. First, what constitutes "essential services" in the context of federal prisons is more limited compared with the broader community. Second, the dichotomy between the rights of persons in prison versus the protection of society that is produced in development of these laws has significant bearing on the treatment of those in prison. Third, this representation has negative effects on the health of persons in prison. In order to meet United Nations standards, greater attention must be paid to the ways in which laws and other governing practices reproduce inequities in health care provision in prisons.

Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area.

Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records—63 peer-reviewed, 26 from gray literature, and 1 systematic review—reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.

Characteristics of prisoners with intellectual disabilities.

Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences. This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder. The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners. The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison.

Alcohol Brief Interventions (ABIs) for male remand prisoners: protocol for development of a complex intervention and feasibility study (PRISM-A)

IntroductionIn the UK, a significant proportion of male remand prisoners have alcohol problems. Alcohol Brief Interventions (ABIs) are an effective component of a population-level approach to harmful and hazardous drinking....

Suffering at the hands of the state: Conditions of imprisonment and prisoner health in contemporary Greece

With imprisonment rates rising in a large number of jurisdictions worldwide, ever more research attention has been paid to conditions of imprisonment and prisoner health. With a view to contributing to the emerging body of literature, this article offers a systematic summary of key findings from Greece. Prison establishments in this country are vastly overcrowded and material conditions of detainment are deplorable. Healthcare provision in prison is minimal and the prevalence of serious transmittable diseases and mental disorders amongst prisoner populations is high, as are the rates of deliberate self-harm, suicide and death more generally. Prisoner use of prescribed and illicit drugs is alarmingly common, especially as regards injection drugs, and drug overdose appears to account for the majority of deaths in custody.

HEALTH CARE PROVISION IN PRISONS: A REVIEW ON EUROPEAN AND INTERNATIONAL GUIDELINES

Health care provision in prisons is an area of increasing international concern. The spectrum of health problems which prisoners may bring to prison is wide and in many cases prevalence is greater than in the general population. The profound knowledge of delicate issues such as medical confidentiality and informed consent of the patient, with special refer to infectious disease, hunger strike and prison research is necessary in the prison working environment. In the following paragraphs the European and International conventions and guidelines on the matter are discussed.

Patients, prisoners, or people? Women prisoners' experiences of primary care in prison: a qualitative study

The development of primary care services within prisons has been central to improvements in the provision of health care in this setting over the past decade. Despite national imperatives to involve patients in the development of services and numerous policy initiatives, there has been no systematic evaluation of changes in the delivery of primary care and little published evidence of consultation with prisoners. To explore women prisoners' experiences of primary healthcare provision in prison. Qualitative study using focus groups and interviews. Two women's prisons in southern England. Six focus groups involving 37 women were conducted, as well as 12 semi-structured individual interviews. Focus groups and interviews were recorded, transcribed, and analysed thematically. Women prisoners' perceptions of the quality of prison health care were mixed. There were accounts of good-quality care where practitioners were regarded as knowledgeable and respectful, but many perceived that the quality of care was poor. They complained about difficulties accessing care or medication, disrespectful treatment, and breaches of confidentiality by practitioners. They voiced the belief that staff were less qualified and competent than their counterparts in the community. The prison environment presents unique challenges to those providing health care, and much work has been done recently on modernizing prison health care and improving professional standards of practice. However, the accounts of women prisoners in this study suggest that there is a gap between patient experience and policy aspirations.

Audit of healthcare provision for UK prisoners with suspected epilepsy

To describe the prevalence and nature of epileptic seizure disorders in a typical UK prison and compare the care offered to prisoners to the recommendations of the National Institute for Clinical Excellence (NICE). Over a 14-month period, all prisoners identified as having epilepsy were registered by prison primary healthcare services at a category 'C' prison holding 640 male adults. Prison and National Health Service health records were reviewed, prisoners were re-assessed by members of a specialist secondary care service based in the local general hospital NHS. Twenty-six prisoners were thought to have epilepsy. 61.5% of diagnoses had not been made by epilepsy specialists, 73.1% had uncontrolled seizures, only 19.2% had had computed tomography, none magnetic resonance imaging. At review, 30.8% of prisoners were thought to require neuroimaging, 19.2% cardiac investigations. The diagnosis of epilepsy was confirmed in only 57.9% of those prisoners considered to have the condition by prison healthcare services. 53.8% of those prisoners confirmed as having epilepsy had not had a medical review in the past 12 months; 63.2% required a change in their antiepileptic drugs (AEDs). Although the prevalence of epilepsy in this prison population appeared high at first sight, a critical review of the diagnoses reduced the difference to the prevalence of epilepsy in the population at large. Fewer prisoners than expected achieved seizure control. Collaboration with specialist epilepsy services was poor. There were significant discrepancies between the healthcare provision in prison and the NICE epilepsy guidelines.

Prison mental health services

This contribution describes current and future prison mental health service provision in England and Wales. There is a need for the development of multidisciplinary prison health care services, including greater coordination of care, continuity of care between the community and prison, improved information-sharing between agencies and developed care planning for prisoners with mental health problems. Recently, a formal partnership between the Prison Service and the NHS has been established, with the NHS taking responsibility for health care provision in prisons. Central to this debate is the notion of prisoners receiving an equivalence of care to that given to the general public by the NHS, in terms of quality and range of services. The benefits of the NHS taking responsibility for prison health care include common standards of care and continuity of care planning between the community and prison, and vice versa. It remains to be seen how these innovative reforms to the provision of health care in prisons will change the standards of care for prisoners. An evaluation of the effectiveness of the new services will be required to establish whether the change has been beneficial to both prisoners and staff.

Nursing in prisons: understanding educational needs through a case study approach

The health of people in British prisons is subject to scrutiny and comment by several agencies. These include the Home Office – who hold responsibility for services – penal reformers, prisoner representation groups, the media and providers of healthcare within prisons. Nurses make up the largest workforce within the latter group, and are employed outside the NHS. The aim of this research was to explore the educational needs of nurses working in a prison, and to map findings against a nation-wide scoping study of prison nurses’ role commissioned by the UK Central Council for Nursing, Midwifery and Health Visiting (UKCC). Very little research exists on the educational aspects of healthcare provision in prisons, although the nature of ill-health presentations is well documented. The UKCC study is unique, and enables comparison between national findings and this research, which took place in a single location. The objectives of the study were to investigate: the clinical and educational background of nurses working within prisons; the tasks and responsibilities of their role and how they were prepared for them; their perceived educational needs, including the content and structure of any proposed programme, and finally to estimate the degree of match between these findings and the UKCC national findings. Using a case study of one group of nurses working in a prison, data collection methods included a biographical timeline exercise and semi-structured interviews. Content and thematic analysis of transcripts was undertaken, followed by documentary analysis of Nursing in Secure Environments (UKCC 1999). Both sets of findings were then compared for commonalities, anomalies and gaps. Findings revealed that there is no recognized, accredited qualification for a specialist prison nursing role. Induction programmes do not exist in all institutions, and continuing professional development occurs haphazardly according to the individual nurse, with little evidence of strategic planning in order to meet the health needs of people in prison. The implications for practice are diverse, and the opportunities for improvement are enormous. The educational needs of prison nurses are inseparable from the epistemological and ontological assumptions different agencies have about the way in which a society should, or could, treat those who break its rules.