Majesty's Prison Research Articles

A review of general cognitive-behavioral programs in English and Welsh prisons and probation services: Three decades of quasi-experimental evaluations.

For over 30 years, general cognitive-behavioral programs have contributed to the rehabilitation services offered within His Majesty's Prison and Probation Service in England and Wales. There is an extensive body of international evidence that demonstrates the effectiveness of such interventions as a correctional strategy. However, there is widespread variability of program effects associated with the standards of implementation. Over the last 3 decades, British researchers have produced a steady output of quasi-experimental program evaluations that have contributed to the evidence base. The most recent additions are some of the largest and most rigorous available worldwide. This review documents those evaluations and provides a meta-analysis that statistically aggregates the effects of programs delivered in His Majesty's prisons in England and Wales. We suggest there is sufficient evidence from evaluations of acceptable scientific rigor to conclude that general cognitive-behavioral programs delivered in prisons during the last decade and a half (circa 2006 to 2019) have had a small statistically significant mean reductive effect on general reoffending (odds ratio = 0.91). Program characteristics and implementation factors, including program dose, the scale of service delivery and program integrity, are discussed as possible factors associated with the size of the effect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The dynamics of peer support work in a UK adult male prison: A way of performing positive masculinities?

This article explores how peer support work gives male prisoners opportunities to develop and perform positive masculinities within prison. As a former prison officer, I returned to the same prison (a category B local in England) in 2014/2015 to conduct a qualitative/ethnographic study with ( n = 19) male prisoners around engagement with peer support work. Data was analysed thematically to extract narratives relating to expressions of masculinity that challenge existing assumptions of hegemonic masculinity. ‘Insider’ positionality is a key aspect of this article when exploring the dynamics between researcher and researched, especially around building trust and rapport with male prisoners who express emotions and vulnerability. Findings suggest that peer support workers adopt a range of strategic and healthy masculinities, including protective approaches to support vulnerable prisoners. Peer support workers form homosocial bonds with each other and flows of male intimacy and generativity are evident in the care and concern shown towards others. However, there are challenges for peer support workers who have to negotiate multiple audiences to ensure personal safety and survival in prison, thus placing them in a precarious liminal position. In addition, peer support workers can be exploited by staff through neoliberalist policies and practices. Recommendations to support and develop male peer support work schemes concludes this article, which has relevance for prisons internationally that may model progress made within His Majesty's Prison and Probation Service.

'Keeping a lid on it': Exploring 'problematisations' of prescribed medication in prisons in the UK.

The non-medical use of prescription medication and risk of diversion have become policy and practice concerns within prison settings in the UK. These issues have been highlighted by the Advisory Council on the Misuse of Drugs, Her Majesty's Inspectorate of Prisons and Her Majesty's Prison and Probation Service (2019) prison drugs strategy. In 2019, new prescribing guidance was issued by the Royal College of General Practitioners for clinicians working within prison settings. Informed by Bacchi's (2009) What's the problem represented to be? framework, the ways in which the 'problem' of prescribed medication in prisons have been represented is interrogated through an analysis of the prescribing guidance framework for clinicians working in prisons. Restrictive prescribing practices are recommended as a solution to the 'problem' of diversion and misuse of prescribed medication. Prescribers are advised to consider de-prescribing, non-pharmacological treatments and alternative prescriptions with less diversionary potential. They are represented as responsible for the 'problems' that prescribed medication bring to prisons. The guidance is underpinned by the assumption that prescribers lack experience, knowledge and skills in prison settings. People serving prison sentences are assumed to be 'untrustworthy' and their symptoms treated with suspicion. This representation of the 'problem' has a number of effects including the possibility of increasing drug-related harm, damaging the patient-doctor relationship and disengagement from healthcare services. The representation of prescribed medication as problems of diversion and prescribing practices inhibits alternative representations of the problem which would inform different policy directions including improvements to regime and healthcare provision and would include a range of practitioners in prison settings to address the 'problem' more holistically.

Service evaluation of long acting buprenorphine subcutaneous injection (BUVIDAL) in the west Lothian community addictions service

Aims1. To establish if long acting buprenorphine subcutaneous injection retains patients in treatment.2. To obtain the patient opinion of long acting buprenorphine subcutaneous injection and ascertain if it improved other aspects of their life for example relationships and employment.MethodInformation was gathered from TRAK, the patient record recording system, and Illy, the prescribing system. This allowed data to be gathered on previous opiate substitute treatments and when the patient was commenced on the long acting buprenorphine injection. A patient questionnaire was used to obtain qualitative data on the patient's view of this treatment option.ResultWest Lothian Community Addictions Service starting offering long acting buprenorphine injection as a treatment option in March 2020. Since then there has been a consistent demand from patients to be commenced on this treatment. On 31st January 2021 39/53 (73.6%) of patients who had been commenced on long acting buprenorphine for 6 months had been retained on this treatment. Moreover, 3 patients were lost to treatment due to transfer to Her Majesty's Prison. Patients who were commenced on this treatment option were both new to treatment and those who had previously been difficult to retain on methadone or sublingual buprenorphine. The questionnaire supported the antidotal feedback that patients found this treatment option to be hugely beneficial.ConclusionLong acting buprenorphine injection has been well tolerated by patients and there has been a clear demand for this treatment option from patients accessing the service. It appears that the clarity of mind, that is associated with buprenorphine, has not been a barrier to retention in treatment. We have found the retention rate of the patients on this treatment option has been higher than the median 6 month retention for either methadone or buprenorphine, compared to a recent systematic review. In addition, it has helped patients consider employment, improve relationships and maintain a level of stability that they may not have previously achieved on either methadone or sublingual buprenorphine.

Associations between significant head injury and persisting disability and violent crime in women in prison in Scotland, UK: a cross-sectional study

SummaryBackgroundThe prevalence of head injury is estimated to be as high as 55% in women in prison and might be a risk factor for violent offending, but evidence is equivocal. The extent of persisting disability is unknown, making decisions about service needs difficult. The UN recognises vulnerabilities in women in prison, but does not include head injury. This study aimed to investigate relationships among head injury, comorbidities, disability, and offending in women in prison.MethodsIn this cross-sectional study, women were recruited between Feb 2, 2018, and Sept 30, 2019, from four prisons across Scotland, UK: Her Majesty's Prison (HMP) Cornton Vale, Her Majesty's Young Offenders Institute Polmont, HMP Edinburgh, and HMP Greenock (detaining approximately 355 individuals at the time of recruitment). Women were included if they were aged older than 16 years, fluent in English, able to participate in face-to-face assessment and provide informed consent, and did not have a severe acute disorder of cognition or communication. Head injury, cognition, disability, mental health, and history of abuse and problematic substance use were assessed by interview. History of head injury was assessed with the Ohio State University Traumatic Brain Injury Identification method and disability was assessed with the Glasgow Outcome at Discharge Scale. Comparisons were made between women with and without a history of significant head injury.FindingsWe recruited 109 (31%) of the 355 women in these prisons. The sample was demographically representative of the approximately 400 individuals in women's prisons in Scotland. Significant head injury (SHI) was found in 85 (78%) of 109 women, of whom 34 (40%) had associated disability. Repeat head injury was reported in 71 (84%) of the 85 women with SHI and, in most cases, this resulted from domestic abuse that had occurred over many years. Women with a history of SHI were significantly more likely to have a history of violent offences than those without a history of SHI (66 [79%] of 85 women in the SHI group vs 13 [54%] of 24 women in the no-SHI group had committed a violent offence; odds ratio [OR] 3·1, 95% CI 1·2–8·1). This effect remained significant after adjusting for current factors (3·1, 1·1–9·0), including comorbidities associated with post-traumatic stress disorder, and was no longer statistically significant after adjusting for historical factors (3·3, 1·0–10·9), such as abuse as a child or adult. Women with SHI had spent longer in prison than women without SHI after adjustment for current (rate ratio 3·4, 1·3–8·4) or historical (3·5, 1·3–9·2) risk factors.InterpretationIt is recognised that women in prison are vulnerable because of histories of abuse and problematic substance use; however, history of SHI needs to be included when developing criminal justice policy, interventions to reduce mental health morbidity, and assessment and management of risk of violent offending.FundingThe Scottish Government.

Are prison-based therapeutic communities effective? Challenges and considerations.

The purpose of this paper is to detail the impact and efficacy of Her Majesty's Prison and Probation Service ((HMPPS) Therapeutic Communities (TCs) (both democratic and hierarchical). This paper outlines recent developments in the TC literature, to provide readers with an up-to-date overview of the outcomes of prison-based TC treatment, while highlighting the strengths and challenges of this treatment approach. Trends within the research are discussed, and the authors draw attention to any gaps in the current knowledge. This paper uses a narrative literature review approach to review the most current literature around the effectiveness of prison-based TCs in HMPPS. Academic literature published predominantly from 2010 onwards is discussed because of limited literature review publications on this topic post-2010. To obtain literature, searches of relevant databases were conducted, and/or clinical leads at prison sites were contacted for relevant publications. There is a body of research which demonstrates that TCs are an effective form of treatment for people with an offending history and personality difficulties. Evidence indicates that Democratic TC treatment plays a part in reducing reoffending rates, as well as improving psychological features. Further research is needed in a number of areas, specifically with female offenders and individuals who undertake treatment in hierarchical TCs in the UK. It is also suggested that TC treatment aftercare may help to further the positive outcomes identified. To the best of the authors' knowledge, there is no up-to-date review of the impact and efficacy of HMPPS TC treatment. This paper reflects on available research within the current context of TC treatment and provides an original overview of the current UK TC practice. It has value in recommending areas for further research and consideration.

Cost-effectiveness of strategies to improve HCV screening, linkage-to-care and treatment in remand prison settings in England.

A simplified cascade-of-care may improve screening and treatment uptake among incarcerated individuals. We assessed the cost-effectiveness of traditional and simplified screening and treatment in a London remand prison. Using empirical data from Her Majesty's Prison (HMP) Wormwood Scrubs, London, we designed a decision tree and Markov transition state model using national average data for HCV screening and treatment for the base-case scenario. This compared two alternative strategies; (a) general prison population screening and treatment and (b) prioritising screening and treatment among people who inject drugs (PWID) combined with general prison population screening and treatment. Strategies varied the rates of screening (47%-90%), linkage-to-care (60%-86%) and treatment (21%-85%). Cost, utility and disease transition rates were obtained from existing literature. Outcome measures were as follows: screening, treatment and disease-related costs per admitted individual, quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated for each intervention. All costs and utilities were discounted at a rate of 3.5% per annum. Both univariate and probabilistic sensitivity analyses have been conducted. In our cohort of 5239 incarcerated individuals with an estimated chronic HCV prevalence of 2.6%, all strategy ICER values (£3565-10300) fell below the national willingness to pay threshold (£30000). Increased successful treatment (7%-54%) was observed by an optimising cascade-of-care. A robust sensitivity analysis identified treatment cost of, QALY for mild liver disease and probability of completing treatment as important factors that impact the ICER value. In our remand setting, optimising adherence to the cascade-of-care is cost-effective. Where universal screening is not practical, a stratified approach focused on intensive screening and treatment of PWID also results in increased treatment uptake and is highly cost-effective.

COVID-19: digital equivalence of health care in English prisons

COVID-19: digital equivalence of health care in English prisons

Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England

BackgroundIn England, opt-out dry blood spot prison screening for HIV, hepatitis B and hepatitis C (HCV) has been introduced to scale-up access to care. Recent advances in point-of-care HCV diagnostics provide an opportunity to improve diagnosis and treatment uptake. We compared the retention along and time intervals between each aspect of the HCV care continuum for an alternative rapid point-of-care-testing and simplified treatment strategy with existing national opt-out HCV dry blood spot testing and treatment at a large remand prison in West London. MethodsBetween September 2017 and December 2018 universal opt-out dry blood spot HCV testing, clinical assessment and treatment uptake were recorded at Her Majesty's Prison Wormwood Scrubs. Outcomes were compared to a point-of-care-based (salivary Oraquick® anti-HCV screening and Xpert® HCV fingerstick viral load) screening and streamlined treatment pathway offered to all new arrivals to the HMP Wormwood Scrubs substance misuse unit, which ran in parallel to dry blood spot testing between September and December 2018. ResultsDuring the study period 2442 out of 5239 inmates (46.6%) underwent dry blood spot screening, resulting in 62 (2.6%) HCV RNA positive cases. Thirteen (21.3%) individuals commenced therapy and no viral relapse cases were observed to date. In comparison, 162 out of 181 (89.5%) inmates admitted to the substance misuse unit agreed to rapid point-of-care testing; 20 (12.3%) HCV RNA positive cases. Seventeen (85.0%) of eligible inmates commenced treatment. The median length of stay (90 vs 30 days), time to screening (6 vs 2 days), assessment (14 vs 3 days) and treatment (36 vs 1 day) were shorter for the rapid point-of-care screen-and-treat group. ConclusionCurrent scaling-up of prison dry blood spot HCV screening and treatment in England is sub-optimal. In our setting, the cascade of care is time and resource sensitive and is greatly improved by the introduction of a simplified screen-and-treat strategy.

Social impact bonds: The goose and the golden eggs at risk

AbstractPublic goods and services such as prisons are often underfunded compared with private goods and services. Social impact bonds (SIBs) are a new financial vehicle to increase the use of private funds for public good. SIBs use a paid‐for‐success, performance‐based structure to reallocate risk and reward. In the current case, the SIB changes a critical reinforcing loop from a vicious cycle of decay to a virtuous cycle of improvement that can perpetuate SIB benefits far after the bond has been repaid. A simulation model of recidivism at Her Majesty's Prison (HMP) Peterborough and the related SIB is developed to identify high‐leverage parameters and dominant feedback loops. These are used to explain SIB success or failure for two primary participants (HMP system and SIB investors). Model analysis also reveals a tipping point structure that puts the Peterborough programme at risk. Contributions include a formal SIB model, improved understanding of SIB structure and behaviour, an example of tipping point structures in a social system and recommendations concerning SIB design and management.

Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine.

With recent advances in antiviral therapy, there is an opportunity to eliminate hepatitis C virus (HCV) from the UK population. HCV is common in incarcerated individuals, with previous estimates suggesting ~7% of the UK prison population is anti-HCV antibody positive. Increasing diagnosis and treatment of HCV in prison is a priority in seeking to eliminate transmission in the general population. Thus the study aimed to assess the impact implementation of: (a) A universal offer of blood borne virus testing (UOBBVT) using dry blood spot testing for prisoners at reception to increase diagnosis; (b) Telemedicine clinics (TC) within North East England (NEE) prisons to increase HCV treatment rates. UOBBVT was initially implemented at Her Majesty's Prison (HMP) Durham, commencing March 2016. From March 2016 to February 2017, 2831 of 4280 (66%) new receptions were offered blood borne virus (BBV) testing. Of these, 1495 (53% of offered) accepted BBV testing, of whom 95 (6.4%) were HCV antibody positive, with 47 of those 95 (49.5%) HCV RNA positive, suggesting a prevalence of active infection in the tested population of 3.1% (95% CI 2.4%-4.2%). Between August 2015 and October 2017, 80 individuals were seen in the TC and 57 (71%) commenced antiviral therapy. Of those with known outcome (n=29), 100% achieved sustained virological response. In the year prior to implementation, only four patients received HCV treatment. In conclusion, a universal offer of BBV testing to inmates presenting at HMP reception coupled with linkage into specialist care via TC can substantially increase rates of testing, diagnosis and treatment of HCV in this high-prevalence population.

The reliability and validity of the Adaptive Functioning Assessment Tool in UK custodial settings.

Adaptive functioning (AF) has been overlooked in the assessment of intellectual disability within the UK Prison Service, primarily because there are no reliable and valid measures of AF suitable for use with prison populations. This position is incompatible with the obligation of Her Majesty's Prison and Probation Service to provide specialist interventions for individuals with intellectual disabilities. This study assessed the psychometric properties of the Adaptive Functioning Assessment Tool (AFAT), a new measure of AF developed for use in prisons. The AFAT was completed on 61 participants (mean age 41, standard deviation 11.8). Internal consistency was tested using Cronbach's α. Construct validity was assessed using linear regression and a Receiver Operator Characteristic analysis. The findings provide evidence to support the AFAT being a reliable and valid measure of AF in prison populations.

Philosophy Because the World Matters

ABSTRACT“Philosophy Because the World Matters” promotes a valorization of philosophy as a practice able to activate an individual's relationship making to “having a life” and, in turn, to allow the unfolding self-illumination (qua onto-ethical capacity) to effect a constructive world-thinking and hence world-building with others. These education-based workshops with recovering addicts at Her Majesty's Prison Lancaster Castle, UK were influenced by my experience of David Bohm's ‘Dialogue’ and my interest in Paulo Freire's notion of “critical consciousness.” I made a drawing after most sessions, copies of which were distributed to participants to enable further reflection and to honor their discoveries.

Third molar observations in a sample of British male young offenders

Development, morphology and eruption of third molars are highly variable, and it is generally accepted that the emergence time is between the ages of 17 and 21years. This study reports on variation in timing encountered in a sample of 155 young males (15–18years) of British nationality who were detained at Her Majesty's Prison and Young Offenders Institution (HMP&YOI) Ashfield as young offenders. All 155 participants were self-reported in terms of their chronological age and their ethnic origin. Of the 17year-olds, 68% of Black males displayed one or more erupted third molars compared to 39% of the White males. For those who were of mixed ancestry, 50% showed evidence of eruption of at least one third molar in this age group. This difference between Black and White ethnicity was further supported when missing first or second molars were taken into consideration. Whilst it has been suggested in the literature that ethnicity plays no major part in eruption timings for the third molars, this clinical observation poses some interesting questions about the accuracy of dental age assessment.

Historical developments in sex offender treatment

This paper describes our view of the important developments in the history of sex offender treatment with a particular emphasis on aspects of this growth in the UK. We begin where, in our view, treatment of sex offenders was first implemented; that is, at the Institute of Psychiatry in London. After the move across the Atlantic, we note the beginnings of more comprehensive programmes in North America which morphed into the Relapse Prevention model. The implementation of comprehensive programmes in Her Majesty's Prisons led not only to further refinements but also offered the opportunity for researchers to explore all manner of possibilities. The more recent focus on strength-based approaches is examined, and we then spell out our hopes for the future in terms of treatment, assessment and theory.

"New beginnings" in South African shelters for the homeless: piloting of a group psychotherapy intervention for high-risk mother-infant dyads.

The New Beginnings program was developed at the Anna Freud Centre and originally piloted in Her Majesty Prisons in the United Kingdom. This study aimed to explore the use of this manualized parent-infant psychotherapy group model in an African setting with high-risk mother-infant dyads, and describes the implementation and investigation of this 12-week group psychotherapy intervention in two Johannesburg shelters for homeless women. The measures used to investigate treatment efficacy were the Parent Development Interview (A. Slade, J.L. Aber, I. Bresgi, B. Berger, & M. Kaplan,), the Emotional Availability Scales (Z. Biringen, J.L. Robinson, & R.N. Emde,), the Kessler-10 (R.C. Kessler et al.,), and the Griffiths Scales of Mental Development (D. Luiz et al., . At pretesting, infants exhibited delays in a number of developmental areas, and mothers showed high levels of depression and generally low capacities for reflective function. While significant shifts in the mothers' capacities for reflective function were not found in the treatment condition, significant shifts were found in the infants' speech abilities and in the mothers' abilities to structure their interactions with their infants. This suggests that the program enabled mothers to become more sensitized to their infants' needs in interaction and that communication between mother and infant increased. The number of sessions attended by the dyads correlated with improvements made by the mothers and their infants.

Trials and tribulations of hepatitis C treatment in Lothian prisons

Hepatitis C virus (HCV) is blood-borne virus that can cause both acute and chronic infection. In Scotland, it is well known that the main transmission route of HCV is through drug use and a study into prevalence of HCV in Her Majesty's Prisons (HMPs) in Scotland showed that 53% of intravenous drug users (IVDU) tested were antibody positive ( Taylor et al, 2012 ). The aim of HCV treatment is to reduce the risk of progression to cirrhosis, lessen the risk of hepatocellular carcinoma, reduce/clear infectivity and improve the quality of life ( British Liver Trust, 2014 ). Involving non-medical prescribers in the treatment of hepatitis C in prisons has contributed to a more seamless and timely patient pathway, avoiding delays from the onset of symptoms to the issuing of an appropriate medication if indicated.

Multidisciplinary team working in an adult male prison establishment in the UK.

The first two articles in this series exploring the oral and dental health of male prisoners in the UK demonstrated how the general and oral health of prisoners is compromised compared to those of a similar age who are not prisoners. In caring for the oral health needs of this group the high demand for emergency dental services often precludes the delivery of preventive and routine care. Comprehensive oral care for this population requires a level of training to gain the skills and knowledge to manage prisoners' complex medical, dental and social needs and the heightened dental anxiety that prisoners exhibit. The type of training that might be required for prison dentistry will be discussed in the final article. This article will describe a number of cases selected to demonstrate the complex problems presented by male prisoners in Her Majesty's Prison (HMP), Brixton. This article will also discuss the establishment of a primary care inter-professional relationship network (IRN) developed within a prison setting involving a dentist and other healthcare professionals. After informal discussions between the dentist and other prison healthcare professionals, it became apparent that vulnerable patients were not accessing dental services. These patients also cancel/fail to attend their dental appointments more frequently. In order to improve access and provision of dental care for this group of prisoners, an IRN was developed between the dentist, diabetic nurse, forensic psychology team, communicable disease lead, general medical practitioner (GMP), prison officers and healthcare manager within HMP Brixton. The nature of the IRN is presented along with reviews with relevant patient cases. The IRN allowed information sharing between professionals and an open care culture. The network was valued by prisoners. Prison populations show higher rates of general and oral disease, therefore an IRN can help to identify vulnerable groups and allow healthcare providers to give appropriate, targeted and focused care in a timely fashion.

Stealing the Smile from My Child's Face: A Preliminary Evaluation of the “Being a Dad” Programme in a Northern Ireland Prison

Children who have a parent in prison are a vulnerable group. Research suggests that such children experience a range of poor outcomes in relation to well-being, education and relationships. These outcomes are mediated by a range of factors including contact with the incarcerated parent. Similarly, prisoners who maintain contact with their families are less likely to reoffend. Evidence to support the importance of the prison system recognising and helping to maintain parenting roles for parents in prison is beginning to emerge, and this investigation sought to investigate fathers' views of an innovative parenting intervention implemented in Her Majesty's Prison Maghaberry centred around the Being a Dad programme. Eighteen fathers completed the programme. Data collected after participation indicated that fathers reported a range of positive outcomes including improved understanding of child behaviour and development and improved communication quality. Implications for further parenting support within the prison population are discussed.

‘It was just like we were a family again’: play as a means to maintain family ties for children visiting an imprisoned parent

Children can find the process of visiting a prison traumatic and as a result of parental incarceration may experience a range of adverse outcomes. When children stay in contact with their imprisoned parent through prison visiting, however, this seems to be a protective factor. This paper reports on a play visits service based at Her Majesty's Prison Leeds, UK. The service provides supervised play work provision for children visiting their father. Data were derived from prisoners and prisoners' families and were triangulated as a means of achieving a level of validity. The findings reveal that play visits do produce positive outcomes for children and play visits are effective in maintaining and strengthening family ties. These effects may be stronger when compared to standard prison visits, but further research is needed to confirm this.