Prison Service Research Articles

COVID-related disruptions and adaptations to prison-based mental health and substance use services: a narrative review

PurposePublic health experts and advocates have long raised concerns about the pandemic preparedness of prison systems worldwide – an issue that became increasingly salient at the start of the COVID-19 pandemic. People in prison experience poorer health outcomes compared to the general population, making timely access to adequate health services in prison critical for their health and wellbeing. This study aims to identify the extent of the literature on initial changes in mental health and substance use services for people in prison during the COVID-19 pandemic, summarize and synthesize the findings and identify areas in need of further study.Design/methodology/approachThe authors conducted a review of the academic literature published internationally in English between 2019 and December 1, 2020 to describe the disruptions and adaptations to mental health and substance use services in prisons during the onset of the COVID-19 pandemic.FindingsThe authors found that mental health and substance use services in prisons around the world were widely disrupted due to the COVID-19 pandemic – predominantly consisting of the complete suspension of services, discontinuation of transfers to off-site treatment sites and limitations on service capacity. Adaptations ranged from virtual service delivery and changes to treatment dispensation processes to information sessions on overdose prevention.Originality/valueTo the best of the authors’ knowledge, this is the first review to examine the nature and extent of the literature on delivery of mental health and substance use services in prisons during the COVID-19 pandemic.

The police as formal agents of change: Assisting desistance in individuals convicted of sexual offences

Comprehensive and multi-disciplinary public health approaches are necessary to prevent sexual re-offending. However, criminal justice solutions continue to dominate and the arrangement in England and Wales is no exception. The introduction of the Multi-Agency Public Protection Arrangements (MAPPA) in 2003 brought together the work of the police, prison and probation services in order to manage violent and sexual offenders. This paper focuses specifically on the work of the specialist police officers who are tasked under MAPPA with the Management of Sexual or Violent Offenders (MOSOVO) and whether or not they can assist desistance in those who have been convicted of a sexual offence. We argue that the risk-based, highly politicized model of public protection that MOSOVO staff operate within creates tensions more likely to hinder than facilitate desistance. As indicated by findings in an independent review of the police’s management of registered sex offenders (2023), successful desistance journeys are found in people who are supported by formal agents who actively promote hope and optimism and convey a belief that the person attempting desistance can change. In conclusion, we recommend that MOSOVO staff be willing and resourced to help individuals with sexual convictions develop a non-offending lifestyle and identity and support them in achieving this goal, which requires the provision ofcomprehensive support beyond risk management.

Met and unmet prison-based treatment needs for people who are incarcerated with a history of substance use disorder: A nationwide cohort study

BackgroundSubstance use disorders (SUD) are highly prevalent among incarcerated people. However, in some prisons, only a small percentage of those who need treatment receive it. The aims of this study were to examine coverage of treatment for SUD in Danish prisons and assess whether treatment differed by substance class. Further, we examined factors associated with receiving treatment for SUD, and types of services received. Data and methodsWe linked multiple Danish register data using unique personal identification numbers. This study retrospectively analysed data for 49,330 individuals (aged 18–90) incarcerated in Danish prisons between 2008 and 2018. We used a multivariable logistic regression model to predict enrolment in treatment for SUD in prison. ResultsOf incarcerated people with a history of SUD, 34.6 % received treatment care during incarceration. We observed only minor variations in terms of substance classes concerning the type of treatment. Those who were women, immigrants, had higher education, or were married were less likely to receive treatment. ConclusionsImproving access and increasing treatment coverage in the Danish Prison and Probation Services is crucial to reduce the burden of SUD in incarcerated populations.

Dealing with rape cases in Ghana: The law, the victim and the offender

Rape is a criminal offence in all countries of the world. However, what constitutes rape in the legal sense differs from country to country, with many common law countries sharing some similarities in their definition of rape. This paper conducts a critical review of the crime of rape in Ghana by discussing what constitutes rape under Ghanaian law, its key elements which a prosecution has to prove to succeed on a charge of rape, and the challenges of adjudicating rape cases in Ghana, paying particular attention to the victim. Furthermore, the manuscript offers some useful recommendations on improving current practice. Among the challenges identified as militating against the successful prosecution of rape cases in Ghana are the high poverty level resulting in the lack of money to pay for the costs of forensic medical examination by the victim, stigmatisation and ridicule of rape victims, lack of social and psychological support for the victims of rape, the unduly long period adjudication of rape cases take, the gender-specific definition of rape, and the general inadequate or lack of reformative services for rape prisoners. The paper recommends that the state of Ghana should take steps to tackle these challenges in order to promote justice for rape victims, while effectively dealing with the perpetrators of such crimes. These steps could include, the State covering the costs of forensic medical examination for rape victims through the National Health Insurance Scheme, intensifying public education on rape and its consequences, especially on the victim, and amending the definition of rape to make it gender-neutral instead of gender-specific. This paper will be useful to legal, psychological, and sociological researchers in Ghana and the world over.

Taking Prison to Court: Exploring the Judicial Review of Prison Decision-Making Through Supreme Court Judges in Israel

Abstract Scholars have criticized the gap between judicial work and the realities of prison life. In this article, drawn from qualitative findings from Supreme Court Judges in Israel, we analysed how such Judges negotiate their administrative judicial review over prison officials’ decisions. We found that through their judicial review, the Judges either bureaucratise, re-sentence the prisoner or reform prison life. Each theme imagines differently both the purpose of judicial review, as well as the values, emotions, legal ‘tool-kit’, and players (prison service, the claiming prisoners) involved in the review process. The findings move the scholarly focus of judicial decision-making from the quantity to the quality of punishment and expand the understanding of judicial consciousness regarding prison life.

A 3-year review of deaths in people under community justice supervision in Wales: a cross-sectional analysis

BackgroundDespite little fluctuation in the numbers of people under community justice supervision in England and Wales, the number of deaths in this population has more than doubled between 2013–14 and 2020–21, from 560 to 1343 deaths. Contributing factors and causes of mortality are somewhat unknown. The aim of this study was to understand the number and the leading causes of people dying while under community justice supervision in Wales, UK, between April 1, 2018, and March 31, 2021. MethodsPublic Health Wales in collaboration with HM Prison and Probation Service in Wales were provided with identifiable data (name, date of birth, date of death, and the Probation Delivery Unit) of 306 individuals (aged ≥18 years) who had died during this time period while under community justice supervision. Following de-duplication and matching of National Health Service (NHS) numbers using the Welsh Demographic System, 266 deaths were linked to the live Office for National Statistics (ONS) Death Registry to obtain the cause of death. Deaths were grouped based on the International Classification of Diseases (ICD)-10 code assigned as their underlying cause of death. FindingsIn this cross-sectional study, the mortality rate overall was higher in women than in men (7·5 vs 5·6 deaths per 1000 population), despite the majority of deaths being in men, with less than 40 deaths in women. Mortality rates were nearly double in those aged 50 years and older (9·4 deaths per 1000 population) than in those aged 18–49 years (5·0 deaths per 1000 population). Drugs or alcohol were considered a primary cause of death for just under half of all deaths (n=115; 43%), with opiates being the most commonly named substance (n=63; 24%). 70 drug-related deaths involved poly-drug use. Accidental drug-related deaths were four times higher in those aged 18–49 years than in those aged 50 years and older (2·3 vs 0·6 deaths per 1000 population). Diseases of the circulatory system accounted for 13% (n=34) of all deaths and were 5 times higher in those aged 50 years and older than those aged 18–49 years (2·2 vs 0·4 deaths per 1000 population). InterpretationThis study provides valuable insight into the leading causes of death among this cohort, notably deaths associated with substance misuse in younger age groups and with circulatory disease in older age groups. The increase in substance misuse-related deaths reflects recent national UK trends. Further research is required to understand which of these deaths were preventable. FundingNone.

Eye movement desensitisation and reprocessing (EMDR) therapy in prison and forensic services: a qualitative study of lived experience

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is common in people with serious mental illness who come into contact with the criminal justice system. Little evidence exists on EMDR treatment in forensic mental health, with no prior qualitative research exploring lived experience perspectives. Objective: This qualitative study recruited adult forensic mental health patients with PTSD and psychotic disorders, predominantly schizophrenia, who had received EMDR as part of a clinical trial, either in prison or in hospital. We sought to understand their experiences of EMDR therapy while receiving forensic care. Method: Ten in-depth, semi-structured qualitative interviews were undertaken and analysed using thematic analysis. We used an inductive, realist approach, reporting the experiences, meanings, and reality of the participants. Results: Five overarching themes were identified. First, severe trauma was ubiquitous and participants felt Seriously Messed Up by their traumatic experiences, with debilitating and enduring PTSD symptoms contributing to offending and psychosis (‘giving the voices something to feed on’). Second, EMDR was regarded with Early Scepticism. Third, the therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future. Conclusions: The limited research on EMDR in forensic mental health is unfortunate given how common PTSD is in mentally unwell offenders and its potential to impede recovery and contribute to further offending. This first qualitative study found participants experienced positive transformative change, extending beyond symptom reduction. Themes support previously published quantitative outcomes showing EMDR to be safe and effective in this cohort. EMDR was well suited to a forensic setting and was seen as an empowering therapy. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618000683235. Study registration: The study was registered on the Australia and New Zealand Clinical Trials Network, registration number ACTRN12618000683235 (registered prospectively, 24 April 2018), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 374682

What is optimal integrated multi-agency Throughcare? A global e-Delphi consensus study defining core components of effective rehabilitation and reintegration programming

PurposeThe study aimed to identify and define core components of Throughcare. The global prison population has reached its highest level to date (11.5 million), with comparative data on recidivism unavailable. Despite the global shift away from punitive and towards rehabilitative approaches, reintegration programming (Throughcare) is limited, ill-resourced or non-existent in many countries.Design/methodology/approachThis study conducted a global e-Delphi consensus study of professionals working in prison and correctional services to define critical components of effective rehabilitation and reintegration programming. Consensus was defined a priori as 70% or more participants scoring an outcome from 7 to 9 and fewer than 15% scoring it 1 to 3.FindingsFollowing a call for expression of interest circulated to the International Corrections and Prisons Association member list (n = 7282), 175 members agreed to partake in the e-Delphi rounds. In Round One, 130 individuals completed an online survey where 35 statements were scored by importance, each with opportunity to provide written feedback. A total of 33 statements exceeded the set threshold of consensus. Written feedback supported refinement and further development of statements in Round Two. A total of 108 individuals completed Round Two. A total of 39 out of the 40 statements exceeded the set threshold of consensus.Practical implicationsConsensus statements are useful to provide a shared understanding for inter-agency Throughcare partnerships, to inform national prison policies and to expand prison and support staff capacity building and programmes all over the world.Originality/valueTo the best of the authors’ knowledge, to date, this is the first known attempt to elicit consensus from a broad range of professionals working in the field of prison and correctional services on core components of effective rehabilitation and reintegration programming.

Evacuation as a result of exceptional occurrences in the Prison Service practice

ObjectivesThis article aims to present the specificity of evacuationin the Prison Service practice resulting from an exceptional occurrence.MethodsThe article has been written on the basis of the author's experience while working in the prison service as well as document analysis.ResultsThe Prison Service is one of those state dispositional services which enable its adequate protection in the face of various threats. In this case, it is about isolating offenders because they pose a real threat to public order and security. The role of the services is to prepare for emergencies to minimise the risk of injuries, deaths and damage to property that disrupt society and individual administrative systems. It is a significant challenge, as emergency events are impossible to predict, and only their probability can be estimated and preventive and mitigating actions established.ConclusionsThe task of each professionally organised formation is to prepare for various circumstances, including crises. Events that require evacuation in the Prison Service are relatively rare. Evacuation under the conditions of the Prison Service is, therefore, usually a derivative of local threats: fires, natural disasters, and others, which require leaving the penitentiary institution. It should be emphasised that as prisoners serve their sentences of acute deprivation of liberty, penitentiary units must ensure their safety. This means acting in ordinary, everyday activities and responding to complex and unusual situations, including those requiring evacuation.

Hepatitis C Virus Elimination Program among Prison Inmates, Israel.

The Israeli Prison Services implemented a hepatitis C virus (HCV) elimination program in 2020. Inmates considered high risk for HCV were offered serology; HCV-seropositive participants were offered HCV RNA testing. Among participants, 7.0% had detectable HCV RNA and were offered antiviral drug therapy. This program reduced HCV burden among incarcerated persons.

Work for the Prison Service: selected health consequences - investigating the role of personal resources, job demands, work stress, and burnout.

The specific job demands of the Prison Service (PS) may affect the health of officers. The job demands-resources model (JD-R) model was used to design a survey of the consequences of working subject to particular job demands. The aim was to gain an insight into the relationship between job demands, personal resources, occupational stress and burnout and selected health consequence indicators (such as behaviors associated with the consumption of alcohol, stress symptoms). A total of 1732 PS officers in Poland were surveyed. The following tools were used as part of the survey: the Copenhagen Psychosocial Questionnaire (COPSOQ II), the Multidimensional Inventory for Assessing Coping Responses (COPE), the Alcohol Use Disorders Identification Test (AUDIT) and a form with a respondent's particulars. Path analysis using partial least squares structural equation modelling (PLS-SEM) was performed. The assumed hypotheses were partially confirmed by the results. Out of 4 job demands categories only work pace turned out not to be a significant predictor of burnout and stress. For alcohol related behaviors, stress level was the only significant predictor, both as a direct and indirect effect taking into account job demands. It transpired that support from superiors rather than support from colleagues or self-efficacy was a significant moderator in the emotional demands - stress relationship. Limitations of the study and perspectives for its continuation are also presented herein. Based on the obtained results it may be concluded that job demands and support from superiors do have an impact on stress in the PS group. This is also consistent with available reports in literature. At the same time stress is a significant predictor of alcohol related behaviors. Coping through the use of psychoactive substances was not a significant factor in statistical analyses and it has still not been subject to sufficient scientific analysis. Int J Occup Med Environ Health. 2023;36(6):744-60.

Self-Legitimacy of Prison Workers and Treatment of Correctional Clients: A Study in Slovenian Prisons

Studies on self-legitimacy in the prison environment have confirmed the differences in prison workers’ perceptions of their own legitimacy in different cultural settings. This study focuses on factors influencing prison workers’ self-legitimacy and their support of the specific treatment of correctional clients in Slovenian prisons. The results highlighted good relations with correctional clients, satisfaction with payment, internalization of subcultural norms, higher education, and positive perception of workplace (professional) competencies as correlates of prison workers’ self-legitimacy. Prison workers’ support of the resocialization of correctional clients was influenced by their feelings of obligation toward correctional clients, rejection of prison subculture norms, and gender, female prison workers being more inclined toward resocialization. In contrast, lack of cooperation between prison services, bad relations with correctional clients, and lower levels of achieved education were associated with prison workers’ support of the harsh treatment of correctional clients. The implications of these findings are discussed.

Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance-related hospitalisation after release from prison: A cohort study.

Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation. A prospective cohort study. Prisons in Queensland and Western Australia. Participants were incarcerated and within 6weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.

Prescription drugs with potential for misuse in Irish prisons: analysis of national prison prescribing trends, by gender and history of opioid use disorder, 2012 to 2020

BackgroundPharmacotherapy is essential for the delivery of an equivalent standard of care in prison. Prescribing can be challenging due to the complex health needs of prisoners and the risk of misuse of prescription drugs. This study examines prescribing trends for drugs with potential for misuse (opioids, benzodiazepines, Z-drugs, and gabapentinoids) in Irish prisons and whether trends vary by gender and history of opioid use disorder (OUD).MethodsA repeated cross-sectional study between 2012 and 2020 using electronic prescribing records from the Irish Prison Services, covering all prisons in the Republic of Ireland was carried out. Prescribing rates per 1,000 prison population were calculated. Negative binomial (presenting adjusted rate ratios (ARR) per year and 95% confidence intervals) and joinpoint regressions were used to estimate time trends adjusting for gender, and for gender specific analyses of prescribing trends over time by history of OUD.ResultsA total of 10,371 individuals were prescribed opioid agonist treatment (OAT), opioids, benzodiazepines, Z-drugs or gabapentinoids during study period. History of OUD was higher in women, with a median rate of 597 per 1,000 female prisoners, compared to 161 per 1,000 male prisoners. Prescribing time trends, adjusted for gender, showed prescribing rates decreased over time for prescription opioids (ARR 0.82, 95% CI 0.80–0.85), benzodiazepines (ARR 0.99, 95% CI 0.98–0.999), Z-drugs (ARR 0.90, 95% CI 0.88–0.92), but increased for gabapentinoids (ARR 1.07, 95% CI 1.05–1.08). However, prescribing rates declined for each drug class between 2019 and 2020. Women were significantly more likely to be prescribed benzodiazepines, Z-drugs and gabapentinoids relative to men. Gender-specific analyses found that men with OUD, relative to men without, were more likely to be prescribed benzodiazepines (ARR 1.49, 95% CI 1.41–1.58), Z-drugs (ARR 10.09, 95% CI 9.0-11.31), gabapentinoids (ARR 2.81, 95% CI 2.66–2.97). For women, history of OUD was associated with reduced gabapentinoid prescribing (ARR 0.33, 95% CI 0.28–0.39).ConclusionsWhile the observed reductions in prescription opioid, benzodiazepine and Z-drug prescribing is consistent with guidance for safe prescribing in prisons, the increase in gabapentinoid (primarily pregabalin) prescribing and the high level of prescribing to women is concerning. Our findings suggest targeted interventions may be needed to address prescribing in women, and men with a history of OUD.

Kriminalvården och Barnkonventionen

The Swedish Prison and Probation Service's and the UN Convention on the Rights of the Child Children belonging to incarcerated parents are typically a marginalised group within society who are often devoid of efficient support. This article discusses the realisation of children’s rights within the Swedish Prison and Probation Services based on the perspectives of staff members. This qualitative study has employed data collection through thematic interviews with staff at five institutions. In this article, the following four themes have been discussed: the difference in children’s rights based on a parent’s gender, the rights of a child to contact their incarcerated parent, the participation of a child within the Swedish Prison and Probation Services, and the staff's thoughts on the Prison Service's child rights perspective, current and future. The results display traditional norms continue to steer work within the Swedish Prison and Probation Services, partly creating differences in how children’s rights are realised, resulting in largely unseen parenting from fathers. There exist good examples of such realisations; however, a child’s perspective is largely influenced by staff commitment and individual interests. In implementing the CRC, respondents suggested an accompaniment of children placed in central units with their parents to provide the necessary support from educated staff. Furthermore, there is an additional desire for improved cooperation with social services.

An Exploration of the Capacity to Mentalize Following an Introductory Mentalization Based Treatment Group within an Irish Prison Service

ABSTRACT Objectives This study explored participant experience of mentalization after the completion of an introductory MBT group within an Irish prison. Methods Data were collected from four participants using semi-structured interviews which were analyzed according to IPA methodology. Results Four group experiential themes were identified from the data: making sense of difficulties with emotions in the context of early life experiences, learning to feel and manage emotions, keeping other minds in mind and mentalizing in practice. Conclusions This study adds to the wider qualitative literature on MBT and presents a unique insight into participant experiences of developing their mentalizing capacity within a prison setting.

Suicide risk in male incarcerated individuals in Spain: clinical, criminological and prison-related correlates

BackgroundPrison suicide is a complex phenomenon that may be influenced by individual, clinical, social and environmental factors. In Spain, few studies have explored the relationship with institutional, prison-related variables. The aim of this study is to examine correlates of suicide in a sample of male incarcerated individuals from 5 Spanish penitentiary centers.MethodsThis present study entails a secondary data analysis, using data from the Prevalence of mental disorders in prisons study. This is a cross-sectional multicenter study conducted in 2007–2008 across 5 penitentiary centers in Spain. The Spanish version of the Plutchik suicide risk scale was used to assess the risk of suicide (those scoring ≥ 6 were considered to be at risk of suicide). Sociodemographic, clinical, criminological and prison-related data were collected via face-to face interviews and criminological data were confirmed using penitentiary records.ResultsThe final sample included 707 male incarcerated individuals (mean age 36.79 years ± 9.90 years). Several significant correlates associated with higher risk of suicide were identified including criminological factors (having committed a violent offense, being a recidivist), clinical factors (family history of mental disorders, the presence of mental disorders, having physical conditions, contact with a mental health specialist, medication treatment in the last 12 months), and prison-related determinants (workshop/training course participation) was significantly associated with lower suicide risk.ConclusionsSeveral correlates within a comprehensive range of sociodemographic, criminological, clinical and prison-related variables were identified. This information is primordial for preventing suicide and reducing the existing risk. The findings may contribute to developing effective suicide prevention programs within Spanish prison services. Importantly, future research must continue to investigate the nature of suicidal outcomes among incarcerated individuals.

Linking prison health care data to other health data: A novel data linkage study in Northern Ireland

ObjectivesWe describe the progress made in the development of a novel linked database designed to improve understanding about the health, mental health, health service use and mortality risk of people following their release from prison in Northern Ireland (NI).
 MethodsThis is a collaborative project between the ADRC-NI and the NI Healthcare in Prisons service (HIPS) - South Eastern Health and Social Care Trust (SEHSCT). Data about the health of all adult prisoners between 2012 and 2021 (HIPS) will be linked to a healthcare population spine (National Health Application and Infrastructure Services - NHAIS) via a Health and Care Number (HCN), a unique health identifier for each patient in the NHS in Northern Ireland. Data will subsequently be linked to prescribing data (Enhanced Prescribing Database - EPD), in-patient services data (mental health) and mortality data (General Register Office - GRO).
 ResultsEthical and governance approvals have been obtained. A stepwise approach to the development of this novel health database will be presented. Data cleaning has been undertaken by the HIPS team and records with missing HCNs have been identified and updated. Extraction of prison health data is underway for N=14,898 individuals and N=34,213 custodial episodes. Individuals may have more than one prison episode during the study period. Electronic and manual modes were used to extract 25 health-related variables from prison records. Data will be transferred to the Honest Broker Service (HBS), the trusted research environment for health and social care in NI, for data de-identification and linkage, and data access for analysis. Preliminary results and lessons for other related data-linkage projects will be presented and discussed.
 ConclusionWe will describe our progress regarding the development of a novel health dataset comprising routinely collected administrative data and our work about prisoner health. We will report about our experience of assessing data access, cleaning, extracting, and analysing data and the linkage possibilities with respect to the prison health dataset.

Healthcare in prison: Does it matter how it is provided?

ObjectivesFrom April 2013, responsibility for healthcare services for prisoners was shifted to NHS England. Administrative survey data from English prisons covering 2000-2021 was used to identify if this change affected detainees’ experiences of healthcare quality and/or access; as well as the association with other characteristics of prison or prisoner.
 MethodsSince 2000, HM Inspectorate of Prisons (HMIP) has carried out surveys of detainees as part of its inspections. This presentation will highlight the potential of these datasets by presenting substantive results of analysis on detainees’ experience of healthcare in prison. Merging datasets over time provides continuity of some variables over the whole period, with responses from up to 95,000 individuals. Variables of detainees’ assessment of the ease of access to different healthcare professionals, as well as the quality of services provided, were analysed over time and in terms of association with different types of prison and demographics of prisoner.
 ResultsThe HMIP data are used to inform inspections and reports, and an ESRC-funded project has now developed these administrative datasets for wider research use. With a timeframe of over 20 years, the data can be analysed on a range of policy-relevant prison issues, such as safety, preparation for release, support within prison, treatment of prisoners, and access to information, legal rights, education, exercise and healthcare. These can be associated with demographic characteristics of detainees, and functional types of prison; as well as the analysis presented here of trends over time and whether these can be aligned to distinct policy or practice changes. The policy change in healthcare provision in April 2013 is contextualised within trends of greater health needs of prisoners and differentials between prisoners.
 ConclusionHMIP detainee survey data are now archived with the UK Data Service for research use. Cross-sectional analysis on a range of demographic factors shows differential healthcare needs and experiences, and analysis over time indicates both trends and the impact, or not, of policy changes on detainees’ experiences.

Novel linkage of health and prison data in Scotland: Investigating access to services for mental health and substance use following release from prison

ObjectivesTo compare the use of NHS services for mental health and substance use (MH/SU) between people released from prison and the general population. This paper describes the data linkage and analytical process, discusses policy implications and highlights the methodological contributions for future administrative data research in public health and justice.
 MethodsRetrospective cohort study using linked Scottish health data and the Scottish Prison Service (SPS), involving all individuals released from prison in 2015 (n = 14,000), and a random general population sample (n = 70,000), matched on index date, age, sex, and postcode. Analysis will include descriptive comparison of service use between the two cohorts. Multiple regression models will be fitted to examine the influence of confounding variables in service use, and multilevel models will specifically assess cross-level geographical variation where feasible.
 ResultsResults of the data linkage and analysis to date will be presented. This research will contribute to understanding the complex range of contacts people have with health services for MH/SU following imprisonment. It is the first research in Scotland to provide a national-level description of access to health services for MH/SU among people released from prison and offer a comparison to the general population. It also explores within-group differences in service access for people released from prison.
 ConclusionThe linking and analysis of multiple justice and health-related datasets will provide crucial evidence to inform future healthcare delivery for justice-experienced populations. This research also advances our understanding of public health approaches and administrative data research in justice-related contexts.