It is widely recognised that many individuals in prison experience poor mental and physical health and have a range of needs that are often multiple and complex. The last national assessment of health and care needs of Scotland's prison population was carried out in 2007. Since then there have been major changes to how health care is delivered in Scotland's prison and changes to prison population demographics.
In 2020 the Scottish Government, in collaboration with stakeholders, embarked on a programme of research to provide a more up-to-date picture of the health and social care needs of Scotland's prison population; in order to ensure the most appropriate services are in place to support individuals in prison.
Four pieces of research were commissioned to look at different domains of health: social care; mental health; substance use; and physical health. These studies use prevalence and lived experience data to assess health needs and identify specific recommendations to improve health and care provision in Scotland's prisons.
The purpose of this synthesis report is to draw out the common themes and interconnections in the issues and recommendations presented across the four commissioned pieces of research. It is important to note that the issues and recommendations highlighted here do not, therefore, cover every individual recommendation made in each report. This report is not a full summary but rather an analysis of commonality and should therefore be considered alongside the individual research reports to gain a complete picture of health and social care needs.
The wide ranging recommendations, which arise from the entire research programme, are also shown in Annex A. An Easy Read version of this report is also available online.
All four reports describe a high level of health and social care needs among Scotland's prison population. They also note a high level of comorbidity (having more than one mental health, physical, social care or substance use related need), and identify that some subgroups in the prison population, for example, people on remand and older age groups, have particular needs.
Five common themes were identified across the four pieces of research which comprised the health and care needs assessment. Specifically: consistency; information; access to services; staff; and facilities. A summary of the themes and recommendations, which are detailed in this report, are shown in Figure 1.
Figure 1: Summary of key themes and recommendations
Overall, this synthesis report highlights recent improvements in health and care provision to meet the needs of Scotland's prison population, including the expansion of multi-disciplinary mental health teams in prisons, reports of good relationships between NHS and the Scottish Prison Service (SPS), and the availability of training for health care staff. Another positive development is the increased accessibility of secondary care appointments through greater video-calling capabilities in prisons, a consequence of the Covid-19 pandemic restrictions.
However, across the research it is clear that the health and care needs of Scotland's prison population are significant. Covid-19 has exacerbated long-standing issues of staff shortage and retention in Scotland's prisons. Poor data quality hinders an ability to monitor and respond to health inequalities in the prison population in Scotland. In addition, difficulties sharing information between organisations, a lack of national consistency in health and care provision, and facilities ill-suited for people with disabilities or with care needs, remain key challenges to meeting the health and care needs of Scotland's prison population.
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