There are several limitations to the findings of this needs assessment resulting from the continuing COVID-19 pandemic. Face-to-face research was not possible during the timeframe of this project. This required taking an adapted approach using existing and secondary data and undertaking data collection through remote methods only. It is unfortunate to have been unable to go into prisons to speak with staff and residents for this important piece of work.
Had access to prisons been possible, an approach which directly engaged people in prison in a standardised screening process would have been preferred to measure mental health needs in this population. As the project was limited to use of secondary data, it was necessary to estimate the prevalence of mental health problems using data collected on people in the community in Scotland. Quantitative modelling was limited to use of fixed demographic variables as predictors of mental health needs, and could not include other relevant factors such as adverse life experiences and experiences related to imprisonment that increase the likelihood of having mental health needs. The prevalence estimates reported may therefore underestimate likely mental health needs. There were also several mental health needs including psychosis, personality disorder, and neurodevelopmental conditions, which were described in the literature review as experienced by people in prison in the UK, however the prevalence of these needs could not be estimated in this research due to the lack of available data. In the absence of estimates generated from Scotland's prison population, it may still be useful to consider the prevalence reported in the UK prison research literature to inform the planning of services.
While it was possible to use videoconferencing technology to gather the views and insights of individuals with lived experience of mental health problems in prison, access restrictions to prisons and competition for private rooms for remote interviews meant it was not possible to obtain direct input from women, young people, and people with neurodevelopmental conditions currently living in prison. The professional stakeholders who engaged with this project have become familiar and relaxed in their use of videoconferencing technology. However conducting interviews online was a barrier for some individuals with lived experience living in the community due to lack of access to the necessary technology and data/Wi-Fi packages. The research team recognises that in-person interviews might have enriched the interpersonal connection made with these individuals.
Finally, this report highlights the substantial service and workforce pressures experienced by those working to support people living in Scotland's prisons. Not all health professionals who wanted to engage with this needs assessment were able to due to pressures on clinical services and staffing problems exacerbated by the pandemic.
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