Prison populations experience a wide range of physical health conditions at a far higher rate than non-prison/community populations. The last national physical health needs assessment of Scotland's prison population was conducted some 15 years ago (Graham, 2007). Since then, a number of significant changes to health care needs, delivery and policy have occurred that necessitate an updated needs assessment.
It is, therefore, a priority that stakeholders develop an up-to-date in-depth understanding of the physical health challenges facing Scotland's prison population, which can inform the development of effective policies and practices for managing the challenges posed by the unique prison environment.
This chapter presents a literature review of physical health needs of people in prison and the delivery of health care services in prison. Where it wasn't possible to present literature relating to Scotland or the rest of the UK, research from international literature was included.
Scotland's prisons and the physical health care needs of Scotland's prison population
This chapter serves two main functions: 1) it describes Scotland's prison population; and 2) it provides an insight into the physical health care needs of Scotland's prison population. The chapter focuses on 17 areas of physical health need, selected in consultation with the Scottish Government and relevant stakeholders, that present the greatest health burden to people in prison and to health care services. Data pertaining to Scotland's prison population were drawn from a range of sources to provide prevalence estimates for the chosen 17 areas of physical health need. These estimates were compared with prevalence estimates for Scotland's general population and other national and international prison populations (where relevant and available).
Identifying robust data to describe the physical health needs of Scotland's prison population was challenging due to a lack of available data, questionable reliability of existing data sources and challenges identifying directly comparable baselines for national/international prison populations and the general population. This demonstrates a need for more coordinated, joined up data sources relating to the physical health of Scotland's prison population.
Where comparisons were possible, the data suggest that Scotland's prison population experience greater prevalence of some (but not all) physical health conditions examined in this study (particularly: epilepsy, asthma, COPD, hepatitis C, oral health and Covid-19). In general, worse physical health was observed amongst White residents, female residents and residents aged 50+.
Interviews with stakeholders, people with experience of prison, and family members
Qualitative interviews were conducted with a range of stakeholders, people with experience of prison and family members of people in prison. Thematic analysis identified themes related to the health care needs of the prison population and health care provision within prisons.
Interviewees reflected on how a prison sentence should be an opportunity to address the health inequalities of those residing within the prison estate. A number of barriers to this were identified, however. These included prison-based NHS workforce shortages and low retention rates, the reactive nature of health care within an environment which insufficiently engages those for whom health is not routinely prioritised, gaps and inconsistencies in health care provision at points of transition in the prison journey (e.g. reception, liberation and inter-prison transfer), issues with information sharing between community and prison-based services, and missed secondary care appointments due to the unavailability of transfers.
Empirical evidence suggests that people residing in prison suffer from health inequalities relative to the general population. It is therefore necessary to ensure a prison-based physical health care system which engages, supports and provides appropriate health care to people in prison. To ensure resources are appropriately targetted, the physical health care needs of the population need to be understood. Using current information management systems, this is not possible and hence this report calls for the development of a coordinated data management system which should permit the establishment of robust records of physical health, mental health and social care needs.
Further, insights into health care provision obtained from interviews with stakeholders, people with recent lived experience of prison, and family members of people in prison identified the prison sentence as an opportunity to intervene and the improve health outcomes of individuals residing in prison. Despite the benefit of a "captive audience", a number of barriers to appropriate health care provision were identified. On the basis of these findings, a number of recommendations are offered which outline actions to ensure service equity and improved health outcomes for people in prison in Scotland.
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