People with chronic illnesses can experience great difficulties in prison, but people such as drug addicts and the homeless may find their healthcare improves, according to a study in the latest Journal of Advanced Nursing.
Researchers led by the late Gill Hek from the Faculty of Health and Social Care at the University of the West of England, Bristol, spoke to a cross-section of 111 prisoners in 12 prisons across the UK.
The problems they uncovered included an older, incontinent prisoner who had to use a bin bag to protect his mattress and a diabetic who regularly missed breakfast because he was only offered high sugar cereals. "Little account appeared to be taken of the specific needs of these prisoners, which meant that they experienced daily discomfort, combined with fear of bullying" says Gill's co-author Jane Powell.
"We found that policies and standards of healthcare really varied from prison to prison. For example, some diabetic prisoners told us they were able to keep their insulin and blood testing equipment with them, while others had to inject themselves in front of other prisoners in the queue at the medication hatch."
Other prisoners expressed concern that night-time health emergencies wouldn't be handled promptly, saying that they were banned from sounding their buzzers after lock-in and that doors were only unlocked in the most serious circumstances. One prisoner told researchers he had to wait over an hour for staff to open the door after his cellmate hanged himself.
Lack of privacy and confidentiality were also issues, with some prisoners having to discuss problems like sexually transmitted diseases in front of other inmates. There was also a feeling that some staff took a tough approach to all prisoners because a number faked illnesses to get medication or miss work.
A number of prisoners also complained that they were treated according to prison rules, not on the advice of healthcare specialists, including hospital consultants, and that meant being denied certain types of medication. Long waits to see doctors, often following written applications, were also highlighted.
However, there was some positive feedback from the survey, which covered prisoners aged from 16 to 78 and included male and female prisons and young offenders' institutions. One prisoner said that prison had saved his life, as his drug habit had made it difficult to access mental health services outside prison.
While he was on remand he'd seen a psychiatric nurse and psychiatrist and being in prison had enabled him to access diagnosis and treatment for the first time. Many other prisoners welcomed the opportunity to access mental health services.
There were also examples of people suffering from obesity and hypertension who said that being in prison had improved their health, because they had better access to information and services. And one prisoner, who had better things to do than worry about his health on the outside, said that being in prison was his chance to "get healthy, get back to normal".
These comments echo the findings of a 2002 survey by the UK Social Exclusion Unit, which estimated that only half of prisoners are registered with family doctors but make more than average use of health services while they are in prison.
The research team points out that health problems such as smoking, past use of illegal drugs and hazardous drinking are high among UK prisoners and they face an increased risk of hepatitis, sexually transmitted diseases, HIV and communicable diseases.
"Prisoners are also more likely to have mental health problems than the rest of the population and previous research has shown that being in prison tends to make mental health problems worse" says Dr Powell.
The team state that prisoners need to be encouraged and supported to manage their own health within the constraints of the prison regime and to become more aware of their own health needs.
They also maintain that improving the health of prisoners may also help to reduce re-offending rates and problems such as drug abuse when they leave prison. Prisoners' health is an international issue, they add. "Some of the prisoners who took part in the study had experienced confinement in other countries, such as South Africa and Thailand, where healthcare was far less formalised than UK services, which are now overseen by the Department of Health rather than the Prison Service" says Dr Powell.
"We also discovered during our background research that specific healthcare issues differ between countries. For example, tuberculosis is highly prevalent in Russian prisons, HIV is higher in African prisons than elsewhere and same-sex relationships - consensual and non-consensual -- are higher in prisons in America than in Europe or Australia."
All the prisoners who took part in the survey were volunteers who responded to a poster campaign. Prison staff excluded any prisoners whose participation posed a risk to the physical or mental health of the prisoner or the research team and the researchers -- Louise Condon and Francesca Harris - then chose ten prisoners at random from each prison's list.
The study, which was funded by the Department of Health's Policy Research Programme, was led by leading nursing researcher Gill Hek, who died after a sudden illness in November 2006.
"Gill was a great nurse and a great researcher" says Dr Powell. "This paper is an important part of her considerable legacy to nursing research and its publication would not have been possible without the major contribution she made to this important research project."
Reference: Users' views of prison health services: a qualitative study. Condon et al. Journal of Advanced Nursing. 58.3, 216-226.
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