PRISON(ER) HEALTH AND HEALTHCARE

• WHAT DO WE MEAN BY HEALTH 

  ‘Health is a state of complete physical, mental and social well being and not merely the absence of disease of infirmity’.

  ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social education’.
• PRISON(ER) HEALTH: POLICY

  Rationale for prison(er) health: 

  • Human Rights 
  • NHS principle of equivalence
  • Individual Health improvement 
  • Reduce Health inequalities
  • Reduce public health expenditure
  • Rehabilitation and reintegration
• ENGLAND & WALES 

  Patient or prisoner? (1996) 

  • Critical review of prison health form chief Inspectorate of prisons.
  • Staffing: inadequately qualified, lacked suitable training, low morale, poor communication, professional isolation.
  • Control from Home office, Department of Health and NHS.
  • Bringing prison health into public health. 
• Health promoting prisons: a shared approach (2002) 

  5 topic areas: 

  1. Mental health promotion and well being.
  2. Smoking cessation.
  3. Healthy eating and nutrition.
  4. Health lifestyle (e.g. sexual health, relationships, active living).
  5. Drug and other substance abuse. 
• INTERNATIONALLY 

  Health in Prison Project (HiPP)

  Four pillars of the health promoting prison: 

  1. Safe 
  2. Secure 
  3. Reforming and health promoting 
  4. Grounded in decency and respect for human rights 
• THE IMPORTATION - DEPRIVATION MODEL OF PRISON HEALTH (de Viggiani, 2007) 

  Importation factors:

  • Health needs before prison.
  • Beliefs about health.
  • Cultures.
  • Attitudes. 

  Deprivation:

  • Stress of incarceration.
  • Living confinement.
  • Physical environment.
  • Boredom.
  • Restrictions over (health promoting) behaviours.
  • Isolation from friends and family. 
• WHAT ARE HEALTH NEEDS BEFORE PRISON?

  • Mental health 
  • Drug use 
  • Lifestyle behaviours 
  • Chronic conditions 
  • Infectious diseases 
  • Smoking
• HEALTH IN PRISON 

  • Health assessment on entry.
  • Services in prison.
  • Better health on release.
• HEALTH SERVICES IN PRISON

  • GP
  • Pharmacists 
  • Occupational therapists 
  • Psychologists 
  • Psychiatrists 
  • Detox/ drug workers
  • Dentists 
  • Opticians 
• PHYSICAL ACTIVITY 

  • 23 hours ‘bang-up’
  • Lack of purposeful activities. 
• WHY FOCUS ON SPORT IN PRISON

  • ‘By participating in sport [young people] can learn to differentiate between good and bad behaviour’ (Labour Party, 1997).
  • ‘Three things are critical to a smooth running prison: the food, the communication (phone calls and visits) and the gym’ (prison governor).
  • Quiet assumptions that sport contributes to the ‘moral performance’ and ‘therapeutic effectiveness’ of a prison, and can be aligned with the resettlement pathways’ and efforts to promote desistance. 
• Academic assumptions that sport contribute to: 

  • Positive identity, self esteem, self- concept. 
  • Focus of control, self discipline, problem solving, decision making.
  • Empathy, tolerance, co-operation, teamwork and conflict resolution.
  • But potentially also increased aggression, competitiveness, bullying, and exclusion. 
• HOW HAS COVID 19 IMPACTED PRISONER HEALTH 

  A decline in prisoners’ emotional, psychological and physical well-being. They were chronically bored and exhausted by spending hours locked in their cells. They described being drained, depleted, lacking in purpose and sometimes resigned to their situation.