Prison Health The Perspectives of Women Prisoners in English Prisons

1
Prison Health The Perspectives of Women
Prisoners in English Prisons

• Nicola Douglas
• Dr. Emma Plugge
• Prof. Ray Fitzpatrick
• Department of Public Health
• University of Oxford

2
Policy Context

• Historical concerns
• Equity
• Standards
• Professional isolation of staff
• HMPS capacity to deliver healthcare
• 1999 HMPS NHS Executive review
• NHS HMPS to work together to deliver prison
  health
• Introduced the concept of equivalence
• 1st April 2006 - transfer of responsibility to
  local PCTs
• Goal equivalent standard of healthcare to that
  available in the community

3
Study Outline

• Aim examine the impact of imprisonment
• 505 women surveyed 3 times
• Questionnaire validated instruments
• Six focus groups (n37) and 12 interviews
• Purposive sampling
• Qualitative analysis grounded theory, two
  researchers coding

4
Quantitative Data Highlights
5
Qualitative Findings

• Impact of imprisonment
• Barriers to good health
• Perceptions of healthcare provision

6
Impact of Imprisonment

• Emotional impact
• Shock and disbelief
• Worries about children and family
• Crowding, noise and the threatening atmosphere
• Sharing with drug users and mentally ill women

7
Impact of Imprisonment

• Physical impact
• Role of chaotic drug use
• Adequate nutrition
• Shelter
• Safety from violence
• Poorer diet
• Inactivity

8
Barriers To Good Health

• Poor diet
• Inactivity
• Poor hygiene
• Inability to self care disempowerment
• Access to services

9
Healthcare Positive Views

• Examples of good practice
• Competent, compassionate care
• Similar to community services
• Recognised the challenges of prison health

• Participant Group 2 Like, theres one nurse for
  however many people they have to see coming
  through reception here. Like, 40 of them might
  be alcoholics or drug addicts, theyve got to
  take on board everything everyone is saying. Most
  people come in here clucking or withdrawing and
  they want their drugs, they want whatever is
  going to make them feel better now!

10
Healthcare Negative Views

• Access
• Medication battles
• Staff attitudes and interactions
• Privacy and confidentiality
• Professional competence

11
A vulnerable population with extensive health
needs

• An environment not conducive to health

• Healthcare provided limited or less than optimal
  quality

Disempowered to manage own health
12
Conclusions

• Equivalence mind the gap
• Robust standards
• Effective monitoring and clinical governance
• Genuine patient consultation/involvement
• Culture of respect?
• Equivalence or compensatory care?
• Population with elevated health need/risk
• Opportunity to address health inequalities

13
Further Information

• Reference Plugge, E., Douglas, N., Fitzpatrick
  R. (2006) The Health of Women in Prison. Oxford
  University of Oxford.
• Offender Health Research Page http//www.publichea
  lth.ox.ac.uk/units/prison
• Nicola.douglas_at_dphpc.ox.ac.uk
• Emma.plugge_at_dphpc.ox.ac.uk