MinisymposiumMeeting complex health needs in prisons
Introduction
Very few prisoners only have one health- or social-care need, and few only have two. In fact, the vast majority of prisoners have a plethora of needs which combine at different levels of severity. This complexity of needs often amalgamates to include mental and physical illnesses, homelessness, unemployment, and drug and alcohol addictions.
Research by the Sainsbury Centre for Mental Health has shown that:
‘the “default” for prisoners is to have a complex range of problems that interplay with each other. The type of service which will best be able to help a prisoner is one that takes a holistic view and one that is geared to address complexity.’1
When looked at individually, prisoners' needs are often considered to be ‘sub-threshold’ by individual service providers, which means that prisoners are excluded from access. However, when packaged together, prisoners' needs frequently engender very ill and socially excluded individuals.
Therefore, complexity needs to be fully accepted and understood by criminal justice, health- and social-care agencies to ensure that prisoners' needs are addressed and that the right services are delivered within prisons. Engaging prisoners in health- and social-care services is essential in order to ensure that positive health outcomes are achieved, to reduce re-offending, and to save public money.2
‘Complexity’ can serve as an umbrella term for a number of health and social justice agendas, including public health, primary and secondary care, and social care. Delivering services to address complexity will require dynamic and creative working between these agendas, and an understanding of the mechanisms for joint and strategic commissioning will be essential.
This paper sets out some of the issues relating to complexity in prisons and, to demonstrate this further, a case study is set out at the end of this paper demonstrating the challenges presented in delivering health care to prisoners by highlighting the correlation between mental illness and blood-borne viruses.
Section snippets
Complexity: the facts
In 2002, the UK Government's Social Exclusion Unit reported that, compared with the general population, prisoners are:
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13 times as likely to have been in care as a child;
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13 times as likely to be unemployed;
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10 times as likely to have been a regular truant;
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two and a half times as likely to have had a family member convicted of a criminal offence;
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six times as likely to have been a young father;
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15 times as likely to be human immunodeficiency virus (HIV) positive; and
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20 times more likely to have been
Mental health problems and mental illnesses in prisons
The 2008 World Health Organization (WHO) Europe ‘Trencin statement on prisons and mental health’, which followed the WHO HIPP International Conference on mental health and prisons in 2007, noted that ‘international research consistently shows that prisons in Europe hold a very high proportion of prisoners with mental disorders’.4
WHO estimates that 65–70% of prisoners suffer from a mental health problem and/or drug addiction.5 Severe and enduring mental illnesses, such as schizophrenia, are
Mental health and drug dependency (‘dual diagnosis’, ‘co-morbidity’)
The WHO Trencin statement noted that:
‘the global facts are clear and startling: of the nine million prisoners world-wide, at least one million suffer from a significant mental disorder, and even more suffer from common mental health problems such as depression and anxiety. There is often co-morbidity (dual diagnosis) with conditions such as personality disorder, alcoholism and drug dependence.’4
A recent report by the Sainsbury Centre for Mental Health on prisoners' experiences of mental health
Blood-borne viruses and prisons
In addition to the complexities presented to prisoners and prison services by mental health problems and drug addiction, the risk and infection rate of blood-borne viruses is extremely high in prisoners compared with that in the community:
‘in most countries in Europe and central Asia, rates of HIV infection are much higher among prisoners than among the population outside prisons. Studies in countries in Europe have found great variation in the rates of HIV infection among prisoners.’9
WHO has
Case study to illustrate the kaleidoscopic nature of complex needs of prisoners: mental health and blood-borne viruses
As noted above, the ‘default’ in prisons is for prisoners to have a complex range of problems that interplay with one other. The following case study demonstrates a clear link between mental illness and blood-borne viruses; a connection that is well documented in research conducted in the community. This unusual ‘dual diagnosis’ will undoubtedly be having a high impact in prisons, and demonstrates the challenges presented in trying to understand the complex needs of prisoners.
Research has
Conclusion
This paper enables a number of conclusions to be drawn in relation to the ‘complex needs imperative’. It is clear that in comparison with people in the community, prisoners are far more likely to suffer multiple complex needs, which will often include mental health problems, drug dependency, blood-borne viruses, and a range of additional problems related to poor health and social exclusion.
The case study used in this paper identified research conducted in the community showing a clear
Ethical approval
None sought.
Funding
None declared.
Competing interests
None declared.
References (15)
- et al.
Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys
Lancet
(2002) From the inside: experiences of prison mental health care
(2008)Diversion: a better way for criminal justice and mental health
(2009)Reducing re-offending by ex-prisoners
(2002)Trencin statement on prisons and mental health
(2008)Background paper for Trencin statement on prisons and mental Health towards best practices in developing prison mental health systems
(18 October 2007)- et al.
Psychiatric morbidity among prisoners in England and Wales
(1998)
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