Should we use a direct regulation to implement the Healthy Prisons Agenda in England? A qualitative study among prison key policy makers

Estimating a treatment effect on recidivism for correctional multiple component treatment for people in prison with an alcohol use disorder in England

Background

There is an emerging literature on the impact of correctional substance abuse treatment (SAT) on reoffending for people in prison with substance misuse issues. This study estimates a pathway effect for people in prison receiving multiple component treatments for an alcohol use disorder (AUD) to reduce reoffending by applying treatment effect estimation techniques for observational studies. Treatment groups comprised pharmacological treatments, psychosocial interventions (PSIs) and interventions that incorporate Risk Need Responsivity (RNR) programming. RNR compliant treatment matches treatment dose to the risk of reoffending, targets criminogenic need and is tailored to a person’s learning style.

Methods

Multiple treatment effect estimators are provided for people in prison diagnosed with an AUD in England when compared to a derived control group for: Pharmacological treatment only; RNR compliant treatment and PSIs.

Results

The outcomes for RNR compliant treatment suggest a lower recidivism rate compared to the control group. Pharmacological only treatment results in a statistically significant higher level of reoffending relative to the control group.

Conclusions

The creation of a universal system of ‘equivalence of care’ framed within a public health context in English correctional SAT may have had an unintended consequence of diluting approaches that reduce recidivism. There is an opportunity to develop an integrated, cross-disciplinary model for correctional SAT that unites public health and RNR compliant approaches.

Lessons for commissioning and health outcomes from Her Majesty’s Prison Birmingham

Purpose

This study of HMP Birmingham was part of a much larger investigation of health needs assessment (HNA), in the context of a new “HNA Toolkit” developed by Public Health England for use in the prison service. The paper aims to discuss this issue.

Design/methodology/approach

In 2015, details of prison healthcare in HMP Birmingham had figured in the authors’ analysis of documents. In 2018, a crisis in Birmingham typified problems developing more widely in England and Wales. Was the crisis predictable from the initial HNA?

Findings

Recommendations embodied in the 2015 HNA were not acted upon; the eventual problems that combined to overwhelm the running of HMP Birmingham were predictable.

Originality/value

Lessons from this case study could inform more coherent commissioning of prison health services. This in turn could promote timely developments for improved health and morale in the prison, amongst prisoners and staff. Longer term, this might help to avoid future crises.

How do policymakers interpret and implement the principle of equivalence with regard to prison health? A qualitative study among key policymakers in England

BACKGROUND

The principle of equivalence in prison health has been established for nearly four decades. It seeks to ensure that prisoners have access to the same level of healthcare as members of society at large, which is entrenched within the international legal framework and England's national health policies.

AIMS

This study examined how key policymakers interpret and implement the principle of equivalence in English prisons. It also identified opportunities and threats associated with the application of the principle.

METHODS

In total, 30 policymakers took part in this research. These participants engaged in policymaking activities and occupied positions of authority in the prison field.

RESULTS

Despite the policymakers' consensus on the importance of the equivalence principle, there was a varying degree of understanding regarding what constitutes 'equivalence'. Participants described how the security culture impedes prisoners' access to healthcare services. Additionally, the increasing size and complexity of the prison population, coupled with a diminishing level of resources, reduce the level of care being provided in prisons and thus compromise implementation of equivalence in English prisons.

CONCLUSIONS

Inconsistent interpretation of equivalence, the prevailing security drive, increasing numbers and health complexities of prisoners and fiscal austerity threaten the implementation of equivalence in English prisons. This research calls for new guidance on how to interpret and implement equivalence, along with measures to educate prison governors and staff on the prison rehabilitation value, ensure greater investment in prison health and consider alternatives to imprisonment to future-proof the principle of equivalence in the English prison system.

Challenges for prison governors and staff in implementing the Healthy Prisons Agenda in English prisons

OBJECTIVES

In the two decades that have passed since the World Health Organisation established the Healthy Prisons Agenda, there has been no research conducted to investigate barriers and challenges prison managerial and operational staff encounter in implementing the Agenda in the English prison context. This article debates sectoral, institutional and occupational challenges perceived to hinder effective implementation of the Agenda, based on a qualitative study involving prison governors and operational staff.

STUDY DESIGN

Qualitative study taking a grounded theory approach.

METHODS

Semistructured interviews were conducted with 30 participants comprising prison governors, prison officers and external stakeholders with key strategic and operational roles across the prison estate. The interviews were analysed and coded into themes using constant comparative method.

RESULTS

The research identified a range of managerial and operational factors that impeded recognition, acceptance and successful implementation of the Healthy Prisons Agenda. These were found to be associated with scarcity of resources, low prioritisation, perceived low importance, and pressures at operational, managerial and strategic levels to adhere to standard operating procedures. Security, control and discipline tended to supersede other imperatives considered of secondary importance to the effective running of prisons.

CONCLUSIONS

Sustainability of the Healthy Prisons Agenda can only be assured by raising its significance and importance across prison hierarchies and within policies and practices through which operational and strategic objectives are realised. This means achieving wholesale commitment by prisons-among staff at all levels-towards public health goals that are fundamental to a successful and effective criminal justice system.