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During COVID and lockdown, many prisoners have not only been affected by infection transmission in crowded and ill-equipped institutions, they have also been separated from a range of supports, including loss of family and professional supports and support for prisoners with addiction and/or mental health problems has been disrupted. This paper reports on evidence of how peer-based recovery organizations have attempted to mitigate these adverse effects, based on a case study of one prison in the North-West of England, using a range of routine reporting data and original research data. The paper shows how prison-based peer recovery support has not only continued through lockdown but grown both in the prison and in continuing care on release. The key conclusion is that Lived Experience Recovery Organizations (LEROs) have a vital role to play in offering continuing care to prison populations both to support early recovery and to sustain change around release back into the community, in COVID but also more generally. [ABSTRACT FROM AUTHOR]

Women in prison who are pregnant or recently had a baby are a highly vulnerable population due to complex histories, increased risks of poorer outcomes, and mother-infant separation. During the COVID-19 pandemic, these women faced additional challenges due to infection risks and enforced social isolation. In England in March 2020, the Ministry of Justice and Her Majesty's Prisons and Probation Service prioritised the early release of pregnant women and mothers living with their babies in Mother and Baby units (referred to as compassionate release on ROTL – Release On Temporary Licence). Birth Companions, a UK-based charity that works with pregnant and post-natal women in prison, were commissioned to extend its reach to help coordinate care and post-release support to women released under ROTL, and those released as 'business as usual' in all English women's prisons during the pandemic. Here we report insights from an evaluation of this work. Interviews were undertaken with nineteen participants (six women, eight Birth Companions, and five health/social care professionals) and thematic analysis was undertaken. Two themes and associated sub-themes emerged. 'Facilitating support' outlines how women benefitted from the support via engendering trust, promoting coping strategies, and facilitating positive change. 'Challenges in support provision' describes key barriers that Birth Companions faced in accessing and supporting women due to communication barriers and difficulties in coordinating wider support. This study highlights a unique, service model that enabled woman-centred care, despite limitations. Prisons need to revisit existing policies and guidelines to ensure that equitable care is provided during future crises. [ABSTRACT FROM AUTHOR]

This article draws on Incident Reporting System data from the National Offender Management Service over a ten-year period (2004–2014) and limited, small-scale interviews with four custodial managers. Pat Carlen's work (2008) on imaginary penalities provides the theoretical framework for an assessment of the reporting, recording and initial response to sexual assaults in prisons in England and Wales. The article argues that the recording of sexual assaults became part of a response to new management systems that emphasised compliance, process and audit rather than realising safety in custody. Although the data shows substantial levels of initial activity among staff it is, in essence, practice without prospect. The article suggests that outcomes generally for sexual assaults in prisons in England and Wales are uncertain. Incident reporting has become a bureaucratic process 'or paper shadow', which Goffman described as showing 'what has been done by whom, what is to be done, and who last had responsibility for it' (Goffman 1961: 73). [ABSTRACT FROM AUTHOR]

Older adults are the fastest growing age sub-group in prison. Prison, health and social work staff are required to provide support for complex health and social care issues including Dementia and Mild Cognitive Impairment (MCI). Dementia care for those living in the community is a national priority. There is, however, a lack of empirical evidence regarding service provision for those living in prison. This study was the first national survey of England and Wales to establish current service provision. Questionnaires were distributed to heads of healthcare and governors of all prisons in England and Wales. Our response rate was 85 (78%) for governors and 77 (71%) for healthcare managers. Reported prevalence of dementia/MCI from respondents was well below prevalence estimates from research. Furthermore, only 23 prisons (30%) had routine screening, and the majority reported that they did not have a defined care pathway (53; 69%) for dementia/MCI. Overall, the provision of services for those experiencing symptoms of dementia and MCI in prison is sub-optimal; however, many respondents reported aspirations to enhance services for this group. The forthcoming Ministry of Justice's national strategy for ageing prisons should include recommended care pathways for dementia and MCI to strive towards equivalence of care to community settings. [ABSTRACT FROM AUTHOR]

In this paper, we present evidence of estimated significant associations between greenspace and prisoners' self-reported well-being, self-harm and violence in prisons in England and Wales. Refining and extending our previous research that estimated the relationship between greenspace and self-harm and violence while controlling for the effects of prison characteristics (e.g. prison size, over-crowding and security level), the findings in the present study show that greenspace remains significantly related to self-harm and violence when we additionally control for prison population characteristics (such as prisoner age, ethnicity, sentence length) and when we use additional self-reported indicators of well-being. Furthermore, our findings also show that the beneficial effects of greenspace appear to be particularly prominent in prison establishments that suffer from overcrowding or hold relatively large shares of younger and un-sentenced prisoners. Finally, our results reveal that greenspace has important impacts on the inter-relationships between self-reported well-being, self-harm and prison violence. [ABSTRACT FROM AUTHOR]

Background: The mortality rate among people under probation supervision in the community is greater than that among incarcerated people and that among the general population. However, there is limited research on the distinct vulnerabilities and risks underlying the causes of death in this population. In this retrospective cohort study, we examined the individual and criminal justice-related factors associated with different causes of death. Factors were assessed in relation to the type of supervision, distinguishing between those under post-custodial release and those serving a community sentence. Results: The study utilised the official data held by His Majesty's Prison and Probation Service in England and Wales on the deaths of men and women under probation supervision between 01 April 2019 and 31 March 2021 where the cause of death had been definitively recorded (n = 1770). The high risk of deaths primarily caused by external factors (i.e., suspected suicide (10%), homicide (5%), and drug-related death (26%)) in this population was confirmed. A Gaussian Graphical Model (GGM) demonstrated unique relationships with suspected suicide and drug-related deaths for known suicide risk, history of drug use and recent (< 28 days of death) enforcement action due to a breach of probation conditions. Our findings suggest that that familial violence and abuse may be relevant in suicide and drug-related deaths and that minority groups may experience disproportional risk to certain types of death. Conclusions: This study identified unique risk indicators and modifiable factors for deaths primarily caused by external factors in this population within the health and justice spheres. It emphasised the importance of addressing health inequalities in this population and improved joint-working across health and justice. This involves ensuring that research, policies, training, and services are responsive to the complex needs of those under probation supervision, including those serving community sentences. Only then can we hope to see lower rates of death within this population. [ABSTRACT FROM AUTHOR]

Drawing on interviews via letter with 64 prisoners maintaining innocence across England and Wales, this article examines the perceived institutional consequences of claiming innocence within the prison environment. A myriad of areas, ranging from everyday living conditions, risk assessment, progression to ultimately parole, are all believed to be impacted by claims of wrongful conviction. As this article illustrates, such a position is often inconsistent with Prison Service Orders and Instructions. These prisoners are thus required to engage and work within a system that is not designed for them and that they believe penalises them as a result of their claims. [ABSTRACT FROM AUTHOR]

A growing body of scholarship draws attention to prisons and environmental justice, pointing out the propensity for prisons to be located on contaminated sites and to be in close proximity to polluting industries, as well as for prisons themselves to contribute to local environmental degradation. Prisoners' immobility renders them unable to relocate away from harmful environments, and there are now numerous suggestions that their wellbeing suffers as a result of the poor quality of many local environments. However, since a relationship between environmental quality and prisoner wellbeing is yet to be robustly demonstrated, there is currently no firm evidence base from which to argue for positive change. This paper therefore examines the effect of the environmental quality of the locations of prisons, approximated as the presence of greenspace in the immediate vicinity of prisons, local species biodiversity and local levels of air and noise pollution, on wellbeing outcomes in a set of prisons in England and Wales. It finds that good environmental quality, in the form of high biodiversity and/or low air pollution, enhances the already-recognized positive effects of greenspace on the wellbeing of incarcerated populations. On the basis of these findings, this paper makes evidence-based policy recommendations intended to enhance the wellbeing of incarcerated populations. [ABSTRACT FROM AUTHOR]

Background and Aim: Prison residents are at high risk for hepatitis C virus (HCV) infection. HCV test‐and‐treat initiatives within prisons provide an opportunity to engage with prison residents and achieve HCV micro‐elimination. The aim of the prison HCV‐intensive test and treat initiative was to screen over 95% of all prison residents for HCV infection within a defined number of days determined by the size of the prison population and to initiate treatment within 7−14 days of a positive HCV RNA diagnosis. Methods: An HCV‐intensive test and treat toolkit was developed based on learnings from pilot HCV‐intensive test and treat events. From January 2020 to September 2021, 13 HCV‐intensive test and treat events took place at prisons in England selected based on high levels of reception blood‐borne virus testing and good access to peers from The Hepatitis C Trust. Results: Among a total of 8487 residents, 8139 (95.9%) underwent testing for HCV. Across the 13 prisons included, HCV antibody and RNA prevalence was 8.2% and 1.5%, respectively. The treatment initiation rate among HCV RNA‐positive individuals (n = 124) was 79.0%. Conclusion: The HCV‐intensive test and treat initiative presented here provides a feasible and rapid test‐and‐treat process to achieve HCV elimination within individual prisons. The HCV‐intensive test and treat toolkit can be adapted for rapid HCV testing and treatment events at other prisons in the United Kingdom and worldwide. [ABSTRACT FROM AUTHOR]

Despite academic, policy and charity commissioned research giving considerable attention to the health of imprisoned women, significantly less research has considered the reproductive health and rights of this group. This shortfall is noteworthy since women who are imprisoned are often in very vulnerable positions, and so their ongoing healthcare in relation to gynaecology, obstetrics and sexual health and wellbeing, as well as access to such rights, should be a priority. These issues are exacerbated for the high number of women who are repeatedly imprisoned for short sentences. Presenting findings of a rapid evidence assessment, this article highlights the lack of attention to this aspect of imprisoned women's health and rights, using the limited information available. The article argues that suitable reproductive healthcare needs to be seen as an essential aspect of women's rights. Furthermore, the current nature of imprisonment in England and Wales results in multiple and frequent rights violations. [ABSTRACT FROM AUTHOR]

A cultural initiative, 'Becoming Trauma-Informed', was introduced into prisons in England and Wales from 2015 based on the work of American clinical psychologist, Dr Stephanie Covington, and as part of a more general trend towards the recognition and treatment of trauma-related conditions in the community and in mental health settings. Becoming trauma-informed training for Prison Officers in England and Wales was carried out in all 12 women's prisons during 2015–2017 and began in the long-term high-secure male estate from May 2018. The becoming trauma-informed work is based on considerable expertise, and a deep commitment by experts and practitioners to the development of trauma-informed practice. The authors welcome this 'trauma-turn' in thinking and practice and describe an extended pilot attempt to operationalise and measure its impact on the prison experience. The results were disappointing. By highlighting challenges, and exploring meaning-in-practice, we hope to contribute to the improvement of these initiatives. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the nature and scope of dog-based programmes in prisons, assessing critically the potential opportunities, benefits, challenges and risks of developing innovative dog-based programmes for older prisoners in England and Wales. This paper outlines the potential benefits and challenges of developing dog-based programmes for older prisoners and sets out next steps for future research and practice. Design/methodology/approach: This study is based on a scoping review of published research literature on prison dog programmes (PDPs) in the USA, the UK and other countries, with particular reference to older people in prison, followed by semi-structured interviews with six members of an expert advisory group. The literature review and data from the qualitative interviews were analysed thematically. Findings: There is a substantial body of published research literature which supports PDPs as having identifiable positive impacts for people and also dogs, and also published research which highlights the benefits to older people of dog ownership or participation in dog-based activities. However, much of this research is small-scale and qualitative, and it has been argued that there is a lack of a quantitative evidence base. This research concludes that findings from the literature review and the semi-structured interviews support further research and the creation of pilot projects to develop dog-based projects for older people in prison. Research limitations/implications: This study was small-scale, and the findings need to be approached with caution. The literature review searched a small number of databases and filtered out articles published in languages other than English, and the review of the grey literature focused on reports from the UK. The number of experts interviewed was small and there was no direct consultation with older people in prison nor with older people with recent personal lived experience of imprisonment and community resettlement. A more extensive future study would benefit from a more extensive literature review, a larger group of participants and the inclusion of service users, prison managers and government policymakers, subject to the appropriate ethical and security approvals. At the time the research took place, ongoing COVID-19 restrictions on prison research meant that research with current prisoners and prison managers would not have been approved by the HMPPS NRC. Practical implications: This research provides a research-based justification for future dog projects for older prisoners, leading potentially to improved well-being for older people in prison. Originality/value: This study brings together the published research literature on PDPs with the research literature on the needs and experiences of older people in prison for the first time, and identifies potential directions for future research. [ABSTRACT FROM AUTHOR]

This article undertakes an analysis of His Majesty's Inspectorate of Prisons' (HMIP) inspection reports of Young Offender Institutions (YOIs) in England over a 20-year period. The analysis is synthesised with the author's lived experience of being both an incarcerated child in YOI and a professional working with children in custody. The analysis was instigated by a letter written by the Independent Monitoring Board (IMB) to the Rt Hon Damian Hinds, Minister of State for Justice, indicating that the current state of affairs in England's YOIs is 'positively inhumane.' The current article argues that YOIs have never been 'positively humane', having always fallen short of 'improving outcomes for children', through the lens of recidivism. The author argues that YOIs also overlook peer-led programmes to promote children desisting from offending, through illuminating a growing body of evidence which suggests this approach can provide 'hooks for change' for children to desist from crime, and that it presents a model of good practice that could be used as a child first approach. [ABSTRACT FROM AUTHOR]

Pregnancy and the first year after childbirth are a high-risk period of a woman's life, and research shows that women in prison are at heightened risk for poor mental health, self-harm, and suicide. Whilst there has been a recent focus on studies into the health care for women in prison, research looking into the specific risk factors for poor perinatal mental health in women's prisons is sparse, with the majority having been conducted within a US context that will have different provisions available and population need. This rapid evidence review explored academic literature published to identify clinical risk factors of poor perinatal mental health for women in prison in England. Following the initial search, 21 documents were identified which were then thematically analysed, resulting in the identification of 72 clinical risk factors. Meta-themes identified included 'individual', 'relationships', 'prison context', 'provision', and 'processes'. The recognition and mitigation of identified clinical risk factors is critical to ensuring quality care for women in prison and reduction of poor perinatal mental health. [ABSTRACT FROM AUTHOR]

Day Reporting Centres as an alternative to prison have become a feature of the Criminal Justice Systems of most States in America. In contrast, Day Centres have virtually disappeared from the curricula of Probation services in England and Wales. In this paper we look back on the short history of day centre provision in this country and examine what can be learned from its different forms and assess the viability of reintroducing the concept as a means of significantly reducing the use of imprisonment this side of the Atlantic. [ABSTRACT FROM AUTHOR]

Despite being the most overrepresented group of women in the Criminal Justice System (CJS), a significant lack of attention has been paid to Black women in academic literature and government policy in relation to this disparity. Using a Black feminist lens, this article seeks to illuminate the mistreatment, neglect, discrimination, and oppression experienced by Black women once in the CJS. The research highlights their voices and experiences through a process of Narrative Interviewing, one of the most effective tools for collecting data from marginalised groups, and the use of Critical Race Feminism (CRF) as the theoretical framework that assists in providing powerful counter narratives. Eight women with experience of imprisonment in England and Wales were interviewed, producing 21 in-depth interviews. This article explores key themes including racist stereotyping, poor healthcare, and poor rehabilitative services. It also presents participant's narratives alongside case examples. The data suggests that, in an already problematic system, poor treatment and negative experiences are due to intersectional factors such as race, gender, religion, and class. The article ends with some considerations of how to minimise exclusionary practices and integrating Black women's narratives into solutions to the highlighted issues. [ABSTRACT FROM AUTHOR]

Background: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. Aims: This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. Method: The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT). Results: In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact. Conclusions: Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed. [ABSTRACT FROM AUTHOR]

Background: There is evidence that prisoners have the highest rate of problem gambling in any population, but little is known about the nature of in‐prison gambling, the motives for it or how it relates to prior gambling behaviour. Aims: To investigate the prevalence and type of gambling prior to prison and the prevalence, type, and reasons for gambling in prison. Methods: Two hundred and eighty‐two male volunteers in a Category B male prison in England completed a questionnaire which included the Problem Gambling Severity Index (PGSI). Results: One hundred and twenty‐six (45%) reported gambling in prison, with eighty‐one (30%) of participants reporting that gambling was a normal part of prison life. Pre‐prison behaviour, whether type of index offence or prior gambling, had little relationship to in‐prison gambling. Frequency of gambling in prison increased with increasing PGSI risk category. The most common types of gambling in prison were card/dice games, sports and ball games, while the most common motives were entertainment, excitement or sense of challenge and to win prizes, with significant differences in motive between PGSI risk categories. Prison canteen items formed the most common currency gambled. People within the higher PGSI risk category were more likely to have borrowed items from other prisoners. Conclusions: Our research has added to existing literature by identifying high rates of gambling in prison and showing that prisoners' perceptions of gambling are as a normal part of prison life. Findings suggest that screening and support should be available to manage gambling in prison, including support to reduce gambling‐related debt, particularly given associations between debt and violence in prison. Relief from boredom and need for excitement were among the most common reasons for gambling in prison, indicating that there is a need to provide a more appropriately stimulating prison environment. [ABSTRACT FROM AUTHOR]

Introduction: From 85348 inmates in England and Wales, over 26,000 incidents of assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.Methods: Data was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome. Cost analysis of care was conducted using a previously published framework.Results: 18 cases from three regional prisons were recorded, with 67% from a single prison. Referrals rose exponentially over time, with 44% occurring in 2017. 94% were scald burns, and 56% secondary to assault, primarily through the use of kettles and mostly targeting the face and trunk. The mean TBSA of burn was 2.89% (<1-8%), and 80% received first aid. 72.2% were admitted to hospital for an average of 4 days. All burns were managed nonoperatively with dressings and underwent on average 2 outpatient reviews (1-8).Discussion: The disproportionate spread of referrals across the prisons correlates partly with the respective populations, but may also represent contrasting medical provisions. The recurring method of assault reflects the relative ease of access to hot water as a harmful agent, predominantly presenting with scalds affecting more critical areas, and with concurrent physical trauma in nearly half of cases which presents management challenges.Conclusion: Targeted education is recommended to reduce the incidence and ensure adequate management of burns in prison, referrals for which are demonstrably rising. Accordingly, the Burns Outreach team can provide training to in-house prison health staff and review referrals to specialist Burns services, aiming to ensure equitable care while alleviating costs associated with transfer to and management in hospital. [ABSTRACT FROM AUTHOR]

This study is the first to explore the relationship between domestic violence perpetration and suicidal behavior in prisoners in England and Wales. The nature of this relationship is unclear, however, understanding and reducing suicide in prisons is a critical issue for frontline staff and policy makers. Eight participants with a history of suicide attempts and domestic violence perpetration were interviewed. Five key themes were identified through thematic analysis; "Trauma, victimization and life struggles," "Relationship ideals versus relationship reality", "Explaining domestic violence", "The impact of prison" and "Suicide as a coping strategy". This study shows that the relationship between domestic violence and suicide risk in prisoners may be better understood through a pathway of experiences rather than individual risk factors. Further research is needed to test the replicability of this pathway in other samples. [ABSTRACT FROM AUTHOR]

Purpose: In the past decade, there has been growing awareness of well-being and its importance and an increase in the development of activities or programmes aimed at improving well-being. The purpose of this study is to investigate what well-being programmes were being offered to prisoners in England and Wales and what benefits and other outcomes were experienced. Design/methodology/approach: The study used a mixed-methods exploratory design in two phases. Phase 1 was a questionnaire survey of all adult prisons in England and Wales, completed by prison staff. In Phase 2, a sample of survey respondents took part in in-depth interviews. Findings: The programmes identified in Phase 1 included physical activities, creative arts, mindfulness, horticulture, reading and animal-assisted activities. Prison staff reported a range of universally positive outcomes shared by all programmes, including enthusiasm from prisoners, enjoyment of the activities and being able to do something different from the usual prison routine. However, in Phase 2, interviewees rarely mentioned direct health and well-being benefits. The impetus for programmes was varied and there was little reference to national policy on health and well-being; this reflected the ad hoc way in which programmes are developed, with a key role being played by the Well-being Officer, where these were funded. Originality/value: The literature on well-being programmes in prisons is limited and tends to focus on specific types of initiatives, often in a single prison. This study contributes by highlighting the range of activities across prisons and elucidating the perspectives of those involved in running such programmes. [ABSTRACT FROM AUTHOR]

Background: Little is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS "prison-transfer" patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too "high risk" to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community. Aim: (a) To describe the characteristics of prison-transfers who receive an RMO directed discharge fromMSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge. Methods: Prospective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk--20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community. Results: Persons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of <6 months. Individuals returned to prison displayed significantly more issues with psychological adjustment at time of discharge, and had a higher risk of future violence and a lower prevalence of protective factors that mitigate subsequent risks of relapse and reoffending. Discussion: MSs in England and Wales are returning vulnerable individuals to prison in lieu of adequate aftercare services. The role of and responsibilities of MSSs as regards admissions from prison needs to be reconsidered. [ABSTRACT FROM AUTHOR]

Almost a quarter of women released from prisons in England and Wales reoffend; this figure is three times higher for women serving less than 12-month sentences. Offender programmes used within prison, probation, and forensic inpatient services aim to reduce an individual's risk of reoffending. Whilst offence-specific interventions are widely offered to men who offend, comparatively few are offered to women. The current systematic review aimed to evaluate the efficacy of offence-specific interventions in reducing women's recidivism. Overall, recidivism in programme completers was low (m = 14.05%). However, the quality of studies included (n = 7) was low, limiting the conclusions drawn. Several studies yielded met the inclusion criteria, with the exception of reporting recidivism outcomes. A second review was conducted incorporating these studies, broadening the outcomes of interest to include incidents of violence in hospital or prison and self-report outcomes related to offending (n = 10). Incidents reduced following programme completion; however, self-reported outcomes were mixed. The review highlighted a lack of evidence for the efficacy of offence-specific interventions facilitated with women and limited use of recidivism as an outcome measure within the literature, despite often being a key aim of the interventions. [ABSTRACT FROM AUTHOR]

There has been an enormous growth in New Psychoactive Substances (NPS), sometimes erroneously referred to as 'legal highs', over the past 15 years. There are currently at least 800 such compounds, and we lack adequate data on all their effects and harms. Synthetic cannabinoid receptor agonists (SCRAs), often referred to by the generic name 'spice', are particularly notable in this regard. There has been a lack of research on forensic patients' experiences of SCRAs, their consumption, and any adverse impact they might have. This work qualitatively explored the experience of NPS and SCRA use in 19 male patients recruited from three secure forensic services in the South of England. The majority of participants discussed experiences of using SCRAs whilst in prison as opposed to their current forensic hospital admission. Three key themes emerged which describe participants experiences of SCRA use: (i) perpetuating cycle of drug use, mental ill-health, and crime; (ii) environmental injustices and consequences; and (iii) shame and stigma associated with SCRA use. The findings provide insights into the challenges faced by forensic patients as a result of SCRA use, as well as notable opportunities. A common call was for greater psychoeducation on drug harms and treatment opportunities. [ABSTRACT FROM AUTHOR]

In England and Wales, there has been considerable work over recent years to reduce the numbers of deaths in custody. Currently, there is no standard, internationally agreed definition of a death in custody, which limits comparisons. In addition, rates of death in custody are often reported per country or region inhabitants, but it would be more useful to report per number of detainees. In this short communication, we present data on deaths in individuals who have been detained in England and Wales between 2016 to 2019. We also present a method to calculate rates of death per custodial population in key settings using routine data, allowing for more consistent comparisons across time and different settings. Most deaths in custody between 2016–2019 occurred in prisons (56% of all deaths in custody over 2016–19; Table 1). However, when rates are considered, those detained under the Mental Health Act had the highest rate of deaths, which ranged from 1103–1334/100,000 persons detained. Around one in five deaths were self-inflicted. The data presented highlights the need to maintain focus on improving the physical health and mental health of all those detained in custody, both whilst in detention and after release. [ABSTRACT FROM AUTHOR]

This paper demonstrates for the first time that prisons with a higher proportion of natural vegetation within their perimeter have lower levels of staff sickness absence. It makes three significant contributions. First, it extends studies of workplace nature contact into the un-researched carceral context. Second, whereas previous workplace nature contact studies have largely utilized single-site surveys, it presents national-level, statistically robust analysis. Third, it brings a novel new perspective to studies of sickness absence within correctional workforces, by considering the effect of the physical environment. Econometric estimations presented in the paper confirm lower levels of staff sick-leave in prisons with more greenspace. This relationship persists when we control for prison size, security level, age, level of crowding, levels of self-harm and violence among prisoners, and assaults against staff. The findings are significant in demonstrating the benefits of nature contact in workplaces in general, and carceral environments in particular. Importantly, this has the potential to influence future prison design. [ABSTRACT FROM AUTHOR]

Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases. Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors. Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons. Results: The UK Government's Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants. Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons. [ABSTRACT FROM AUTHOR]

Background: Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU).Methods: The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016.Results: Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs - Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI - 0.276 to 0.449, p = 0.621). No adverse events were reported.Conclusion: The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU.Trial Registration: Current Controlled Trials: ISRCTN11841493 , 25/10/2012. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to outline qualitative research into what influences, maintains and reduces prolific self-harm within women's prisons across England. Design/methodology/approach: Semi-structured interviews were conducted with participants who were identified as engaging in prolific self-harm. Thematic analysis was applied to two data sets, and analyses were combined to generate final themes. Findings: Six overarching themes were identified which served to explain what influences the repetitive nature of prolific self-harm and also what helps to reduce it. The themes were reasons for self-harm, trauma, being in prison, support, other support and interventions: management and rehabilitative. Research limitations/implications: Owing to the sensitive nature of the research a stringent exclusion criteria was applied which limited the data sample from the original pool. Variance in detail was observed from the interviewer transcripts. The data sample was not large enough to examine the influence of protected characteristics. Practical implications: Responsivity in the support offered by staff is critical to a reduction in repetitive harm. A re-focus on staff training, plus support mechanisms for staff supporting people in women's prisons who self-harm prolifically has been recommended. Originality/value: This paper has focussed specifically on prolific self-harm within women's prisons. This has not been an area that has been investigated separately to the general self-harm literature in prisons. This paper provides insight into factors which influence, maintain and reduce prolific-self harm in women residing in prison. [ABSTRACT FROM AUTHOR]

This article explores how the 2013 Woolwich murder in the streets of London and the conflict in Syria "played out" in one high security prison in the north of England. Building on research that has advocated for approaches that study prisons as inextricably connected to the outside world, it explores how wider anxieties and "moral panics" over Islam and extremism are configured locally in a high security prison. It utilizes ethnographic description that attends to feelings, the body, sounds and visual materials as spatializing tools that mark "place" and define social boundaries. A description of ordinary prison spaces – the chapel, workshops, and a staff office – shows practices that transform these spaces into "battlegrounds" of ethno-religious and geopolitical tension. [ABSTRACT FROM AUTHOR]

A wealth of literature exists detailing the nature and extent of sexual activity in the US penal estate while little attention has been paid to the subject in English prisons. The purpose of this article is to explore the nature of sexual activity occurring in a medium security sex offender only prison in England. Based on a six-month prison ethnography including 30 semi-structured interviews, it will be shown that sex offenders engage in sexual activity whilst in prison despite the prohibition on sexual activity. For sex offenders, prison sex is not solely about the performance of masculinities, power and dominance, but was instead used for sexual gratification and the sexual exploitation of others. The exploitative nature of the sexual activity was inextricably linked to the sub rosa economy of the prison. As such, prison sex for sex offenders is qualitatively different to previous depictions of prison sex among mainstream offenders. [ABSTRACT FROM AUTHOR]

Purpose: The outbreak of the severe acute respiratory syndrome coronavirus 2 virus and subsequent COVID-19 illness has had a major impact on all levels of society internationally. The extent of the impact of COVID-19 on prison staff and prisoners in England and Wales is unknown. Testing for COVID-19 both asymptomatic and symptomatic, as well as for antibodies, to date, has been minimal. The purpose of this paper is to explore the widespread testing of COVID-19 in prisons poses philosophical and ethical questions around trust, efficacy and ethicacy. Design/methodology/approach: This paper is both descriptive, providing an overview of the widespread testing of COVID-19 in prisoners in England and Wales, and conceptual in that it discusses and argues the issues associated with large-scale testing. This paper provides a discussion, using comparative studies, of the issues associated with large-scale testing of prisoners across the prison estate in England and Wales (120 prisons). The issues identified in this paper are contextualised through the lens of COVID-19, but they are equally transferrable to epidemiological studies of any pandemic. Given the prevalence of COVID-19 globally and the lack of information about its spread in prisons, at the time of writing this paper, there is a programme of asymptomatic testing of prisoners. However, there remains a paucity of data on the spread of COVID-19 in prisons because of the progress with the ongoing testing programme. Findings: The authors argue that the widespread testing of prisoners requires careful consideration of the details regarding who is included in testing, how consent is gained and how tests are administered. This paper outlines and argues the importance of considering the complex nuance of power relationships within the prison system, among prisoner officers, medical staff and prisoners and the detrimental consequences. Practical implications: The widespread testing of COVID-19 presents ethical and practical challenges. Careful planning is required when considering the ethics of who should be included in COVID-19 testing, how consent will be gained, who and how tests will be administered and very practical challenges around the recording and assigning of COVID-19 test kits inside the prison. The current system for the general population requires scanning of barcodes and registration using a mobile number; these facilities are not permitted inside a prison. Originality/value: This paper looks at the issues associated with mass testing of prisoners for COVID-19. According to the authors' knowledge, there has not been any research that looks at the issues of testing either in the UK or internationally. The literature available details countries' responses to the pandemic rather and scientific papers on the development of vaccines. Therefore, this paper is an original review of some of the practicalities that need to be addressed to ensure that testing can be as successful as possible. [ABSTRACT FROM AUTHOR]

This article examines women's experiences of participating in 'Healing Trauma'; a gender‐responsive, trauma‐informed intervention delivered in women's prisons in England. Victimisation and trauma are prevalent among women in the justice system but are not perceived to be amenable to criminal justice intervention, and there are compelling arguments that correctional environments are inappropriate settings for trauma‐informed programmes. This article analyses focus group discussions with women who completed Healing Trauma to examine the legitimacy of developing trauma‐informed practice in prisons. The women's testimonies indicate that Healing Trauma offers a meaningful opportunity to begin to explore past victimisation that has contributed to their criminalisation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the social needs and experiences of older prisoners who were attending one of two social initiatives in a prison in England. Design/methodology/approach: This paper is based on an interpretative phenomenological study, conducted in a prison in the South West of England. Older prisoners attending an initiative implemented for those over 55, a purposive activity or a social task group, participated in focus groups, which were audio recorded and thematically analysed. Findings: Two overarching themes were identified. Firstly, the need to feel safe: prisoners felt attending an initiative provided them with a safe haven away from noisy and boisterous younger prisoners, who they perceived as different from them and who received preferential treatment. Secondly, being provided with a purpose: prisoners felt they belonged among their peers, which motivated them to attend and support group activities. Research limitations/implications: This study was completed in one prison. However, both initiatives supported the social needs of older prisoners and enabled them to leave their cells, although they felt unsafe when not attending an initiative. Originality/value: There remains a need to support the process of integrating younger and older prisoners, by the provision of both integrated and separate initiatives, with the aim of developing cross-generational and bi-directional peer support. [ABSTRACT FROM AUTHOR]

Background: Homicide rates have fallen markedly in the UK over the past decade. There has been little research on whether homicides by people with mental disorder have contributed to this downward trend. Furthermore, there is limited information on trends in court outcomes for people with mental disorder who commit homicide. Aims: To examine trends in general population homicide and homicide by people with mental disorder, and to explore court outcome. Method: We conducted a national, consecutive case series of homicide in England and Wales (1997–2015). Data were received from the Home Office Statistics Unit of Home Office Science. Clinical information was obtained from psychiatric reports and mental health services. Results: There has been a fall in the homicide rate in England and Wales since 2008. Despite this, the relative contribution of mental disorder as a proportion of all homicide has increased. Our findings also showed the inappropriate management of people with serious mental illness convicted of homicide. Of those who committed homicide and were diagnosed with schizophrenia, a third were imprisoned, and there was a marked fall in hospital order referrals. We found this to be linked to substance misuse comorbidity. Conclusions: The proportional increase in homicide by people with schizophrenia suggests more complex factors may be driving rates, such as substance misuse. Addressing substance misuse comorbidity and maintaining engagement with services may help prevent patient homicide. Despite their complex needs, people with serious mental illness continue to be imprisoned. Improvements in assessment and the timely transfer of prisoners to health services are required. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine lived experiences of opioid agonist treatment (OAT) during and immediately following release from detention in prisons in England and Scotland., Design/methodology/approach: Surveys were completed by serving prisoners in both countries and by those recently released from prison (England only). The survey findings were discussed in focus groups of people with lived experience. The combined findings from the surveys and focus groups were shared with an expert group of prison OAT providers and people with lived experience with the purpose of making recommendations for more accessible and effective OAT in custodial environments and continuity of OAT on release., Findings: The quality and accessibility of OAT varied considerably between establishments. It was reported to be harder to access OAT in Scottish prisons. It was often hard for people in prison to get the dosage of OAT they felt they needed and it was generally harder to access buprenorphine than methadone in English prisons. Only Scottish people in prison were aware of long-lasting forms of buprenorphine. People in English prisons had mixed experiences of the help available in prison, with no improvement recorded since a 2016 study. People in Scottish prisons were more likely to rate the help available as poor., Research Limitations/implications: The number of people accessed while actually in prison (73) was reduced by the impact of the pandemic, making it more difficult to access people in prison and because some were resistant to participating on the basis that they had already been consulted for a wide variety of research projects focused on the impact of COVID. The Scottish cohort (a total of 19 individuals comprising 14 survey respondents and five focus group members) is clearly too small a number on which to base robust claims about differences in OAT provision between the English and Scottish prison systems.., Practical Implications: The study identifies key barriers to accessing OAT in prisons and suggests key components of more user-friendly approaches., Social Implications: This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release and offers valuable recommendations on how to make service provision more effective and consistent., Originality/value: This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release in England and Scotland and offers valuable recommendations on how to make service provision more effective and consistent., (© Emerald Publishing Limited.)

In the United Kingdom, prisoners with mental disorder who require inpatient treatment may be transferred to hospital under mental health legislation. This retrospective service evaluation of 75 prisoners across Scotland aimed to evaluate transfers and their duration under the Mental Health (Care and Treatment) (Scotland) Act 2003. The median time from referral to transfer was 12 days, a result much shorter than reported timescales in England. Transfer duration was affected only by the level of security the prisoner was transferred to. Findings from this study support the case for increasing the provision of secure beds across the country and designing much needed specialised forensic services. [ABSTRACT FROM AUTHOR]

There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty's Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a 'whole-prison approach' to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective. [ABSTRACT FROM AUTHOR]

Background: A simplified cascade‐of‐care may improve screening and treatment uptake among incarcerated individuals. We assessed the cost‐effectiveness of traditional and simplified screening and treatment in a London remand prison. Methods: Using empirical data from Her Majesty's Prison (HMP) Wormwood Scrubs, London, we designed a decision tree and Markov transition state model using national average data for HCV screening and treatment for the base‐case scenario. This compared two alternative strategies; (a) general prison population screening and treatment and (b) prioritising screening and treatment among people who inject drugs (PWID) combined with general prison population screening and treatment. Strategies varied the rates of screening (47%‐90%), linkage‐to‐care (60%‐86%) and treatment (21%‐85%). Cost, utility and disease transition rates were obtained from existing literature. Outcome measures were as follows: screening, treatment and disease‐related costs per admitted individual, quality‐adjusted life years (QALYs). Incremental cost‐effectiveness ratios (ICERs) were calculated for each intervention. All costs and utilities were discounted at a rate of 3.5% per annum. Both univariate and probabilistic sensitivity analyses have been conducted. Results: In our cohort of 5239 incarcerated individuals with an estimated chronic HCV prevalence of 2.6%, all strategy ICER values (£3565‐10 300) fell below the national willingness to pay threshold (£30 000). Increased successful treatment (7%‐54%) was observed by an optimising cascade‐of‐care. A robust sensitivity analysis identified treatment cost of, QALY for mild liver disease and probability of completing treatment as important factors that impact the ICER value. Conclusion: In our remand setting, optimising adherence to the cascade‐of‐care is cost‐effective. Where universal screening is not practical, a stratified approach focused on intensive screening and treatment of PWID also results in increased treatment uptake and is highly cost‐effective. [ABSTRACT FROM AUTHOR]

Procedural justice (PJ) theory suggests that if incarcerated people perceive their treatment to be fair and just, greater acceptance of staff authority, less misconduct, better mental health, and improved recidivism outcomes will follow. This study developed a measure of and explored PJ perceptions for people in English and Welsh prisons. Factor analysis was used to create a 27-item PJ measure, using data from around 20,000 people who completed the Measuring quality of prison life survey during a 4-year period. The measure had good internal consistency. We found differences in perceptions across groups of people and prison types. Poorer perceptions were weakly associated with self-harm and attempted suicide. There was a negative association between perceptions and misbehavior/incidents in custody, although PJ perceptions were not a significant predictor of incidents. [ABSTRACT FROM AUTHOR]

Since 2010, synthetic cannabinoid receptor agonists (SCRAs) have dominated concerns about drug use in prison; particularly as their use increases in custody and has profound impacts on users, non-users and prison staff. However, far less is known about whether SCRA use continues on release, when ex-prisoners are under the supervision of Community Rehabilitation Companies or resident in Approved Premises (APs). This study, the first of its type, examined experiences of SCRAs amongst recently released ex-prisoners and found that, most often, use discontinues on release, suggesting that SCRAs are seen predominantly as a 'prison drug' or, for those continuing use, as a way to avoid a positive drug test and/or breaching their licence whilst living in an APs. Awareness of SCRA use amongst their clients differed notably between Community Rehabilitation Company staff and APs staff; with the former having far less awareness and thus, also far less experience of the associated problems for supervision of their clients. [ABSTRACT FROM AUTHOR]

Purpose: There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required to understand health promotion in prison. The purpose of the paper is to examine the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments.Design/methodology/approach: Independent prison inspections, conducted by Her Majesty's Inspectorate of Prisons for England and Wales, form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis.Findings: Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data show examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change.Practical Implications: Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment.Originality/value: This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to evaluate the current service provision offered by a mental health service in a young offenders institute (YOI) in England. Design/methodology/approach: A qualitative exploratory approach was adopted. Five prison officers (POs) (four male and one female) with direct experience supporting young people through mental health intervention were interviewed using semi-structured interviews. Data was analysed using thematic analysis (Braun and Clarke, 2006), which allowed evaluation of the current mental health provision to evolve. Findings: Five overarching themes (process of referrals; intervention and its impact; role and function of the health and well-being team; collaboration and involvement; and feedback, communication and intervention) were found to be highly salient when evaluating service provision. Notably all themes interrelated with one another, demonstrating that changes or improvements made to the service need to consider all factors individually and collectively. Research limitations/implications: This study was based on a small sample of POs in only one YOI in England, and therefore cannot be generalised to the entire prison estate. However, it does offer a rich insight into local service provision from the perspective of a group whose opinion is rarely sought. Practical implications: POs' perspectives of service provision are important in informing service developments. Lessons can be learnt from their unique insight into how prison mental health services are run to improve processes and collaborative working in the management of young offenders with mental health difficulties. Originality/value: This preliminary and exploratory study is, to the best of the authors' knowledge, the first study evaluating service provision by using the perspectives of POs. The findings suggest that POs make valuable contributions to the service development and should be involved in similar evaluations in future. [ABSTRACT FROM AUTHOR]

Taking as its focus a wall painting at Pittleworth Manor, Hampshire, this essay investigates the concepts of place and of dwelling as they were understood and experienced in Renaissance England, particularly by those without a true dwelling-place. The anonymous painting, dated 1580, represents the Biblical story of rich Dives and the beggar Lazarus. It articulates the position of the placeless both in life and after death, and questions what it really takes to "dwell" in this life. The owner of Pittleworth was himself concerned with place-making in a different way, for as the hereditary prison-keeper of Winchester he enabled his co-religionists, recusant Catholics, to turn their prison into a dwelling. The wall-painting declared that he shared with his community values of hospitality and charity when in fact their positions diverged considerably. [ABSTRACT FROM AUTHOR]

Throughout the world, women involved in criminal justice systems often present with substantial needs and vulnerabilities. Diverting vulnerable people away from prison is government policy in England and Wales, but full psychiatric and social assessments are expensive and hard to access. A screening and quick response initiative - alternatives to custodial remand for women (ACRW) - was implemented across three areas of London (West, South and East) to supplement existing court liaison and diversion services, to assess the feasibility of a supplementary custodial remand service as part of a women's specialist service pathway in the criminal justice system in England. Three mental health trusts and two voluntary sector providers offered this service enhancement - a screening and service link provision in three London boroughs between 2012 and 2014. We conducted a service evaluation using routinely collected service use record data. The service made 809 contacts, of whom 104 had contact on multiple occasions. Many were identified as at risk of self-harm (46%) or had histories of hospital admission for mental disorder (36%), but few were referred either to the liaison and diversion service or specialist mental health services. The largest group of referrals was to women's community services outside the health service (e.g. counselling, domestic violence or sexual abuse services). 180 women had dependent children and 22 were pregnant, increasing the urgency to find non-custodial alternatives. As well as confirming high levels of need amongst women entering the criminal justice system, this evaluation confirms the feasibility of working across sectors in this field, providing an extra layer of service that can complement existing liaison and diversion service provision. The service was responsive and most women using it were kept out of custody. Research is now required to understand the appropriateness of the referrals, the extent to which women follow them through and the impact on their mental health and desistance from offending. [ABSTRACT FROM AUTHOR]

The world's prison population is aging. Older prisoners, those aged 50 years and older, are at risk of poor health and developing a dementia. Prisoners with dementia may present challenges to the regime within the prison and require extra support. However, prison staff and health and social care professionals have reported a lack of skills and knowledge to identify and support prisoners with dementia. This may be due to a lack of dementia education programs developed specifically for the prison setting and delivered comprehensively for all who work with prisoners. The aim of this article is to describe the development and implementation of a dementia education workshop for the prison setting that is suitable for all prison staff, prisoners, and health and social care professionals. [ABSTRACT FROM AUTHOR]

This article acts as a reflexive account of my experience of doing qualitative research with d/Deaf people in a prison setting. This research was the first in England and Wales (excluding small-scale unpublished undergraduate dissertations) to include semi-structured interviews with multiple d/Deaf prisoners, and thus the journey documented is both innovative and unique. Because I was entering unmarked territory methodologically, my experience was laden with obstacles, as is discussed throughout. Key issues explored relate first to the process of gaining access to d/Deaf prisoners, second to researcher–participant language barriers, and third to issues of ethics and authenticity generated by the Deaf participants' preference for a visual language (British Sign Language) in a setting like prison. Guidance is given throughout about how to overcome complex methodological issues, and concluding remarks include a set of recommendations for prospective researchers. [ABSTRACT FROM AUTHOR]

Background. Self-harm is common in prisoners. There is an association between self-harm in prisoners and subsequent suicide, both within prison and on release. The aim of this study is to develop and evaluate a prediction model to identify male prisoners at high risk of self-harm. Methods. We developed an 11-item screening model, based on risk factors identified from the literature. This screen was administered to 542 prisoners within 7 days of arrival in two male prisons in England. Participants were followed up for 6 months to identify those who subsequently self-harmed in prison. Analysis was conducted using Cox proportional hazard regression. Discrimination and calibration were determined for the model. The model was subsequently optimized using multivariable analysis, weighting variables, and dropping poorly performing items. Results. Seventeen (3.1%) of the participants self-harmed during follow up (median 53days). The strongest risk factors were previous self-harm in prison (adjusted hazard ratio [aHR] = 9.3 [95% CI: 3.3-16.6]) and current suicidal ideation (aHR= 7.6 [2.1-27.4]). As a continuous score, a one-point increase in the suicide screen was significantly associated with self-harm(HR=1.4, 1.1-1.7). At the prespecified cut off score of 5, the screening model was associated with an area under the curve (AUC) of 0.66 (0.53-0.79), with poor calibration. The optimized model saw two items dropped fromthe original screening tool, weighting of risk factors based on amultivariablemodel, and an AUC of 0.84 (0.76-0.92). Conclusions. Further work is necessary to clarify the association between risk factors and selfharm in prison. Despite good face validity, current screening tools for self-harm need validation in new prison samples. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.Design/methodology/approach: A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).Findings: Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.Originality/value: Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff. [ABSTRACT FROM AUTHOR]

Women's Enhanced Medium Secure Services (WEMSS) was a concept borne out of findings that an inappropriate number of women were being held in high secure services, despite not fulfilling high secure criterion. A qualitative study of women service users' views of living in WEMSS and comparator medium secure services (MSS) in the UK is presented. Sixteen service users participated in semi-structured interviews. Thematic analysis identified four main themes: experiences of current placement versus previous placements, relationships with staff, challenges of living with other women and having a voice – being involved in care and treatment. The accounts reported suggest that women in WEMSS and standard MSS have very similar experiences of their service, relationships with staff, living with other women and involvement in care. This qualitative study suggests that women in WEMSS and comparable women in MSS have very similar perspectives on what works well in their current services and what is important to them. The main differences between WEMSS and MSS women's accounts were in relation to the amount of pre-transfer information they received and levels of staff support. Implications for practice are discussed, including service-user empowerment addressing barriers to relational security. [ABSTRACT FROM AUTHOR]