Characteristics of women in a prison mental health assessment unit in England and Wales (2008-2010)

Co-producing a complex psychosocial intervention during COVID-19 with young people transitioning from adolescent secure hospitals to adult services in England: Moving Forward intervention (MFi)

BACKGROUND

Young people moving from adolescent secure hospitals to adult care present with multiple and complex needs which often remain unmet during transition periods. This paper delineates the process of developing and co-producing the moving forward intervention (MFi), which aims to address the psychosocial needs of transitioning youth who have limited access to well-researched and tailored service provisions.

METHOD

An extensive search of the relevant literature was conducted to generate themes and guide the co-production phase. Fourteen Advisory Group Meetings were held virtually during COVID-19 to design the MFi module content with 17 keyworkers, 2 parents and 13 young people aged 17-18 years across six adolescent secure hospitals in England. Thematic analysis was used to reflect on the field notes discussed in the Advisory Groups.

RESULTS

Co-produced themes from the literature and the Advisory Groups informed the development of the proposed intervention. Three overarching themes pertinent to expectations in adult services, improving communication gaps between services and facilitating the letting go period emerged from the co-production phase. It was suggested the MFi is co-delivered by a peer with lived experience to build trust and create hopefulness among young people. The importance of promoting graded transitions through standardised procedures was highlighted.

CONCLUSIONS

The current findings promote evidence-based initiatives and build robust practice frameworks that inform treatment and policy guidelines. The young people, parents and keyworkers found the MFi supportive and valued the co-production experience. As such, co-production has been a vital tool in promoting patient engagement and empowerment, and reducing service inequalities, especially in adolescent secure hospitals.

The Process of Becoming a Mother in French Prison Nurseries: A Qualitative Study

BACKGROUND

Many variables can influence the process of motherhood, including environmental precarity and personal adversity. One about which little is known is the impact of incarceration on women during or after pregnancy. In France, pregnant women or those with children up to 18 months old can be incarcerated with their child in specific units called nurseries. We sought to explore incarcerated women's experience of motherhood in prison environments and its potential consequences on the construction of their identity as mothers.

METHOD

We conducted semi-structured interviews to collect the experience of the process of motherhood among 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data.

RESULTS

Four different themes emerged: prison conflates their status as inmates and as mothers; it limits their freedom as mothers; it disrupts their family structure; and motherhood may help distinguish them from other inmates.

CONCLUSION

Incarceration of pregnant women or young mothers in prison nurseries might disrupt the process involved in becoming mothers, causing their identities as prisoners to englobe their identities as mothers and resulting in inappropriate parenting support by prison staff. A professional specialized in peripartum issues should help each woman disentangle her identity as inmate and mother and enable her placement at the facility best adapted to her individual needs as a mother. In any case, if prison must continue to be possible, it must always be a last alternative for women with young children.

Alternatives to custodial remand for women in the criminal justice system: A multi-sector approach

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.

Contemporary women prisoners health experiences, unique prison health care needs and health care outcomes in sub Saharan Africa: a scoping review of extant literature

BACKGROUND

Sub Saharan African (SSA) prisons have seen a substantial increase in women prisoners in recent years. Despite this increase, women prisoners constitute a minority in male dominated prison environments, and their special health needs are often neglected. Research activity on prison health remains scant in SSA, with gathering of strategic information generally restricted to infectious diseases (human immunodeficiency virus infection HIV/tuberculosis TB), and particularly focused on male prisoners. Health care provisions for women (and pregnant women) in SSA prisons are anecdotally reported to fall far short of the equivalence care standards mandated by human rights and international recommendations, and the recent agreements set out in the Southern African Development Community (SADC) Minimum Standards for HIV in Prisons.

METHODS

A scoping review mapped what is currently known about women prisoners' health experiences, unique prison health care needs and health care outcomes in SSA. A systematic search collected and reviewed all available and relevant published and grey literature (2000-2017). Following removal of duplicates and application of exclusion measures, 46 records remained, which represented 18 of the 49 SSA countries. These records were subsequently charted and thematically analysed.

RESULTS

Three themes were generated; 'The Prison Regime'; 'Navigating inside the Prison Health Infrastructure' and 'Accessing the outside Community and Primary Care Health Services'. Women in SSA prisons experience the same substandard nutrition, overcrowding and unhygienic conditions which exacerbate poor health and infectious disease transmission as males. Human rights abuses, substandard prison conditions and poor access to prison based and community clinical care, along with the invisible nature of women and that of their unique health needs are deplorable.

CONCLUSIONS

The review has highlighted the dearth of gender specific strategic information on women prisoners in the region, appalling environmental conditions and prison health care provision, and violation of human rights for those incarcerated. Enhanced donor support, resource allocation, prison health and population health policy reform, health systems surveillance and gender sensitive prison health service provision is warranted. This will help address women prisoners' conditions and their specific health needs in SSA prisons, and ultimately bridge the gap between prison and population health in the region.

Health and healthcare access among Zambia's female prisoners: a health systems analysis

Background

Research exploring the drivers of health outcomes of women who are in prison in low- and middle-income settings is largely absent. This study aimed to identify and examine the interaction between structural, organisational and relational factors influencing Zambian women prisoners’ health and healthcare access.

Methods

We conducted in-depth interviews of 23 female prisoners across four prisons, as well as 21 prison officers and health care workers. The prisoners were selected in a multi-stage sampling design with a purposive selection of prisons followed by a random sampling of cells and of female inmates within cells. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems.

Results

We identified compounding and generally negative effects on health and access to healthcare from three factors: i) systemic health resource shortfalls, ii) an implicit prioritization of male prisoners’ health needs, and iii) chronic and unchecked patterns of both officer- and inmate-led victimisation. Specifically, women’s access to health services was shaped by the interactions between lack of in-house clinics, privileged male prisoner access to limited transport options, and weak responsiveness by female officers to prisoner requests for healthcare. Further intensifying these interactions were prisoners’ differential wealth and access to family support, and appointments of senior ‘special stage’ prisoners which enabled chronic victimisation of less wealthy or less powerful individuals.

Conclusions

This systems-oriented analysis revealed how Zambian women’s prisoners’ health and access to healthcare is influenced by weak resourcing for prisoner health, administrative biases, and a prevailing organisational and inmate culture. Findings highlight the urgent need for investment in structural improvements in health service availability but also interventions to reform the organisational culture which shapes officers’ understanding and responsiveness to women prisoners’ health needs.

Prison Mental Health In-reach: The Effect of Open Referral Pathways

In England and Wales, mental health in-reach teams manage high levels of mental disorder in prisons, but problems with reception screening and referral triage have been identified. As one potential solution, we examined the effect of an open referral pathway upon one in-reach team by evaluating its referrals and caseload across two time periods (in 2008 and 2011). There was a doubling of team referrals (from 101 to 203) with significantly improved identification of people with no mental health history. There was further evidence for a lowering of thresholds for referral and assessment, an approach that can be seen as helpful within a system that is known to under-identify mental health problems. Despite limitations, this evaluation offers some evidence for the effectiveness of open referral systems. It also raises questions about the potential effects of liaison and diversion services that are presently being piloted for national introduction.

Assaults by Mentally Disordered Offenders in Prison: Equity and Equivalence

Managing the violent behaviour of mentally disordered offenders (MDO) is challenging in all jurisdictions. We describe the ethical framework and practical management of MDOs in England and Wales in the context of the move to equivalence of healthcare between hospital and prison. We consider the similarities and differences between prison and hospital management of the violent and challenging behaviours of MDOs. We argue that both types of institution can learn from each other and that equivalence of care should extend to equivalence of criminal proceedings in court and prisons for MDOs. We argue that any adjudication process in prison for MDOs is enhanced by the relevant involvement of mental health professionals and the articulation of the ethical principles underpinning health and criminal justice practices.