By Polly Wright (P. Wright Consultancy).

For the purposes of this report we refer to the individual in custody as the ‘patient’, as their experiences are considered in terms of their health and wellbeing needs. Families’ experience of the impact of the criminal justice system on the health and wellbeing of patients.

Messages from families Where patients present complex and/or significant mental health needs, alternative diversionary treatment should be more readily considered (in line with Public Protection requirements). This should be informed by all agencies currently working with the patient, as well as their family/ significant others (where appropriate). Care not custody required Many of the families consulted felt that their loved ones’ involvement in the criminal justice system was as a result of persistent, systemic failure of services (education, social care, health and/or criminal justice) to meet their needs. Almost a third of families described their loved one as having an acute mental health crisis immediately prior to their contact with the criminal justice system. While families acknowledged patients had committed a criminal offence, many felt that the criminal justice system had failed to effectively consider alternative diversionary treatment appropriate to the patients’ needs. Potential for positive health outcomes Families acknowledged that when the criminal justice system works well, positive health outcomes can be achieved and for some patients, contact with the criminal justice system had had a positive impact as it had provided: consistent access to ongoing support the opportunity to receive mental health diagnosis and treatment that had not been forthcoming in the community removal of risks associated with previous lifestyle quicker access to healthcare access to peer support. Custody as a barrier to positive health outcomes The majority of families witnessed a significant decline in their loved ones’ mental and physical health during their custodial sentence. They attributed this to numerous and inter-related systemic factors including: the pr

London: PACT (Prison Advice and Care Trust) 2023. 80p.

By Miranda Davies, Rachel Hutchings and Eilís Keeble

There were 11,494 people under 25 years of age in young offender institutions and prisons in England and Wales as of 31 December 2022, representing 14% of the total population in custody. While the number of children (under 18) in secure settings has fallen sharply over the past 15 years, very serious challenges remain over the use of force in the children’s secure estate, with ongoing concern over children being held in solitary confinement, some for extended periods. From a legal perspective, young people are treated as adults from the age of 18 within the criminal justice system, but there is recognition of the needs of 18- to 25-year-olds as ‘young adults’ (see the work of t2a.org.uk), distinct from the needs of children or other adults. This analysis uses routinely collected hospital data to look at the service-use patterns of children and young adults aged 25 and under in young offender institutions and prisons in England. We engaged with experts and looked at the literature to consider this in the context of the key health care needs of young people. Looking across the children’s secure estate as well as the adult estate provides a novel perspective on the key health care issues for young people, allowing us to compare experiences in the so-called ‘children and young people secure estate’, which caters for those aged 18 and under and is run as a distinct part of the custodial estate, with those in the adult estate, which manages young adults alongside prisoners in older age groups. Understanding how health care access and needs differ is important, because the distinction between the two parts of the system is becoming increasingly blurred. Recently, population pressures in the adult estate have led to an increase in the number of young people aged 18 or over in the children’s secure estate, which will drastically alter the age profile of the children’s secure estate population.

A summary of the key findings and some considerations for policy-makers are provided below. We found that some of the biggest problems affecting the adult prison estate – violence and self-harm – have a disproportionate impact on young adults. We consider how the prison service can meet the needs of young people in custodial settings, and the benefits of providing tailored support for young adults in particular.

London: Nuffield Trust, 2023. 55p.

By Miranda Davies, Lucina Rolewicz, Laura Schlepper and Femi Fagunwa

There were, on average, 83,000 people in prison in England and Wales at any one time last year, yet relatively little is known about prisoners’ physical health care needs; how and why they access hospital services; and whether their physical health needs are being adequately met. Drawing on over 110,000 patient hospital records for prisoners at 112 prisons in 2017–18, this study provides the most in-depth look to date at how prisoners’ health needs are being met in hospital. Prisoners use hospital services far less and miss more hospital appointments than the general population • Prisoners had 24% fewer inpatient admissions and outpatient attendances than the equivalent age and sex demographic in the wider population, and 45% fewer attendances at accident and emergency departments. • 40% of outpatient appointments for prisoners were not attended (32,987 appointments) – double the proportion of non-attended appointments in the general population. Our research found that the value of non-attended appointments by prisoners in 2017/18 where no advanced warning was given equated to around £2 million for the NHS. Prisoners have particular health needs related to violence, drug use and self-harm • Injury and poisoning were the most common reason for prisoners being admitted to hospital, accounting for 18% of cases (2,169 admissions) compared to 6% of all admissions in the general population (aged 15+). • Psychoactive substance use was recorded in more than 25% of all inpatient admissions by prisoners in 2017/18. Hospital data reveals potential lapses of care within prisons for certain groups of prisoners • Six prisoners gave birth either in prison or on their way to hospital, representing more than one in 10 of all women who gave birth during their prison stay. • There were 51 hospital admissions by 39 prisoners with diabetes as a result of diabetic ketoacidosis (DKA), an avoidable and potentially life-threatening complication of diabetes caused by lack of insulin. This analysis points to two key areas where more focused policy attention could result in improvements to prisoner health: improving prisoners’ access to hospital care and making better use of hospital data. We therefore make the following recommendations for the five public authorities involved in the National Partnership Agreement for Prison Healthcare – the Ministry of Justice, Her Majesty’s Prison and Probation Service, Public Health England, the Department of Health and Social Care, and NHS England – as well as prisons, health care providers, commissioners, and the research community .

London: Nuffield Trust, 2020. 83p.

By Miranda Davies, Rachel Hutchings, Eilís Keeble and Laura Schlepper

The number of older people in prison in England and Wales is increasing, but prisons are not well set up to meet health care needs associated with ageing. Between 2010 and 2022, the number of prisoners aged 50 or older increased by 67% (from 8,263 to 13,835),2 and is predicted to increase to 14,800 by July 2025.3* Prisoners tend to be in poorer health than the general population, and this is particularly the case for older prisoners, who are considered to be ‘older’ from the age of 50 in recognition of their additional health care needs. Tough conditions in prison – regime constraints, poor living conditions and the threat of violence – disproportionately affect older prisoners, but these are not new problems. The extent to which the needs of older people in poor health can be met effectively in a prison setting is questionable, given the multiple competing priorities. For this work we used routinely collected hospital data to look at the health care needs of older people in prison in England. A summary of the key findings and considerations for policy-makers are provided below. We found significant health care needs associated with frailty among our older prisoner population. We consider the implications for the prison service of managing increasing numbers of older prisoners as the population continues to age.

London: Nuffield Trust, 2023. 51p.

By The Independent Monitoring Boards

Independent Monitoring Boards (IMBs) monitor and report on the conditions and treatment of those detained in every prison in England and Wales. The government recently rejected the Justice Select Committee’s recommendation for a resentencing exercise to take place for anyone serving an IPP sentence. IMBs submitted current findings on the impact of this decision, and the sentence itself, on IPP prisoners’ wellbeing. This briefing summarises findings from 24 IMBs submitted between 17 February and 9 March 2023 and references two 2021-22 annual reports from IMBs at HMPs Hewell and Moorland, which conducted surveys with IPP prisoners. Key findings The findings indicated: • Serious safety implications were heightened by the recent announcement, with assessment, care in custody and teamwork (ACCT) documents being opened for several IPP prisoners. Three apparently self-inflicted deaths of IPP prisoners occurred in three prisons in the four weeks following the announcement. • IPP prisoners had increased feelings of hopelessness and frustration following the announcement, which IMBs noted could act as a catalyst for poor mental health, violence and disruptive behaviour. • Variable and often inadequate staff engagement both pre- and post-announcement, with some prisoners only learning of the decision through a letter. • Progression pathways were poor and unclear to prisoners, which meant many prisoners questioned whether they would ever be released following the announcement. Some prisoners were being held in inappropriate establishments, often without access to required courses. The increasing difficulty of transferring to open conditions has left some prisoners ‘institutionalised’. • Insufficient preparation for parole hearings and for release, with reports of inadequate care plans and ‘through the gate’ provision. This lack of provision contributed to recall: for example, some prisoners were recalled only because of issues arising from the loss of accommodation.

London: Independent Monitoring Boards, 2023. 6p.

The Monitoring Team is issuing this Special Report to advise the Court and the Parties of the continued imminent risk of harm to incarcerated individuals and staff in the New York City jails. The first few months of 2022 have revealed the jails remain unstable and unsafe for both inmates and staff. The volatility and instability in the jails is due, in no small part, to unacceptable levels of fear of harm by detainees and staff alike. Despite initial hopes that the Second Remedial Order (dkt. 398), entered in September 2021, would help the Department gain traction toward initiating reform on the most immediate issues, the Department’s attempts to implement the required remedial steps have faltered and, in some instances, regressed. These failures suggest an even more discouraging picture about the prospect for material improvements to the jails’ conditions. Furthermore, the Department’s staffing crisis continues and the New York City Mayor’s Emergency Executive Order, first issued on September 15, 2021, and still in effect (through multiple extensions) as of the filing of this report, acknowledges that, among other things, “excessive staff absenteeism among correction officers and supervising officers has contributed to a rise in unrest and disorder.” The Monitoring Team’s staffing analysis, discussed in detail below, reveals that the Department’s staff management and deployment practices are so dysfunctional that if left unaddressed, sustainable and material advancement of systemic reform will remain elusive, if not impossible, to attain. …

New York: The Independent Monitoring Team, 2022. 78p.

By Avik Chatterjee; Michelle Weitz; Alexandra Savinkina, et al

Key Points - Question: Is provision of medications for opioid use disorder (MOUD) during incarceration associated with fewer overdose deaths? Findings: This economic evaluation of a model of the natural history of OUD in Massachusetts found that a strategy offering buprenorphine, methadone, and naltrexone during incarceration was associated with 192 fewer overdose deaths (a 1.8% reduction) and was less costly than a naltrexone-only strategy averting 95 overdose deaths (a 0.9% reduction). The 3-MOUD strategy was also cost-effective at $7252 per quality-adjusted life-year gained. Meaning These findings suggest that offering 3 MOUDs during incarceration is a life-saving, cost-effective intervention

JAMA Network Open. 2023;6(4):e237036. doi:10.1001/jamanetworkopen.2023.7036

By Leah wang

Over 1 million people sit in U.S. state prisons on any given day. They are also suffering from physical and mental illnesses, or navigating prison life with disabilities or even pregnancy. We add to the existing research showing that state prisons fall far short of their constitutional duty to meet the essential health needs of people in their custody. As a result, people in state prison are kept in a constant state of illness and despair. This report is divided it sections: Physical health problems: Chronic conditions and infectious disease Access to healthcare: People in state prison disproportionately lacked health insurance Mental health problems: Exceptionally high rates among incarcerated people Disabilities: Disproportionate rates of physical, cognitive, and learning disabilities Pregnancy and reproductive health: Expectant mothers are underserved in prison Conclusions and recommendations: How do we begin to address unmet needs in prisons? About the unique data used in this report This report offers a detailed view of the people in state prisons nationwide, using the most recent self-reported, nationally representative data available, the Bureau of Justice Statistics’ 2016 Survey of Prison Inmates. Though correctional populations are in constant flux, the Survey data released just over a year ago are essential to understanding incarceration today.

Northampton, MA: Prison Policy Initiative, 2022. 29p.

By National Council for Behavioral Health and Vital Strategies

This toolkit provides correctional administrators and health care providers recommendations and tools for implementing medication-assisted treatment (MAT) in correctional settings. It provides examples from the field that can be widely applied and adapted for programs that serve justice-involved individuals. It was developed by the National Council for Behavioral Health, Vital Strategies, and faculty from Johns Hopkins University, with support from CDC and Bloomberg Philanthropies.

2020. 312p.

By David Redemske

While there are numerous built environmental models for prisoner health care, little has been done to assess the models to see if a particular location for care better serves the inmate population’s health needs over other locations. “Mass incarceration” has been used to describe the recent dramatic expansion of the criminal justice system in the United States. Underserved communities with minimal access to healthcare services disproportionately bear the burden of mass incarceration. This huge influx into the prison population of those who have received little or no medical care throughout the course of their lives, along with a court ruling mandating a constitutional level of care for prisoners, has resulted in a greater demand for healthcare services for this population. The purpose of this literature review is to shed light on the challenging healthcare process, the best environments for prison inmates to receive care, and to generate recommendations for the future.

Omaha, NE: HDR, 2018. 198p.

By Laura M. Maruschak and Marcus Berzofsky

In 2011–12, half of state and federal prisoners and local jail inmates reported ever having a chronic condition (figure 1). Chronic conditions include cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma, and cirrhosis of the liver. Twenty-one percent of prisoners and 14% of jail inmates reported ever having an infectious disease, including tuberculosis, hepatitis B and C, and other sexually transmitted diseases (STDs). About 1% of prisoners and jail inmates who had been tested for HIV reported being HIV positive.

Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics 2016. 23p.

Edited by Lars Møller, Heino Stöver, Ralf Jürgens, Alex Gatherer and Haik Nikogosian

Based on the experience of many countries in Europe and the advice of experts, this guide outlines some of the steps prison systems should take to reduce the public health risks from compulsory detention in often unhealthy situations, to care for prisoners in need and to promote the health of prisoners and staff. This especially requires that everyone working in prisons understand well how imprisonment affects health and the health needs of prisoners and that evidence-based prison health services can be provided for everyone needing treatment, care and prevention in prison. Other essential elements are being aware of and accepting internationally recommended standards for prison health; providing professional care with the same adherence to professional ethics as in other health services; and, while seeing individual needs as the central feature of the care provided, promoting a whole-prison approach to the care and promoting the health and well-being of those in custody.

Copenhagen: WHO Regional Office for Europe, 2007. 198p.

By Penal Reform International

As the COVID-19 pandemic affects more people in an ever increasing list of countries, PRI has published a briefing note, Coronavirus: Healthcare and human rights of people in prison. With the fast-evolving situation, there is legitimate concern at a further spread of the virus to places of detention. The difficulties in containing a large outbreak in detention facilities are clear. People in prison and the personnel who work with them are in close proximity and in many cases in overcrowded, cramped conditions with little fresh air. People in detention also have common demographic characteristics with generally poorer health than the rest of the population, often with underlying health conditions. Hygiene standards are often below that found in the community and sometimes security or infrastructural factors reduce opportunities to wash hands or access to hand sanitizer – the key prevention measures recommended by the World Health Organization.

Our briefing outlines the key measures that criminal justice systems, including prisons and courts, have taken to prevent the spread of COVID-19 – and the impact of these in light of the UN Nelson Mandela Rules and other key standards. Action needs to be taken now and immediately, given the risk people in prison are exposed to, including prison staff. Such action should be guided by international standards and the values of: Do no harm, equality, transparency, humanity.

London: Penal Reform International, 2020. 13p

By Helen Fair and Jessica Jacobson

When the World Health Organization (WHO) declared COVID-19 a global pandemic on 11 March 2020, there was immediate concern about the potential health impacts on prisoners and prison staff. Concern focused on the close proximity in which prisoners live, particularly in overcrowded systems; the prevalence of underlying health conditions which affect many of those in custody; and the porous nature of prison walls and boundaries, presenting a risk of infection spreading from prisons to local communities. In the wake of the declaration of the pandemic, penal reformers and human rights organizations around the world called for measures to be taken to reduce the numbers of people in prison, particularly in overcrowded systems, and to contain the risks of infection spreading. This report examines the population management and infection control measures (excluding direct health interventions) taken by prison systems in a diverse group of ten countries spanning all five continents: Kenya, South Africa, Brazil, the USA (and more specifically, New York State), India, Thailand, England and Wales, Hungary, the Netherlands, and Australia (more specifically, New South Wales). The report is produced under the banner of ICPR’s international, comparative project, ‘Understanding and reducing the use of imprisonment in ten countries’, launched in 2017.

London: Institute for Crime & Justice Policy Research, 33p.

Edited by Emily A. Wang, Bruce Western, Emily P. Backes, and Julie Schuck

The conditions and characteristics of correctional facilities — overcrowded with rapid population turnover, often in old and poorly ventilated structures, a spatially concentrated pattern of releases and admissions in low-income communities of color, and a health care system that is siloed from community public health — accelerates transmission of the novel coronavirus (SARS-CoV-2) responsible for COVID-19. Such conditions increase the risk of coming into contact with the virus for incarcerated people, correctional staff, and their families and communities. Relative to the general public, moreover, incarcerated individuals have a higher prevalence of chronic health conditions such as asthma, hypertension, and cardiovascular disease, making them susceptible to complications should they become infected. Indeed, cumulative COVID-19 case rates among incarcerated people and correctional staff have grown steadily higher than case rates in the general population. Decarcerating Correctional Facilities during COVID-19 offers guidance on efforts to decarcerate, or reduce the incarcerated population, as a response to COIVD-19 pandemic. This report examines best practices for implementing decarceration as a response to the pandemic and the conditions that support safe and successful reentry of those decarcerated.

Washington (DC): National Academies Press ; 2020. 161p.

Edited by Elisabeth Fransson, Francesca Giofrè and Berit Johnsen.

“My cell is as large as a student’s small room: I would say that roughly it measures three by four and a half meters and three and a half meters in height. The window looks out on the courtyard where we exercise: of course it is not a regular window; it is a so-called wolf’s maw with bars on the inside; only a slice of sky is visible and it is impossible to look into the courtyard or to the side.”

Creative Commons (2018) 349p.