Nick de Viggiani

Surviving Prison: Exploring prison social life as a determinant of health

Prison social environments play an important role in the health of prisoners. How they respond to imprisonment is partially dependent upon how effectively they integrate into an institution’s social structure, learn to fit in with others and adapt to and cope with becoming detached from society, community and family ‐ hence, how they personally manage the transition from free society to a closed carceral community. This paper reports on findings of an ethnography conducted in an adult male training prison in England, which used participant observation, group interviewing, and one‐to‐one semi‐structured interviews with prisoners and prison officers. The research explored participants’ perceptions of imprisonment, particularly with regard to how they learned to adapt to and ‘survive’ in prison and their perceptions of how prison affected their mental, social and physical well‐being. It revealed that the social world of prison and a prisoner’s dislocation from society constitute two key areas of ‘deprivation’ that can have important health impacts.

Trying to be Something You Are Not Masculine Performances within a Prison Setting

Men in prison commonly deploy ‘front management’ strategies in striving to portray ‘legitimate’ prison masculinities in the company of fellow prisoners or prison personnel. This theme emerged ethnographic research in an English male training prison. A range of attitudes and behaviours were displayed by participants, perceived as necessary responses – even survival strategies – for living under the tense, testing conditions of a closed all-male prison environment. These findings have important implications for the health and wellbeing of male prisoners, for they infer that prison environments can facilitate ‘pathological’ attitudes and behaviours that mitigate against offender management and health goals relating to rehabilitation, resettlement, personal and social development, health improvement and reducing reoffending.

Music making for health, well-being and behaviour change in youth justice settings: a systematic review

Youth justice is an important public health issue. There is growing recognition of the need to adopt effective, evidence-based strategies for working with young offenders. Music interventions may be particularly well suited to addressing risk factors in young people and reducing juvenile crime. This systematic review of international research seeks to contribute to the evidence base on the impact of music making on the health, well-being and behaviour of young offenders and those considered at risk of offending. It examines outcomes of music making identified in quantitative research and discusses theories from qualitative research that might help to understand the impact of music making in youth justice settings.

A new approach to prison public health? Challenging and advancing the agenda for prison health

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organizations vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization’s vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.

A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service

Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships.

“Don’t mess with me!” Enacting masculinities under a compulsory prison regime

It is our nature to conform; it is a force which not many can successfully resist […]. Self-approval has its source in but one place and not elsewhere – the approval of other people […] by the natural instinct to passively yield to that vague something recognized as authority, and […] by the human instinct to train with the multitude and have its approval. (Mark Twain 1923: p. 401)

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

Background The principle of equivalence in prison health has been established for nearly four decades. It seeks to ensure that prisoners have access to the same level of healthcare as members of society at large, which is entrenched within the international legal framework and England’s national health policies. Aims This study examined how key policymakers interpret and implement the principle of equivalence in English prisons. It also identified opportunities and threats associated with the application of the principle. Methods In total, 30 policymakers took part in this research. These participants engaged in policymaking activities and occupied positions of authority in the prison field. Results Despite the policymakers’ consensus on the importance of the equivalence principle, there was a varying degree of understanding regarding what constitutes ‘equivalence’. Participants described how the security culture impedes prisoners’ access to healthcare services. Additionally, the increasing size and complexity of the prison population, coupled with a diminishing level of resources, reduce the level of care being provided in prisons and thus compromise implementation of equivalence in English prisons. Conclusions Inconsistent interpretation of equivalence, the prevailing security drive, increasing numbers and health complexities of prisoners and fiscal austerity threaten the implementation of equivalence in English prisons. This research calls for new guidance on how to interpret and implement equivalence, along with measures to educate prison governors and staff on the prison rehabilitation value, ensure greater investment in prison health and consider alternatives to imprisonment to future-proof the principle of equivalence in the English prison system.