Improving health for prisoners and their families

Changing public-health policy and practice within the prison system, improving health outcomes for prisoners and their families in the UK and internationally.

Improving health for prisoners and their families

the challenge

Research addressing the health of marginalised groups has been a long-standing priority at Leeds Beckett University (LBU), particularly in relation to prisoners and their families who face disproportionate rates of poor health. Research suggests that, in the UK, imprisonment impacts not only on those directly in prison but also prisoners’ families and relatives and the prison workforce.

The initial work of Woodall, Dixey and South stimulated a focussed interest in the prison as a distinct setting for health promotion practice and policy development. This included a wider view of the prison setting encompassing both prisoners, families and prison staff. The research argued that a disease-focussed, reductionist model of prison health was too limited in fully addressing the myriad of issues facing this population and instead a more ‘upstream’ salutogenic focus (the focus on human health and wellbeing rather than on factors that cause disease) was necessary to address the inequalities faced in this population.

The Approach

Building on this work and the LBU, NIHR funded study ‘People in Public Health’, further NIHR funding enabled a study exploring the effectiveness and cost-effectiveness of peer interventions in prison settings. This was conceived and led by LBU, in collaboration with health economists at the University of Leeds plus two GPs working in prison healthcare.

This systematic review, the first comprehensive review on this issue, showed the benefits of peer interventions for influencing health outcomes, including the management of poor life style choices with increased health risks. The research included ‘expert hearings’ which brought together stakeholders from the prison service, health services and the voluntary sector to identify implications for policy and practice, including how peers could be recruited, trained and supported.

The research showed clear health outcomes from this intervention mode (particularly HIV prevention outcomes), but also provided understanding of context and delivery mechanisms required for success (including the need for organisational buy-in; funding and resource; and a recognition of placing prisoners in positions of relative power and trust).

Research focussing more specifically on prisoners’ families and children has been undertaken by Dixey and Woodall. This research has had academic and sectorial impact in understanding the role of prison visits in maintaining family ties and supporting the wider health and wellbeing of prisoners, their families and their children. This work has highlighted the pivotal role of prison visitors’ centres (in providing practical, social and emotional support to families) and the prison visit (in relation to reduced re-offending) to government and agencies in addressing health and social outcomes for families, children and prisoners themselves. These groups are often the most vulnerable and socially excluded in society. This research has been important as, to date, there is no mandate for prisons to have dedicated facilities for families. The research has demonstrated the positive impact of such facilities in creating healthier prison environments.

Signpost with words coming off of it; Health Trainer, Mentor, PID Worker, Listener, Peer Advisor

Artwork commissioned as part of peer intervention in prison study

The Impact

The underpinning research has resulted in changing UK government policy in relation to prisoner health as well as leading health service, public health and criminal justice agencies in developing policy, commissioning and practice guidance. The underpinning research has also impacted directly on policy and practice in the Canadian health system.

Outputs and recognition

  • South, J., Bagnall, A-M. and Woodall, J. (2017) Developing a typology for peer education and peer support delivered by prisoners.  Journal of Correctional Healthcare. 23 (2), 214-229
  • South, J., Woodall, J., Kinsella, K. and Bagnall, A-M. (2016) A qualitative synthesis of the positive and negative impacts related to delivery of peer based health interventions in prison settings.  BMC Health Services Research. 16 (525), 1-8
  • South, J., Bagnall, A., Hulme, C., Woodall, J., Longo, R., Dixey, R., Kinsella, K., Raine, G., Vinall, K. & Wright, J. (2014) A systematic review of the effectiveness and cost-effectiveness of peer-based interventions to maintain and improve offender health in prison settings.  Report for the National Institute for Health Research (NIHR) Health Services and Delivery Research (NIHR HS&DR) programme Project: 10/2002/13
  • Bagnall, A-M., South, J., Hulme, C., Woodall. J., Vinall-Collier, K., Raine. G., Kinsella, K., Dixey, R., Harris, L. and Wright, N.M.J. (2015) A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons.  BMC Public Health. 15 (290), 1-30
  • Woodall, J., South, J., Dixey, R., de Viggiani, N. and Penson, W. (2015) Factors that determine the effectiveness of peer interventions in prisons in England and Wales. Prison Service Journal. 219, 30-37
  • Woodall, J., South, J., Dixey, R., de Viggiani, N. and Penson, W. (2015) Expert views of peer-based interventions for prisoner health.  International Journal of Prisoner Health. 11 (2), 87-97

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