A healthy prison strategy for HMP Bristol

This report summarises progress in establishing a Healthy Prison strategy for HMP Bristol. It follows a period of consultancy with the prison commissioned by NHS Bristol, and carried out as follow-up to a 2007-8 Health Needs Assessment (HNA) conducted at the prison. The aims of this work were to: [1] assess and build commitment within the prison for a ‘healthy prison’ strategy; [2] produce a realistic and feasible plan for developing the strategy; [3] create a strategy group to lead and drive the project; and [4] form and publish key performance standards for the prison. A period of consultation preceded publication of this report, which involved interviews and meetings with a range of Prison Service and NHS stakeholders and close scrutiny of relevant reports and publications. It should be noted that work on this strategy is ongoing and now forms part of the core business of HMP Bristol

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

© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ. 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

Challenges for prison governors and staff in implementing the Healthy Prisons Agenda in English prisons

© 2018 The Royal Society for Public Health Objectives: In the two decades that have passed since the World Health Organisation established the Healthy Prisons Agenda, there has been no research conducted to investigate barriers and challenges prison managerial and operational staff encounter in implementing the Agenda in the English prison context. This article debates sectoral, institutional and occupational challenges perceived to hinder effective implementation of the Agenda, based on a qualitative study involving prison governors and operational staff. Study design: Qualitative study taking a grounded theory approach. Methods: Semistructured interviews were conducted with 30 participants comprising prison governors, prison officers and external stakeholders with key strategic and operational roles across the prison estate. The interviews were analysed and coded into themes using constant comparative method. Results: The research identified a range of managerial and operational factors that impeded recognition, acceptance and successful implementation of the Healthy Prisons Agenda. These were found to be associated with scarcity of resources, low prioritisation, perceived low importance, and pressures at operational, managerial and strategic levels to adhere to standard operating procedures. Security, control and discipline tended to supersede other imperatives considered of secondary importance to the effective running of prisons. Conclusions: Sustainability of the Healthy Prisons Agenda can only be assured by raising its significance and importance across prison hierarchies and within policies and practices through which operational and strategic objectives are realised. This means achieving wholesale commitment by prisons—among staff at all levels—towards public health goals that are fundamental to a successful and effective criminal justice system

Should we use a direct regulation to implement the Healthy Prisons Agenda in England? A qualitative study among prison key policy makers

© The Author 2017. Background The Healthy Prisons Agenda seeks to reduce prisoners' health risks, balance prisoners' rights with a security regime, ensure equivalent prison health service provisions to community health services, and facilitate the whole-prison approach. There is an established assumption that legislation will ensure better implementation of health promotion programmes. This study aimed to examine whether a legislative framework, via a direct regulation, could lead to enhanced implementation of the Healthy Prisons Agenda in England. Methods A qualitative study design was conducted using semi-structured interviews with 30 key prison policy makers in England. Findings Our findings contradict the established assumption that legislation improves the implementation of health promotion programmes. A direct regulation was perceived as restrictive, manifesting excessive compliance and encouraging a risk-averse culture, whilst preoccupation with security, order and discipline amongst prison governors and custody staff was deemed an internal institutional barrier to implementing the Healthy Prisons Agenda. External barriers included diminishing resources, lengthier or delayed sentencing, and an unsympathetic public and political stance towards prisoner rehabilitation. Conclusions A direct regulation should not be used to operationalize the Healthy Prisons Agenda. Rather, self-regulation, along with proactive solutions for the identified barriers to implementing the Agenda, is the most appropriate path forward

The new prison framework will be inflexible, costly and do nothing to ease chronic overcrowding and violence

The Conservative manifesto planned to create a series of legally enforceable standards that prisons, and those who work with inmates, will have to meet. Nasrul Ismail and Nick de Viggiani (University of the West of England) have interviewed 30 prison policymakers about the proposed new framework. They warn its inflexibility will lead to a ‘compliance mindset’ and make the job of running England’s already overcrowded prisons much harder

Drug education as diversion: A mixed methods evaluation of the Avon & Somerset drug education programme

This evaluation was undertaken on behalf of the Office of the Avon and Somerset Police and Crime Commissioner to evaluate Avon and Somerset Constabulary’s Drug Education Programme (DEP). The DEP is an education programme that has operated in South West England since 2016, initially in Bristol before it was extended across the Avon and Somerset Force area in 2019. The programme provides people caught in possession of illegal drugs with an alternative to criminal prosecution or conviction. It is a preventive education programme to which people caught in possession of illegal drugs are referred. Its overarching aim is to reduce drug-related offences in the Avon and Somerset Police Force area, to reduce the burden on the criminal justice system and to build improved relations between local communities and the Police. The aim of the DEP is to educate participants about the health, social and legal effects of drugs and to encourage attitude and behaviour change towards desisting from further drug misuse or drug-related offending. This report presents an evaluation of the DEP using mixed research methods and provides recommendations for its future development. The evaluation was undertaken between October 2020 and November 2021

Music in time: An evaluation of a participatory creative music programme for older prisoners

This evaluation was developed as a research collaboration between the University of the West of England (UWE), Bristol and a Community Interest Company, Superact, which is affiliated with the south west regional branch of an arts charity, Live Music Now! The funding for the project was awarded by the former Department for Innovation, Universities and Skills (the Transformation Fund) to support the development of a creative music educational programme for older prisoners. Superact CIC and Live Music Now! have extensive experience of delivering music education programmes for prisoners. UWE was invited to provide research expertise in terms of developing and conducting the evaluation. The evaluation took a formative, qualitative approach to enable the creative music programme provided by Superact CIC to be evaluated from the points of view of prisoners across a range of establishments in the south west of England. This report describes the aims and objectives of the evaluation, provides an overview of the context, describes the methodology and fieldwork processes and reports on the findings. It is hoped that the information in the report can help inform future developments of creative arts programmes in this field

Expert views of peer-based interventions for prisoner health.

Purpose: Formalised support services for prisoners that rely on peer methods of delivery show promising health and social outcomes but there is also conjecture that negative effects, both at an individual and organisational level, can occur. Design/methodology/approach: Individuals with recognised professional expertise from various sectors (including ex-prisoners) were invited to contribute to an expert symposium to share their perceptions of the positive and negative effects of peer interventions in prison. Discussions and debate were audio recorded with the consent of all delegates and verbatim transcripts were analysed using Framework Analysis. Findings: According to the participants, peer interventions in the prison setting created both positive and negative impacts. It was clear from the evidence gathered that peer interventions in prisons can impact positively on health outcomes, but these effects were perceived to be more well-defined for peer deliverers. The notion that peer deliverers can be subjected to ‘burnout’ suggests that supervisory processes for peer workers need to be considered carefully in order to avoid the intervention from being counter-productive. Organizationally, one of the salient issues was the adverse effects that peer interventions cause to the security of the prison. Originality/value: To our knowledge, this is the first time an expert symposium has been conducted to specifically examine peer interventions in prison and to consider the effects, both positive and negative, of such schemes

Musical pathways: An exploratory study of young people in the criminal justice system, engaged with a creative music programme

There is growing evidence from across the arts and health field that suggests that participatory arts programmes can contribute to health improvement, emotional resilience and social reintegration, among vulnerable and excluded groups including criminal justice populations. This report presents a three-year research project funded by the BIG Lottery Fund that completed in 2013. The project was a collaboration between Superact Community Interest Company and the University of the West of England, Bristol. It used mixed methods to investigate a participatory music programme delivered to young people in justice settings by Superact.The research was conducted within a range of custody and community based youth justice settings. These included Young Offender Institutions, Juvenile Secure Units and Prisons, Secure Children’s Homes and Youth Offending Teams. Ethnographic research explored responses and perceptions of Superact’s music programme, focusing on links between music and health, wellbeing, behaviour and social inclusion. Data collection included participant observation, semi-structured interviews and focus groups across eight sites and fifteen programes. As well as examining in depth the responses and views of young people who took part, the research explored the perceptions of stakeholders including prison staff and musicians. A key objective of the research was to pilot conventional validated health, wellbeing and social inclusion questionnaires with this population, partly to establish baseline scores and also to explore the feasibility of measuring these indicators with a transient and ‘hard-to-reach’ population.The research has yielded valuable insight into the perspectives and attitudes of young people in justice settings, in relation to music and their identification with it, and participatory music programming. The research reveals the effects of group dynamics, institutional systems, behavioural factors and population transience on delivery of programmes across these settings. Perhaps inevitably, the high degree of transience of the population impacted on programme attendance and participation, limiting what could be drawn from the quantitative data. However, while the baseline questionnaire data reveal no significant findings with respect to health, wellbeing and social inclusion indicators, the qualitative findings reveal a myriad of themes that underlie the process of programme delivery and the value of music to individuals. These data reveal significant affordances offered by music making for young people and illustrate programme and contextual factors necessary for these affordances to be realised. Essentially, creative music making has the potential to engage even ‘hard to reach’ young people, delivering positive learning experiences and enabling them to forge new identities. Active engagement in arts programmes of this kind can deliver life-changing benefits for some individuals; certainly, for the majority of participants in this study, the programme was valuable in helping them cope with difficult circumstances, including custody, and to consider how music could help them look positively towards the future. Team-building, group dynamics and creativity were key factors underlining successful programme delivery and effective engagement of young people.In conclusion, we argue that participatory music programmes provide opportunities to young people to engage alternative skills and competencies that are not routinely afforded them via conventional education and training programmes. Moreover, music provides a medium that enables young people to engage their life experiences in creative ways, to identify positively with music, to draw on knowledge and experiences, and to engage with their peer group. An important feature of programmes delivered by professional musicians is that they have the skills and experience to garner respect from young people, particularly groups that are difficult to engage and present with challenging attitudes and behaviours. We believe that music programmes that take this approach are a major asset to youth justice organisations, especially since they are located outside the system and therefore command respect and credibility from young people