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People in prison

  • The majority of prisoners are young and male.
  • Most prisoners are in custody for periods of weeks or months, rather than years.
  • Sixty to seventy per cent of them were using drugs before imprisonment and over 70% suffer from at least two mental disorders.
  • It is estimated that at least 80% of prisoners smoke.
  • Sixty-six percent of all injecting drug misusers in the community have been in prison at some time, of whom half had been in prison before they started injecting.
  • Male prisoners are much more sexually active in the community than the general population; all age groups having more lifetime sexual partners, and more partners in the year before entry to prison, than would be expected from the general population. They are also six times more likely to have been a young father.                  

34. Generally speaking, people in prison have poorer health than the population at large and many of them have unhealthy lifestyles. Many will have had little or no regular contact with health services before coming into prison, and prison populations reveal strong evidence of health inequalities and social exclusion.

35. Initiatives to improve health of prisoners offer a valuable opportunity to identify and tackle the wider health needs of a vulnerable and socially excluded population. They could, for example, be given information on health services and how to use them as well as information and support aimed at influencing their drug and alcohol and tobacco usage. Even if this did not persuade them to stop it might influence them towards less risky behaviour, such as not injecting and adopting safer sexual practices.

36. Some health promotion work has already been undertaken with prisoners. Results from prison smoking cessation programmes continue to be encouraging, with quit rates as good as, or better than, those in the outside community. The 'Walking the Way to Health' initiative, is being piloted in 10 prisons and promoting healthier eating and weight management proved a success in a project in a women's prison. 

People in prison are being helped to stop smoking through services specially targeted to their needs, including access to Nicotine Replacement Therapy (NRT). These services are proving very successful. Early indications are that quit rates amongst prisoners, some 80% of whom smoke, are as good as or better than rates for other groups in the community. The initiative for prisoners grew out of a project between the Department of Health and the Prison Service. Learning from the project has been evaluated and disseminated to the field. Longer-term evaluation is taking place with prisons in the North West. Regional seminars have spread the learning widely across the NHS. This resulted in a set of 'transferable principles' being identified to reach disadvantaged smokers.

'Acquitted best practice guidance for developing smoking cessation services in prison' Mark Braham, published Department of Health, 2003.

Case study

Young people with psychosis who were previously 'missing' from mental health services in Plymouth are getting help from Insight, a local youth agency project which won a National Institute for Mental Health in England Positive Practice Award in 2003.

Sixteen to twenty-five year olds had been reluctant to access mental health services but now they wait at the doors at the Insight early intervention project, an integrated part of the Plymouth Youth Enquiry Service (YES). This aims to foster independence and inclusion in mainstream youth activities of those who are experiencing psychosis for the first time in their lives.

YES Deputy Director, Ruth Marriott, said, 'Walking into a youth service used for social and leisure activity has a different feel to walking into adult mental health provision. Because the services on offer include sexual health, personal development and accommodation, as well as mental health, no one knows what aspect young people are accessing when they come in. This has helped to reduce the stigma attached to mental health issues.

'The focus is on all the issues that affect young people at this transitional time in their lives, such as housing, education and employment. We support them in making choices which have a positive impact on their mental health.'

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