Transcript Effective Health Promotion interventions

Promoting health in the
Prison environment
Dr Dina Berkeley and Sharon Watts
Public Health Directorate
East Riding of Yorkshire
10 November 2010
A prison, as a setting, is
A microcosm consisting of ..
• Offenders
• Prison Officers
• Healthcare staff
• Other staff.
As a microcosm, there is some interdependence between
the various elements of the system, especially
concerning their health and wellbeing.
An example of the dynamic of the prison system
Typical approaches to Prison health
• Focus on offenders’ health (e.g., HNAs being based on
usage of Healthcare Services by offenders)
• Pay little attention, if any, to what difference Prison
Officers’ behaviour and attitudes may have on offenders’
health
• Pay little attention to Prison Officers’ own health which
is affected by, and affects, offenders’ health.
The interventions we will describe go beyond such
approaches.
Factors affecting the health of offenders
before incarceration
• Biological – no reason to believe that offenders have any
particular biological predisposition to ill-health
• Lifestyle – very chaotic and self-harming before
imprisonment
• Social and community networks – mixing with similar
types of people, perpetuating re-offending
• Living and working conditions – often unemployed,
homeless, drug-addicts
• Socio-economic, cultural and environmental
conditions: low educational/skills level and, often,
mental health/substance misuse problems.
Offenders have
• Higher level of health need to start with (due to past
lifestyles)
• Exhibit 3.8 times the rate of consulting a GP in prison
(reasons for consultation while in prison being the same
as the ones identified on reception to the prison)
• High rates of smoking, alcohol abuse, drug use, poor
nutrition, low level of exercise
• Mental health problems existing before imprisonment
or stemming from imprisonment. (72% of male and 70% of
female sentenced prisoners suffer from two or more mental health
disorders. 20% of prisoners have four of the five major mental
health disorders. High incidence of self harm. Suicide rate is 5 times
greater than for men in the community.)
Factors affecting the health of offenders
during incarceration
• Biological –ill-health acquired in the past and during
incarceration
• Lifestyle – constrained, old habits
• Social and community networks – mixing with similar
types of people, disconnected from family/friends
• Living and working conditions – lack of autonomy,
meaningless employment (if any); confidentiality
problems when they see a health professional
• Socio-economic, cultural and environmental
conditions: low income (if any), authoritarian
environment, some training, many hours spent alone in
cell, lack of natural sunlight in many cases.
While in prison and beyond..
• 45% lose contact with their families
• 22% of married offenders get divorced
• Prisons are usually in rural locations- difficult for families
to access them
• Very few have an address to go to on release
• Stigma of imprisonment – problems with employment
after release
• High potential for re-offending (“Revolving doors”)
• 12.7% rate of death higher than community after release.
Positive aspects of imprisonment
• Prison is a good setting for tackling offenders’ health
needs
• Good experience of seeking help, and getting it ,could
make offenders seek help when released
• Good setting for tackling infectious diseases
• Hard-to-reach group while in the community but
captive audience while in prison.
Barriers to promoting health in prisons
• Punitive /authoritarian culture
• Considering health promoting activities (e.g., gym) as a
privilege which can be withdrawn as punishment
• Limited resources (funding)
• The public’s view of offenders (“they are not worth it!”)
• Low literacy/health literacy levels
• Frustration/Aggression/Violence
• Etc.
Ways prisons can affect the health of offenders
positively during & after incarceration
• Biological – provide health care for existing problems
• Lifestyle –educate & support health promoting activities,
provide basic healthy living skills
• Social and community networks – peer support,
encourage contact with family/friends, link with
agencies working in the community
• Living and working conditions – create less stressful
environment , provide training for employment
• Socio-economic, cultural and environmental
conditions: improve educational/skills level, provide
support for mental health/substance misuse problems,
prepare offender for release.
Health Fairs in prisons
Aims:
• Raise awareness of healthier lifestyles
• Raise awareness of existing Services
• Promote self-care
• Encourage interaction between offenders and staff in a
relatively neutral environment
• Facilitate interaction between Services found in the
Community with Services found in prison
• Engage offenders and staff
• Opportunity to share views with others and with
professionals (e.g., discuss issues of concern).
Typical “topics”
• Physical health (e.g., blood pressure, cholesterol level
measurement, BMI, Chlamydia testing, self-testing for
breast/testicular cancers, bone/spinal problems)
• Hygiene (e.g., hand washing, dental health care)
• Lifestyle (e.g., Stop smoking, effects of alcohol/drugs,
healthy eating/exercise)
• Mental health (e.g., Listeners, Samaritans, In-reach)
• Community Services which can help to prepare one for
release or after release.
Health Fairs at HMP Everthorpe
(Category C prison; about 680 male adult
offenders)
In 2009 and 2010 so far
• About 600 offenders attended (9:30 am – 3:30 pm)
and 50 members of Prison staff each time
• 170-180 Chlamydia tests done each time
• Persons with identified problems were instructed to visit
the GP
• 70-80 signing up for the Stop Smoking Service
• Professionals gaining an understanding of level of need
and each other’s skills/knowledge which can be used
productively.
Potential Difficulties
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Venue (e.g., overcrowded)
Security (e.g., type of prison)
Prison Staff availability
Offenders’ unwillingness to participate
Raising expectations which may not be met in practice
Increasing demand for Services
Lack of confidentiality/privacy for any personal issues
one may wish to raise (resulting in frustration).
Ways of overcoming them
• Get the active support of the Governing Governor and
other important stakeholders
• Good organisation and planning long in advance
• Good advertising and communication (provide enough
details to make the event of interest to both offenders
and staff)
• Anticipate demand and ensure constraints are addressed
• Use the Health Fair as a useful resource for identifying
what kind of health promoting activities are further
needed and at what level they should be targeted.
(That’s how we identified the need for the following
interventions.)
Mental Health training at HMP
Everthorpe
From HMP Everthorpe offender survey (July 2010; 200
respondents, just under 1/3 of the prison population)
• 42% of respondents reported experiencing common
mental health problems (e.g., depression, anxiety, panic
attacks)
• No self-reporting of psychosis
• 62% of respondents commented on the care they had
received from mental health service
• No questions were asked about suicidal thoughts .
Mental Health First Aid (MHFA) – an
International Training Programme
Aims of the training are to provide:
• Better understanding of mental health problems
• More confidence about mental health problems and
what to do to help others
• Reduced stigma about mental health problems
• Better awareness of participants’ own mental health and
other people’s mental health.
(www.mhfaengland.org)
Mental Health First Aid (MHFA)
Course outline
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Why MHFA?
Mental Health Policy
What is mental health?
Common mental health problems (what is depression,
symptoms of depression, risk factors for depression,
depression in the workplace; anxiety; psychosis; Suicide;
other expressions of distress)
• Attitudes and anti-stigma campaigns
• The five steps of mental health first aid.
Delivery of training at HMP Everthorpe
Participants:
12 offenders (8 Listeners & 3 Health Trainer Champions)
plus 4 staff, (Chaplain, 2 Officers, and a Careers Advisor)
undertook the course together.
One of the unforeseen and highly recommended bonuses
came from having a joint offender/staff group which
helped both sides appreciate one another’s viewpoint
and, for the staff participants, it was a very valuable and
enlightening experience.
Specific comments from participants
• “Will suggest that the course becomes compulsory to all prison
staff as the content is Extremely valuable”
• “I now know how to cope better myself and to help others too”
• “There are no improvements needed. The course is brilliant and
more people should do it especially in the prison system. There is a
major problem with staff limited knowledge of mental health in
here”
• “The video clips had real life people who had been through it so they
were very good and very informative”
• “For me, I have been in contact with loads of these illnesses so this
has answered loads of questions I have had unanswered so I’m well
satisfied.”
Suicide Prevention
SafeTalk: an International Programme
• Part of our community plan for suicide prevention
• Suicide is everyone’s business
• Helping people with thoughts keep safe from suicide is
not limited to certain professional groups. Everybody
can learn to do this.
• Safe – Suicide Alertness for Everyone
• Talk – The steps: Tell, Ask, Listen, Keepsafe
• Challenges the Myths.
(www.livingworks.net)
SafeTalk: an International Programme
Aims are to
• Learn how to be suicide-alert
• Identify persons with thoughts of suicide and how to
connect them with caregivers trained in suicide
interventions.
Participants at HMP Everthorpe:
17 offenders plus 10 staff (Prison Officers and Education
staff) undertook the workshop together.
Specific comments from participants
• “Very interesting, I feel more confident – it raised my
awareness.”
• “ I enjoyed the training; it opened my eyes.”
• “ It was very good and helped me consider a different
way of supporting people.”
• “ Every single adult in the UK would benefit from this
training.”
During the training, one prisoner asked the group directly
if they had experienced suicidal thoughts. The responses
were quite informative.
In conclusion
Prison, as a setting for health promotion interventions,
needs to be appreciated for the multitude of influences
which affect both offenders’ and staff’s health and
wellbeing.
A systems’ approach needs to be taken in order to ensure
that all elements of the system (i.e., prison) can work
together to facilitate improvement in the health and
wellbeing of all.