Date Published: 13 February 2007
Oxford University findings on the health of female prisoners
The health of female prisoners who are drug users tends to improve during their time in prison, an Oxford University study has found.
Three-quarters of the 505 female prisoners studied by researchers from Oxford’s Department of Public Health had used illegal drugs in the six months before imprisonment. These women saw their health improve in prison, which the researchers assume is both because of the reduced availability of drugs and because their lifestyle in prison was healthier than their life outside.
For the study population taken as a whole, some health behaviours had improved in prison and others had not. The proportion of smokers remained the same but the amount smoked had decreased; alcohol consumption and drug use had decreased; and fewer women were exchanging sex for goods or money. After three months, women were more likely to taking antidepressants or medication for high blood pressure, suggesting that health consultations in prison had addressed unmet needs. There was no improvement in exercise and diet, and no statistically significant change in rates of self harm.
The team studied 505 female prisoners, asking them about their health immediately on arrival in prison, after one month (by which time the study population had fallen to 222 women), and after three months (by which time the study population had fallen to 112 women). The study used questionnaires, rather than medical tests, to find out about the women’s subjective sense of their own health, as well as about diet, alcohol consumption and drug use. In addition, the researchers interviewed the women.
" The most striking finding was just how poor the women’s health was on arrival," said Dr Emma Plugge, lead author of the study.
" Their health was very bad – in the case of drug users, significantly worse than that of women in social class V, the group within the general population with the poorest health."
Before coming into prison, 85% of the study population smoked; 42% drank alcohol in excess of the recommended amount; 75% had used illegal drugs in the previous six months; 27% had at some point been paid for sex; and 16% had self harmed in the previous month. Just 13% met government recommendations on exercise, and 13% met government recommendations on diet. The women were less likely to be registered with a GP and more likely to make use of hospital services than the general population. 83% reported a longstanding illness, and 73% were taking some form of prescribed medication. Poor mental health, mainly depression and anxiety, was a common and significant feature of their descriptions of their health status.
After one month and after three months, drug users’ health had improved – though it still remained lower than the general population.
" Regular meals, consistent shelter and protection from violence by a partner or street violence were all things which many of these women were not getting in the outside world," said Dr Plugge.
" Prison provided food, shelter, and safety from violence.
_ In interviews, women described the way in which acquiring drugs and maintaining their addiction had taken precedence in their lives to the detriment of almost everything else, including their health. Many were underweight and many had problems sleeping. These women led such chaotic lives outside prison that prison life was a respite. Their health improved as a result. "
The overall health of those who were not drug users stayed roughly the same during their time in prison, according to the questionnaire data. However, in interviews, the women reported that they felt their health had declined. They reported being less active, having poorer nutrition and greater incidence of illness.
When talking to the researchers in interviews women in the study had both negative and positive things to say about healthcare in prison. Drug users highlighted the regular meals, shelter and protection from violence as particularly positive aspects of the prison regime. However, women were critical of aspects of the wider prison environment which they felt affected their health, citing poor hygiene, poor diet, few opportunities to exercise, and sometimes difficult relationships with custodial staff.
" While some positive accounts were forthcoming, it was more frequently the case that women used the opportunity presented by the interviews and focus groups to detail their complaints about their reported experiences of healthcare services, " said Dr Plugge.
" There are undoubtedly some problems with the provision of health care in prison and these need to be – and are being – addressed. However, it has been observed elsewhere that when patients are asked about health service quality, they are more likely to focus on perceived shortcomings than positive aspects. "
The researchers noted that were it not for certain health issues – such as drugs or mental illness – many of the women may not have ended up in prison in the first place.
" It became clear that for many of these women, their prior health status was directly linked to their offending," said Dr Plugge.
" There was theft to finance chronic addiction, and offences directly linked to mental health problems.
_ There is a challenge to improve healthcare in prison and address some of the issues raised by the interviews with women – and this is already being tackled by the NHS working in partnership with the Prison Service. However, the bigger, yet largely unrecognised, challenge is addressing these women’s health issues in the community, both before and after prison."
Source: Oxford University (England, UK)