Challenges in Providing Prison Healthcare Sample Clauses

Challenges in Providing Prison Healthcare. There are a number of challenges in providing healthcare in prison and indeed prisons have sometimes been described as fundamentally anti-therapeutic places (Xxxxx, 2004). The prison environment and prison service regimes create problems for healthcare providers and the work of mental health inreach teams must be seen in the context of problems that limit their ability to provide care in the same way as community services. In the years preceding this thesis, there was a large increase in the number of prisoners in England and Wales with the population doubling from 41000 to over 85000 between 1993 and 2012 (Xxxxxx & Dar, 2013) and standing at 85892 at the end of recruitment in late 2015 (Ministry of Justice, 2015). During the thesis period, there has also been a large reduction in prison spending (HM Treasury, 2015) leading to prison closures, including the loss of over 6000 prison places, and reductions in prison officer numbers that mean prisons have been described as both overcrowded and understaffed (Xxxxxx League for Penal Reform, 2014). The number of prison officers in England and Wales was reduced from 27650 in 2010 to 19325 in 2013 and at the prisons included in this thesis the number of prison officers was reduced by between 25% and 42% over this period. These low staffing levels have meant that prisoners often cannot be escorted between parts of their prison and this affects activities such as work and exercise and this also reduces access to healthcare centres (Prison Reform Trust, 2015). At one of the largest sites for this thesis, the prison regularly exceeds 170% of its officially recommended capacity (Ministry of Justice, 2015). Mental health care services must work within these constraints and whilst wing-based care can reduce the need for escorts, prisoners are often not accessible to health care professionals. Mental health inreach teams are required to provide support for prisoners with mental health problems who are dealing with a highly stressful period of their life but the methods that they can recommend for managing stress are greatly restricted. A mainstay of mental health care is to recommend lifestyle changes and the adoption of meaningful activities, but this approach is not available to prisoners who are confined to their cells for up to 23 hours a day (HM Inspectorate of Prisons, 2015) and whose recreational and occupational activities are otherwise restricted. This is a longstanding concern but has been exacerbated in recent ...