10 | Nursing in Practice | Autumn 2022
PRISON NURSING
Caring for the convicted : the challenges of nursing on the inside
Wiliam Hunter looks at the demands of delivering healthcare behind bars and the unique complexities of the role of a prison nurse
At the start of September , there were 81 , 245 people serving out prison sentences in the UK . 1 According to the latest report from the Prison Reform Trust this number is expected to increase by a further 18,000 by 2026 . 2
Yet for a population soon to be equivalent to that of a large town , the healthcare needs of prisoners are surprisingly overlooked and often underfunded .
While government spending on healthcare grew 7.4 % between 2020 and 2021 , hitting a record high of £ 227bn 3 , healthcare funding in prisons actually fell by more than £ 10m between 2019 / 20 and 2020 / 21 . 4
But for the nurses who work within prisons , the care that they are able to provide has come a long way .
‘ People don ’ t fully understand how much healthcare is delivered in prison ,’ says Maggie Woods , director of nursing and quality at Practice Plus Group , an independent provider of NHS services in justice settings .
‘ In the past , health in justice was seen as a bit of a backwater , but now we have the ability to look after some really complex patients .’
While their work is hidden behind walls , Ms Woods says healthcare staff in prisons provide everything from mental health and maternity support to cancer treatment and end-of-life care . The care is varied , often complex , and delivered to a particularly vulnerable patient group . Not only are there growing numbers of people in prison but they are now in there for longer . More than twice as many people received sentences in excess of 10 years in 2020-21 compared with 2007-08 . The average sentence for more serious offences is now 55 months , two years longer than in 2008 . 5
Balancing security and health An increase in older prisoners means nurses are likely to manage larger and more complex workloads . This is the case for Deanna Mezen , an advanced clinical practice nurse and palliative care expert , who has won a number of awards for work in end-of-life care in prison .
The number of prisoners over 60 has increased by 82 %, in the past decade and by 243 % since 2002 . The House of Commons Justice Committee predicts a continued rise due to longer sentences being handed down . 6
‘ It ’ s a Marmite sort of job ,’ says Ms Mezen , ‘ It ’ s very challenging , but I could never work anywhere other than health and justice . It ’ s the most rewarding job I ’ ve done .
‘ It can be anything from headaches to very complex cardiac issues ; you have to be a bit of a jack of all trades .’
Vanessa Garrity is the national head of mental health for the health in justice division of Practice Plus Group . For her , navigating the complexities of nursing in prison is part of what makes the career so exciting .
‘ When you get assigned to someone , you might be the main person in charge of their care . The level of complexity is far greater as the level of psychological trauma is high . It can be quite challenging balancing security and health , and taking decisions that wouldn ’ t be required of you in another role .’
Ms Mezen says a prison ’ s natural focus on security can make even routine work difficult . ‘ Security overrides everything , and when you first come into the setting it can be hard to get your head around that .
‘ If somebody is self-harming and they ’ ve got a blade , we can ’ t physically go in and retrieve it from them , so we just have to wait . That can be quite emotionally draining .’
RCN professional lead for justice and forensic nursing Liz Walsh comments : ‘ Nurses working in prison experience high levels of emotional labour . Through the pandemic they have been exposed to very stressful working conditions , which I believe may have led to moral injury , just as in the wider nursing community .’
Locked out from care The UK ’ s healthcare system is facing unprecedented strain . Vacancies in nursing positions have hit new highs , and pressures usually associated with a challenging winter are already kicking in . In prisons , these issues are likely to be far worse .
Prison populations generally have poor health . People frequently have a history of substance abuse and emotional trauma , and may not have been accessing healthcare services in the community .
Prison healthcare workers who spoke with Nursing in Practice referred to a ‘ 10-year effect ’, whereby the health issues associated with a 60-year-old can expect to be seen in a prisoner who is only 50 .
And while all prisoners are vulnerable , female prisoners experience exceptionally high rates of mental health problems .
Government data show that at times during Covid restrictions , the rate of self-harm was seven times higher among the female prison population than among their male counterparts . 7
Likewise , a briefing published by HM Inspectorate of Prisons in February revealed that a ‘ far higher proportion of women reported mental health problems on arrival at the prison and almost double the proportion of women then men felt suicidal ’. 8
These challenges are then intensified by the institutional security-first approach . ‘ Some prisons are still in [ Covid ] lockdown 23 hours a day , and that itself points to the staffing challenges in prison ,’ says Dr Miranda Davies , a senior researcher at The Nuffield Trust who has been studying healthcare in prison . The official Government guidance , updated in August , does not recommend this but stringent guidelines on visiting and isolation remain in place . 9
It ’ s a Marmite sort of job but I could never work anywhere other than health and justice Deanna Mezen