It was one of those conversations. I put the phone down, swore gently to myself, and sat staring into space. Four hours later and I still don’t know what to do with the information I received. Putting it on a screen is one thing, finding an adequate personal response is another.
I found Alex on the internet. He’s fiendishly articulate, writes brilliantly and happens to have spent some time detained at Her Majesty’s pleasure. He also, it turned out, was open to having a conversation with me about health care in prisons. It’s that conversation that I’m recording here, and in acknowledgement that in a world of multiple truths, this is one of them.
As of last week 85,678 people are detained in prisons in England and Wales, their health cared for by a range of services commissioned by NHS England. Except there’s long been evidence to suggest that health isn’t cared for very well at all. In 2016, in England, there were 354 deaths in prison, 119 of them suicide. That’s one prison suicide every three days.
That statistic doesn’t come as a surprise to Alex. With up to 90% of prisoners estimated to have a mental health diagnosis, he describes prison psychiatry services as ‘so stretched that unless you actually try and kill yourself no one's going to see you’. Phone lines to the Samaritans aren’t PIN protected, but, says Alex, most people won’t have a phone in their cell ‘so most of the time you can’t get to one and if you can then everyone else can listen in’.
Then on to sex in prisons. When the then Secretary of State for Justice, Chris Grayling, famously provoked a mixture of outrage and hilarity in 2012 by attempting to ban sexual activity in prisons (including masturbation), discouraging safer sex was just one of the side effects. Although there’s very little publically available data on the incidence of sexual assault in prisons, Alex informs me that whilst prison rapes and assaults are not infrequent the reporting of them is. In his experience, prison protocol dictates that the person who reports an assault will be placed in solitary confinement themselves, in theory for their own protection. Little surprise perhaps that few choose to disclose a crime, the reporting of which incurs something that looks an awful lot like punishment.
What though of more routine health care in prisons? It is provided, says Alex, but ‘operational considerations trump medical ones’. With outside medicines firmly banned, prisoners entering jail are asked what they take, before anything they have is removed from their possession. No exceptions. Not for insulin, painkillers, anti-psychotics... Then says Alex, there’s a bit of a risky period – arrive on a quiet Tuesday and you should get a prison issue of your meds that day. A busy Friday and you might be in for a long, dangerous and, for many of those on anti-psychotics, potentially destabilising wait.
As for routine care – for those in a lower category prison with less lock up time ‘that happens at a glass window’. A triage system in which everyone queues, waits and overhears the needs or complaints of the people in front. For prisoners in higher security prisons, where average time out of a cell per day might be minutes rather than hours just getting out of your cell to get to a healthcare professional can be a challenge extreme enough to deter all but the most desperate.
On the conversation goes. We talk about emergency response times in prisons (too slow he tells me – there’s a lot of paperwork involved), the challenges of getting to a hospital appointment when that requires a two staff escort (and there are no ‘spare’ staff left after cuts of almost 1/3 in the prison workforce in the past 5 years). Alex wants me to know that things are likely to get worse rather than better. That the fastest growing demographic in today’s prison population is the over 60s, and that prison healthcare simply isn’t equipped to meet the needs of the frail elderly. That ‘through the gateway’ care is a moot concept for most released prisoners and, with precious little contact with health services outside prisons, ‘continuity of care’ is a hollow phrase.
Well over an hour has passed and my education from Alex continues. His views are his perspective and his truth, and I make no claims to that here. I do however feel affected and affronted by the conversation we have had. I think about health in its wider context – the systematic societal injustices that deprive humans first of opportunity, and ultimately of freedom. The myriad ways in which incarceration impacts health beyond the immediately medical. Deprived of a vote, often illiterate, addicted and mentally ill, we cannot feign surprise that the warehouses in which we choose to detain some of our most marginalised continue to perpetuate the cycles that lead right to their gates.
Since you’re here… ...we’ll let you in on a secret about Kaleidoscope’s funding. Spoiler alert: it’s not a secret. We’re a business. We design and support collaborations, run events, and help to develop strategy and policy. Our work is shaped by our clients’ challenges. We’d love to hear about yours: find out more.