My own interest in prison health care was sparked by being commissioned to carry out a systematic review (Watson et al. 2004). Until that point I had given the subject little thought; I knew that nurses worked in prisons, and that there were prison doctors. However, I did not realize that the health problems of prisoners were greater than those of the general population and that there were some specific problems which had greater prevalence. Furthermore, without any pun intended, it was obvious to me that prisoners were a captive audience in whom targeted health education and health promotion, in addition to the best health care available, could have a significant effect on their lives and on the community to which most are released following incarceration. The review, in this issue of JCN by Condon et al. (2007) is, therefore, very welcome and I am very pleased to publish it.
The provision of prison health care in England and Wales has changed in recent years with a move away from having a prison health care service to having prison health care integrated within NHS primary care. This is well meaning in the sense that there should be no difference in the standard of health care provided to prisoners from the general population. This is not to imply that the provision of health care up to recent years has been poor – the specific needs of prisoners, it could be argued, require specific services. The purpose of prison is several-fold: there is an element of punishment, separation from society for the safety of society and rehabilitation to life outside prison. However, health care should play a positive part in all of these and should not be seen as part of the punishment or separation. If a prisoner has a health problem or health education needs then these should be approached with the best of intentions supported by the best evidence and within a system that is wholly accountable to the public, which the prison system serves.
Nevertheless, the specific needs of prisoners and the scale of the health problems they face should not be underestimated. Some of the reasons people arrive in prison are related to their lifestyle and poor health related practices such as abuse of alcohol and misuse of drugs. Dealing with a person whose bad habits have made him ill and unable to function is one thing; dealing with a person whose bad habits have led to a life-changing event like imprisonment and the concomitant stigma is quite another. The naïve assumption that incarceration and separation from society will lead to separation from the source of a problem like illegal drug use is simply that: naïve. Drugs find their way into prisons with remarkable ease and, of course, could be seen by prisoners as an alleviating factor in an otherwise difficult situation. Drug testing does not solve the problem because there is an inverse relationship between the ‘hardness’ of the drug and its half life in the blood: drug testing can drive prisoners from ‘softer’ to ‘harder’ drugs.
There have been an increasing number of documents in recent years in the UK on the issue of prison health care but there is little that is truly in the public domain or in which the general public really seems to take an interest. It is to be hoped that this is not a result of apathy regarding the health care of prisoners or a feeling that prisoners are less deserving of good health care. The paper by Condon et al. (2007) is one of very few in the nursing literature, as my own systematic review showed. As such, it is an important milestone in the development of appropriate health services for prisoners in the UK. JCN covers all aspects of nursing practice; if nurses do it, it is clinical, and that includes prisons. I hope there will be further papers on the provision, by nurses, of health care to prisoners, and not just from the UK.