Intended for healthcare professionals

Primary Care

Influence of environmental factors on mental health within prisons: focus group study

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7413.480 (Published 28 August 2003) Cite this as: BMJ 2003;327:480
  1. Jo Nurse, specialist registrar in public health (jonurse66{at}hotmail.com)1,
  2. Paul Woodcock, senior health promotion specialist1,
  3. Jim Ormsby, specialist registrar in forensic psychiatry2
  1. 1North and Mid Hampshire Health Authority, Harness House, Basingstoke, Hampshire RG24 9NB
  2. 2Ravenswood House, Knowle, Fareham, Hampshire PO17 5NA
  1. Correspondence to: J Nurse Health Policy Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  • Accepted 18 June 2003

Abstract

Objective To increase understanding of how the prison environment influences the mental health of prisoners and prison staff.

Design Qualitative study with focus groups.

Setting A local prison in southern England.

Participants Prisoners and prison staff.

Results Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a “circle of stress,” whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families.

Conclusions Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.

Footnotes

  • Contributors JN had the idea for the study, planned the design and schedules, participated in the running of the focus groups, analysed the data, summarised the results, wrote the first draft of the paper, and is the guarantor. PW and JO both contributed in the planning stages, participated in running the focus groups, assisted in validating the data, reviewed drafts, and contributed to writing the paper.

  • Funding North and Mid Hampshire Health Authority. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared.

  • Ethical approval: We sought advice from the National Prison Health Task Force and local Health Authority Ethics Committee regarding ethical approval, and were informed that official approval was not needed as the primary aim of this study was for service improvement. We took all measures to conduct the study in an ethical manor.

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