International Prison Health Conference

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International Prison Health Conference

• Scottish Prison Service
• Cytology Screening Programme for female offenders

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Scottish Prison Service

• 15 Prison Establishments
• Health Centres ( managed by the SPS ) in each
  Prison staffed by registered nurses,
  healthcare and pharmacy assistants with part time
  medical support
• 1 prison exclusively for female offenders
• HMP YOI Cornton Vale

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SPS Health Issues

• Health care provision in all establishments
  concentrates on 3 main health categories
• Mental Health
• Addictions
• Primary Care

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Health Promotion

• In the SPS emphasis is placed on health
  promotion
• Our Aim is to
• Increase health awareness in the three category
  areas and by doing so improve the health of
  prisoners and reduce crime and re- offending.
• Have an impact on the health and well being of
  the wider population

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Health Promotion InitiativeCytology Screening
Programme for Women Prisoners

• Developed by four clinical staff working with
  women prisoners at HMP YOI Cornton Vale
• Dr Katie Roxburgh, a local GP
• Lesley McDowall, Clinical Nurse Manager
• Linda Hildreth and Maureen Smith, Sexual Health
  Nurses, HMP YOI Cornton Vale

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Background to the work

• A health survey of female offenders showed that
• They had a high risk of sexual health problems
• They were erratic users of health care services
• A high proportion had history of physical,
  psychological and sexual abuse
• A significant proportion had been involved in
  prostitution and the Sex industry
• They placed little value on their own health

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Implications of the findings

• The lack of attention they paid to their own
  health had the potential to impact on the wider
  community
• The period of imprisonment was a good opportunity
  to provide healthcare intervention not sourced
  outside prison due to their chaotic life styles

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Response to the survey

• Development of a programme of cytology
  screening
• Scale and scope of the work
• To provide access to health prevention and
  promotion opportunities equivalent to those in
  the community
• To create a proactive screening service
• To create a dedicated screening clinic one day
  per week at HMP YOI Cornton Vale
• To raise awareness and educate the client group
• To make the experience a positive one with the
  aim of increasing continued use of these
  services after release

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Empirical evidence

• The impact of the programme can be shown through
  the numbers of smear tests taken

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Benefits of the programme

• There have been a number of quantifiable
  benefits from the programme
• An increase in up take of smear tests, as shown
• Health questionnaires now include routine
  questions about smear history
• Complementary increase in requests for other well
  woman services
• Actual treatment for 22 women whose condition may
  have been otherwise undetected

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Impact of the programme

• Genuine engagement of prisoners previously
  reluctant to manage their own health
• Raised level of consciousness of health issues
  within the prisoner group
• Strengthened links with community health
  providers who will carry on the work with the
  prisoners after their release

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Impact of the programme on staff

• Increased knowledge base through access to
  information and resources in the community
• The opportunity to acquire research and
  evaluation skills transferable to other projects
  and other employment
• A sense of fulfilment and achievement

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Lessons for other Prison Authorities

• This is a low tech programme that could be
  implemented relatively simply in other prisons
• Required resources
• Smear test facilities
• Nurses to conduct the tests
• Access to a testing facility (local hospital)
• Time devoted to health promotion - supported
  through existing nursing staff

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Acknowledgements

• This programme was driven by the enthusiasm and
  commitment of four members of the healthcare team
  at HMPYOI Cornton Vale who wanted to make a
  difference to the health care, and the lives, of
  the female offenders in the Scottish Prison
  Service.
• They are to be congratulated and commended for
  this excellent work.
• John Porter, Nursing Services Manager, SPS