Health care in prisons: A health care needs assessment Dr Tom Marshall, Dr Sue Simpson and Professor Andrew Stevens Department of Public Health & Epidemiology Public Health Building University of Birmingham Edgbaston Birmingham B15 2TT February 2000 Table of contents Executive Summary ...................................................................................................................................................... 1 Preface ............................................................................................................................................................................ 3 Introduction ................................................................................................................................................................... 4 Health care and the prison estate in England and Wales......................................................................................... 6 Models of health care provision in prisons ............................................................................................................... 8 Providing health care in a custodial setting.............................................................................................................. 9 Describing the prison population .............................................................................................................................. 10 Overall description of the prison population and trends........................................................................................ 10 Description of the prison population by category of prisoner................................................................................ 11 Description of the prison population by category of prison ................................................................................... 12 Description of the prison population by age ........................................................................................................... 13 Males .................................................................................................................................................................... 13 Females................................................................................................................................................................. 15 Description of the prison population by ethnicity ................................................................................................... 17 Other important factors describing the prison population ..................................................................................... 18 Socio-economic backgrounds of prisoners ......................................................................................................... 18 Childhood influences ........................................................................................................................................... 18 Stressful life events affecting prisoners .............................................................................................................. 19 Adverse experiences in prison............................................................................................................................. 19 Sub-categories of health care needs .......................................................................................................................... 21 Categorisation by type of prison.......................................................................................................................... 21 Categorisation by type of health problem ........................................................................................................... 21 Other sub-categories ............................................................................................................................................ 21 Sub-categorisation chosen for health care needs assessment of a prison population........................................ 22 Prevalence and incidence of health problems.......................................................................................................... 23 Health promotion...................................................................................................................................................... 23 Minor illness ............................................................................................................................................................. 25 Prevalence of minor illness in the prison population.......................................................................................... 28 Physical health problems ......................................................................................................................................... 29 Epilepsy ................................................................................................................................................................ 30 Diabetes ................................................................................................................................................................ 32 Ischaemic heart disease and cardiovascular risk factors..................................................................................... 33 Infectious diseases................................................................................................................................................ 34 Dental health ........................................................................................................................................................ 38 Special senses and disability................................................................................................................................ 40 Pregnancy and maternity care ................................................................................................................................. 42 Mental disorders....................................................................................................................................................... 44 Background .......................................................................................................................................................... 44 Personality disorders............................................................................................................................................ 45 Functional psychoses ........................................................................................................................................... 46 Neurotic disorders................................................................................................................................................ 48 Overview of mental health data from other sources........................................................................................... 52 Self-harm and suicide .......................................................................................................................................... 53 Tom Marshall, Sue Simpson, Andrew Stevens; Department of Public Health and Epidemiology, University of Birmingham i Alcohol and drug misuse .......................................................................................................................................... 58 Alcohol misuse..................................................................................................................................................... 58 Drug misuse.......................................................................................................................................................... 60 Overview of other data sources ........................................................................................................................... 62 Services available......................................................................................................................................................... 63 Introduction............................................................................................................................................................... 63 Overview of services available by type of prison............................................................................................... 64 Overview of models of health care provision in prisons.................................................................................... 65 Health care in the community.............................................................................................................................. 66 Health care in prisons........................................................................................................................................... 67 Overview of health care services available in prisons............................................................................................ 68 Self-care, informal and semiformal care............................................................................................................. 68 Primary care ......................................................................................................................................................... 69 Secondary care ..................................................................................................................................................... 73 Health promotion 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