Trauma-informed care for women post-prison

Lately I have tried to keep an eye out for interesting stories or topics, and I happened to listen to two radio features on prisons in one week on my commute. The first was an interview about the Inspectorate of Prisons review of HMP Eastwood Park, a women’s prison in Gloucestershire. The second was another Radio 4 show about trans women in prisons. Given that Eastwood Park is within the Severn area, the subject, particularly referencing women in the justice system, is very relevant to general practice in our area, and of course a hugely important national policy area.

I am not going to stick my neck out and offer up a debate on whether prisons should exist or address the complex question of appropriate forms of punishment. We are therefore going to think about the role of general practice, given the context of the system that we are currently dealing with.

The report on Eastwood Park is pretty damning. Many of the criticisms will be familiar to you and reflect pressures felt in primary care as well - lack of time, resources, staff and money. With regard to health, the report states “We were, however, not confident that all officers had a good understanding of how best to work with women who had experienced significant trauma or those who had mental health problems” and “Women repeatedly told us that self-harm was caused by a number of triggers, including too much time locked in their cells, a lack of purposeful activity, frustrations about basic requests taking too long to resolve, insufficient support with mental health issues and not enough contact with family and friends”.

There was also something in a King’s Fund podcast on prison health that really stuck with me when I heard it, where it reinforced that a prison sentence is meant to be a deprivation of a person’s liberties, not their health – for example, people would be unable to prepare for a health appointment, as they would only be told of the appointment outside the prison on the day. Another insightful podcast on this topic discussed alternatives for women in the justice system.

Developing trauma-informed care

In primary care, no matter where you are based, there will be interactions with people with lived experience of prisons, and other vulnerable groups in the community. The challenges, like lack of time and training, faced within the prison may also be present in the surgery, and it is likely that there is a high degree of complexity associated with prison experience. So how do we best serve our patients? I have been trying to find some resources around trauma-informed care and discovered a few examples. A document on ACE Hub Wales sets out a framework to support a “coherent, consistent approach to developing and implementing trauma-informed practice across Wales”. Its five principles are:

1. A universal approach that does no harm
2. Person-centred
3. Relationship focused
4. Resilience and strengths-focused
5. Inclusive

I also found a trauma-informed training workbook produced by Barnardo’s Cymru. This has implications beyond people with lived experiences of prison, and might be an excellent resource to be a starting place to design a quality improvement project, that could have leadership, staff development, and clinical outcome objectives. 

Addressing inequality

From what I have listened to, the role of women’s centres is crucial in helping women across the life course, including helping in the rehabilitation process after a prison sentence. Signposting women to these services could make all the difference. Women’s Aid has a search directory to help you identify local and national services. When searching through the south west of England filter, there are 17 local services with links to their websites. Research into recidivism (the reoffending rate) of women in prisons has found that services offering gender-specific, health, trauma and substance misuse treatment services can be beneficial. The new integrated care ideologies map well onto trauma related care and women with lived experience of prison could be well served by developments in this area.

The idea of a community dividend is where health gains achieved within the prison service have the potential to influence not just that person’s life and health, but other people in the community. If this is then supported by integrated, trauma-informed primary and community care, some of the staggering inequalities faced by this group might begin to be addressed. 

About the writer

Dr Eve Barnes is a member of the RCGP’s Severn Faculty, where she serves as Foundation Doctor Rep F2 and Assistant Comms Lead.

If you have any experiences of trauma informed care, any reflections of practice, any comments about the podcasts shared here, tips or QI project ideas, it would be great to hear from you so we can get the conversation going and get women with lived experience of prisons to be a talking point in Severn primary care.

The RCGP Secure Environments Group offers resources providing guidance for GPs and primary care teams working in prisons and other secure environments.