Inside prison during the pandemic

07 May 2020

Dr Caroline IJ Watson, RCGP Clinical Champion for healthcare in Secure Environments

Pandemics have been shown to have adverse effects on mental health, triggering negative psychological and behavioural responses. Because of the impact of coronavirus across the country, we have probably all felt fear to some extent over the last few weeks; fear for our own health and fear for our loved ones.

So, can you imagine how it might feel if you were to find yourself in prison or a secure hospital during the coronavirus pandemic, having one door to separate you from the potential ‘epidemiological pump’ for virus transmission? Can you imagine how your fear might be magnified? Being afraid might cause you to show exaggerated ‘distress’ and ‘risky’ behaviours. This might be particularly true if being locked in a room reawakens the childhood trauma you experienced of being abandoned or abused or controlled.

'All work, education, visits and gym cancelled'

While many people are relying on digital technology to stay connected, people in prison access a telephone once a day. People outside prison may be feeling cooped up because of government guidance on social distancing. But imagine being locked behind your door and sharing a room with a stranger? All work, education, visits and gym cancelled. Time out is simply to collect your meal, to have up to 30 minutes outside and a shower (staffing levels permitting), and to make that all-important daily phone call.

The RCGP Secure Environments Group has created resources for clinicians working in secure environments. These can guide those starting out or assisting in a secure environment for the first time or returning from retirement to help cover staff shortages during the coronavirus pandemic. The resources contain guidance on prescribing safely in a context where ordinary medicines are at risk of being misused or diverted and becoming a potential source for bullying.

Guidance covering a wide range of complex issues

In our COVID-19 Resource Hub there is a comprehensive COVID-19 guidance for healthcare in secure environments section. This covers a wide range of complex issues, such as safely locating people who have newly arrived in prison or just returned from hospital and using telephone triage when there is only a shared wing-based phone. This section also has guidance on prescribing to ensure continuity of medicines on release. The guidance includes advice on opiate substitute treatment, in the context of reduced access to community primary care, community drug clinics and significantly restricted supervised consumption services in pharmacies across the UK.

The College’s Secure Environments Group hopes to meet patient needs directly and has published a patient guide entitled, ‘What can I do to keep myself safe from coronavirus while I'm in prison?, in a question and answer format. And to help meet those heightened adverse psychological and behavioural responses?

With the permission of the Prison Phoenix Trust, we have produced printable yoga and relaxation resources. With the permission of LJ Flanders, we also have a selection of Cell Workouts. In progress at the moment, we are co-creating a book about COVID-19 without words, specifically to meet the needs of people in prison and secure hospitals who have learning disabilities or low levels of literacy. Watch this space!

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