Table 7 Challenges to Healthcare

Challenges included: conflicting priorities of custodial and care frameworks (du Toit & Ng 2022) a lack of intervention evaluations or reviews to inform practice (Treacy et al., 2019; National Institute for Health and Care Excellence, 2017; Gaston & Axford, 2018); a lack of resources (specialists, escort staff and money) (Inspector of Custodial Services, 2015; Welsh Government and Ministry of Justice, 2011; Fazel et al., 2002); staff resistance (Turner, 2018); lack of understanding of the prison context (Gaston & Axford, 2018; Williams, 2014); high levels of staff burnout (Gaston & Axford, 2018); people not accessing healthcare for fear of bullying (Cipriani et al. 2017); not being able to physically access healthcare centres (Treacy et al., 2019; Her Majesty's Inspectorate of Prisons, 2017b; Welsh Government and Ministry of Justice, 2011, Gaston & Axford, 2018); limited access to healthcare services (Moore & Burtonwood, 2019); delays in arranging assessments (Forsyth, Heathcote and Senior et al. 2020); diagnosis and/or the provision of care (Forsyth, Heathcote and Senior et al. 2020) and; healthcare staff lacking access to prisoners at night (Welsh Government and Ministry of Justice, 2011). There are barriers for nurses to develop therapeutic relationships with those they care for due to correctional requirements and the physical environment, affecting nurse–patient relationship building (Pandey et al., 2021). There may also be a mistrust of prison healthcare staff (Moore & Burtonwood, 2019). The mental health services are often focused on other inmates whose behaviours are more challenging (Pandey et al., 2021). There were multiple issues around referrals, with some people not ‘able’ to self-refer (Prisons and Probation Ombudsman, 2016), prison staff can be a barrier, and so referrals should not have to go through them (Treacy et al., 2019; Her Majesty's Prison & Probation Service, 2018), although it was also suggested that healthcare staff should accept referrals from prison staff as they are the prison frontline (Brown, 2016; Moll, 2013; Treacy et al., 2019; Ministry of Justice, 2013; Prison and Probation Ombudsman 2016, Welsh Government and Ministry of Justice 2011]. Cognitive decline is also a barrier to providing health care in prison from the help-seeking side is a further impediment (Pandey et al., 2021). One suggestion was that healthcare staff automatically book in check-up appointments (Her Majesty's Inspectorate of Prisons, 2015), and one prison ran an in-reach programme of healthcare assistants worked on prison wings to identify concerns (Her Majesty's Inspectorate of Prisons, 2017a)