An exploratory study of male ex-prisoners’ experiences of health and healthcare in prison and the community

  • James Fraser

Student thesis: Doctoral Thesis


Background: In November 2011, prisoner healthcare in Scotland became the combined responsibility of a partnership between the Scottish Prison Service and the National Health Service. Very little is known about the experience of male prisoners with regard to their health care while in prison and immediately following release.

Aim: Against the backdrop of organisational restructure, the purpose of this study was to investigate the experiences of male prisoners in order that future policy developments can be more grounded in their experience.

Methodology: The study was conducted from a phenomenological perspective. Data was gathered from semi-structured interviews with male ex-prisoners in the community. Interviews were audio-recorded and transcribed where consent was given; detailed field notes were made in interviews where consent was not given for audio-recording. Transcripts of the recorded interviews and field notes were analysed using inductive phenomenological analysis.

Findings: Twenty-nine ex-prisoners participated in semi-structured interviews. Nine consented to being audio-recorded. Analysis revealed the following themes:
1. The meaning of health. Participants experienced their own health predominantly as a physical phenomenon related to their ability to function physically in the world. Mental ill-health had been experienced and was spoken about in terms of stigma and ensuring/maintaining personal safety. Substance misuse was not seen as a health issue but more as an issue of poor service provision.
2. Access to and use of healthcare provisions in prison and the outside community. Problems were experienced regarding medication and the prescribing practices of doctors. Participants’ experience of accessing healthcare services in prison was of a difficult and frustrating process that was controlled by nurses whose attitudes and use of power were perceived as a major factor in prisoners’ ability to access and use the services available. All participants described professionals' high level of mistrust in them and the issues surrounding their health status as a result of the phenomenon known as the credibility gap. This appeared to impact upon their perceived ability to access health care whilst in prison and the outside community.
3. Difficulties in interagency communication of care. Participants expressed experience of an increasingly bureaucratic process of access to health services characterised by form-filling. This was perceived to disadvantage and discourage prisoners with literacy difficulties. Participants expressed that new complaints procedures were not explained and appeared to be designed in a way to deliberately discourage and delay complaints. Participants expressed that the access arrangements for healthcare appointments were also bureaucratic, slow, and perceived to be designed to discourage them from accessing the healthcare services.
4. Vulnerability and hope. The role of the family and the support that they provide following liberation was stated to be important and helpful in preventing relapse into former health threatening behaviours. Such support was also described as helping to prevent participants from becoming embroiled in a revolving door syndrome of release and reoffending. The important mechanisms were identified as a source of accommodation and a permanent address, which was essential to access a number of healthcare services and benefits. Planned, consistent throughcare and opportunities were identified as helpful, especially those from the third sector.

Discussion: This study provides a voice to the participants. Healthcare in prison was largely experienced in terms of physical health; mental health is seemingly experienced as stigmatising. Ex-prisoners experience a communication failure among services. Access to healthcare in prison is experienced as overly bureaucratic.

Conclusion: Ex-prisoner participants' experiential accounts raise problematic issues relating to the effectiveness of 2011 policy changes that were intended to ensure equity in health services for prisoners and ensure that they received improved opportunities to benefit from NHS care. The changes have not translated into an improved experience for prisoners during and following their incarceration a renewed commitment to providing equivalency of opportunity in healthcare for prisoners is required.
Date of Award24 Oct 2017
Original languageEnglish
Awarding Institution
  • Abertay University
SupervisorJames Moir (Supervisor) & Geoffrey L. Dickens (Supervisor)


  • Ex- prisoner
  • Health
  • Healthcare
  • Health promotion
  • Healthcare services
  • Prison nursing
  • Community
  • Experience
  • Interview
  • Qualitative research

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