Death, Addiction and Decay - Health matters in Scottish prisons

Annual Report of the Chief Medical Officer 2013 - Medical Leadership in Scotland

The Scottish Prison Service and NHS face a daily challenge ensuring those detained in prison receive all necessary forms of care. Given the extremely high levels of incarceration in Scotland, this is no small task. That is why the recent Annual Report of the Chief Medical Officer provides illuminating, and also troubling insight into care and need in Scottish custody in 2013.

Nationally, health inequalities remain a ‘major problem in Scotland’, operating in criminal justice spheres ‘offers an opportunity for people in the community who find services hardest to reach, to benefit from support even of the briefest nature’. The report makes clear how problematic it can be to craft the policy and practice of healthcare in criminal justice and not consider those inseparable broader social inequities; stating that it ‘remains the case that key determinants of health are poverty, housing and access to welfare or employment opportunities, along with social aspects of rehabilitation. Without addressing them, risk factor and health improvement intervention will have limited impact and this applies equally to police custody and prisons’.

The disproportionately high medical and healthcare need among the Scottish prison population as compared to the general population was illustrated by a number of key statistics:

  • 54% of 200,000 people who had been in police custody in Scotland had problems with alcohol and drugs.
  • 68% of the same group had difficulties with substance misuse, and problems with both medical and mental health.
  • 73% of prisoners are believed to have an alcohol problem.
  • 36% are believed to be alcohol dependent.
  • At the time of the offence, 45% of prisoner reported being under the influence of alcohol, and;
  • 39% reported that at the time of their offence they were under the influence of drugs.
  •  Upon reception to prison, 77% of prisoners tested as positive for illegal drugs (33% for opiates)
  • It is believed that 19% of the prison population are Hepatitis C positive.
  • About 10% of men in the general population in Scotland suffer from dental decay, compared to 29% of men in Scottish prisons.
  • For women in prison in Scotland, 42% suffer from dental decay, compared to 3% of women in the general population.
  • Both men and women who have been in prison have higher risk of death than the general Scottish populace. The risk of mortality is particularly high in the immediate post release period ‘as prisoners return to the poor circumstances, poverty of opportunity and hope that they left’.

Read the report, particularly the Health & Justice section here

Inverclyde - a new year's resolution?


The 2012 Commission on Women Offenders (CWO) recommended that Cornton Vale should be replaced with “a smaller specialist prison for those women offenders serving a statutory defined long-term sentence and those who present a significant risk to the public”.

In response to this recommendation, the Scottish Prison Service (SPS) proposes to replace Cornton Vale with a prison on the outskirts of Greenock to be known as HMP Inverclyde with a capacity to hold 300 women, with the option of increasing this to 350 places. The planned prison would hold convicted and remand adult and young offenders of varying legal and security categories and of varying sentence lengths, from short-term to life sentences.

As Howard League Scotland has made clear before, this represents a clear departure from the recommendation of the CWO report.

Earlier this week, the Cabinet Secretary for Justice Michael Matheson MSP and the Chief Executive of the Scottish Prison Service Colin McConnell gave evidence to the Scottish Parliament’s Justice Committee. Both were clear that they believed the proposed new women’s prison to be in keeping with the spirit and the letter of the CWO report recommendations.

When it comes to prison, size matters. To achieve a more rehabilitative enviroment in prison, smaller is better. More broadly, Howard League Scotland argues that the proposal to build a 350-bed new women’s prison is at odds with the Scottish Government’s commendable aspiration to reduce the prison population and that it undermines all the good work the Scottish Government has done and is doing to implement other recommendations contained within the 2012 report.

There are currently 390 women in prison in Scotland, the majority of whom do not need to be imprisoned for reasons of public protection. If the proposal for HMP Inverclyde goes ahead, the capacity of the female prison estate will be 500. Far from aiming for a reduction in the number of women in prison in Scotland, the Scottish Government is planning for an increase in that number.

There are a number of other options that would better deliver the recommendations in the report of the Commission on Women Offenders, which have not been considered by the Scottish Government. These could include, for example, the construction of a new small specialist prison - as envisaged in the CWO report - within the campus of Cornton Vale and surveying the possibility of converting available public or other accommodation, which might be used as local low security units to be managed by SPS or other agencies. Moving into 2015, there should be a proper examination of these options and the plan to build HMP Inverclyde should not proceed in its present form.

Find out more:


Can Prison Work?

The Glasgow Skeptics invited Vice-Convener of HLS, Prof Richard Sparks, to give a talk, Can Prison Work? Professor Sparks, a Professor of Criminology at the University of Edinburgh, gives his talk a Scottish focus - asking what is prison for? Can hope for more? Does it matter what the stated aims of imprisonment are? Does it matter who runs the prisons? Are all prisons basically alike?

Watch the talk here: Can Prison Work?

New Cabinet Secretary for Justice

Howard League Scotland welcomes the appointment of Michael Matheson MSP as Cabinet Secretary for Justice. We hope this heralds a renewed energy and commitment to achieving penal reform in Scotland. Scotland imprisons 147 people per 100,000 of the general population, one of the highest uses of imprisonment in Western Europe. Howard League Scotland looks forward to working with the new Cabinet Secretary to realise the Scottish Government’s welcome aspiration to reducing the size of the Scottish prison population and to develop just responses to the causes and consequences of crime more generally.

Ageing Prison Population

Ageing prison populations are increasingly a major point of concern for penal policymakers. According to a recent Scottish Justice Matters article, ‘The number of prisoners aged over 50 in Scotland increased by 71% from 387 in 2001 to 660 in 2011’. Scotland already produces a designated census on older prisoners which gives us some insight into this group of incarcerated people. Some headline statics include: 87% of older prisoners have accessed a doctor, 36% report that they have a disability and 46% of them report having a long term illness (compared to 27% of prisoners under 50).

What these statistics fail to capture is the qualitative and more complex dimensions of daily life for older people in prison in Scotland. Have there been changes in their healthcare and treatment for their long term illnesses upon entering prison? Does being in prison exacerbate these illnesses? If they were retired, what sort of activities do they partake in? Particularly as work is often used and encouraged as an important dimension of prison rehabilitation programmes. For staff as well, do they feel equipped to support older prisoners? The system is generally organised around young men, often unemployed and likely to be suffering from multiple addictions (usually a point made in relation to how prisons marginalise women). In Scotland in particular, we hear so much of the desistance language framing SPS decisions, polices and programmes, but do we need to think differently about desistance in relation to older prisoners?

These concerns have begun to dominate the minds of policymakers as there is a growing number of older people in prisons. According to a detailed brief from RECOOP, in England and Wales older people are the fastest growing demographic group in prisons. Charities which attend to the particular needs of older citizens have also begun to address the very specific needs of caring for elderly prisoners (For example, see this report from the Australian group, Alzheimer’s Australia: Dementia in Prison)

This year the Chief Inspector of Prison, David Strang, highlighted that Scotland too has an ageing prison population. Consequently, facilities which support and care for the increased number of people incarcerated with disabilities and dementia need to be in place. Even the basic design of prison space, particularly cells, needs to be adapted to meet the needs of older people, particularly those with limited mobility.

How can SPS and Scottish prison policy strategies develop to best support this particular group of people? Prison may be concerned with punishment and rehabilitation, evidently, it must also address and support the care needs of older people in their custody.  Otherwise, the risk is that we compound the experience of punishment for older people in prison. As Juliet Lyon and Mark Day remarked in a recent Guardian article ‘Some older people have committed serious crimes and it is important that justice is done, whether someone is aged 18 or 80. But imprisonment for many old, disabled people can amount to a double punishment’.