Everyday bullying, violence, boredom and substance abuse make prisons a challenging environment for maintaining good health whilst inside and even after release when people are trying to rebuild a life outside.
Prisoners all over the world tend to have poorer physical, mental and social health than the population at large, and they suffer from a wide variety of health issues. One of the biggest health problems facing prisoners is mental well-being as being in prison can have an adverse effect on the mental health of inmates.
For instance, some 26% of women and 16% of men received treatment for mental health problems in the year before going to prison in England and Wales, according to the Prisoners’ Education Trust, (PET), a charity working across prisons in England and Wales.
In turn, boredom inside can trigger mental health problems or make them worse.
“Sometimes people are locked up in their cells for a long time with nothing to do,” says Francesca Cooney, Head of Policy from PET.
Alongside mental health and addiction, people in prison have physical health problems, such as diabetes or epilepsy. According to PET, three-quarters of women and half of men in prison are taking medication in England and Wales.
The rate of infection for blood-borne viruses such as Hepatitis B and C and HIV is four times higher in prisons than in the general population and the rate of tuberculosis amongst people in prison in England is nearly five times higher.
In addition, women in prison may face different health issues than men, as they are more likely to be victims of domestic or sexual abuse, as well as having alcohol- and drug dependency problems.
Staying healthy inside with a multi-disciplinary approach
The right education and disease prevention play a key role in the well-being of prisoners. Learning new skills can help to boost one’s self-esteem and mental capacity inside.
Education, whether taught in a class or individual learning, can help people to cope better with a lengthy prison sentence. Rehabilitating inmates back into community is important and educational qualifications can help prisoners to settle back in more easily.
The most effective learning happens when prison and educational staff work with prisoners to support them daily.
A multi-disciplinary approach in adult education can help to up the build physical, mental and social health capacity of prisoners.
Ideally a prison should provide its staff with awareness training, working closely with health care, and ensuring prisoners with learning difficulties have a supportive living plan, which can be accessed by all staff.
“Prisons that support prisoners effectively will identify who has a learning difficulty and who needs one-to-one support in the classroom and in the wider prison environment,” says Cooney.
Communication skills inside can be enhanced with education and, at the same time, offer mental stimuli.
“Education can be a chance to deal with prison life, learn skills to make communication with fellow prisoners and staff possible, and to escape the chaotic life in prison. Some enjoy having a chance to talk to someone – such as a teacher – who has a different perspective and is a window to the world outside,” says Annet Bakker, Chair of the European Prison Education Association, which is focused on promoting and developing education in prisons in Europe on the recommendations of the Council of Europe.
Prisoners can even be taught to adopt healthier lifestyles with the right motivation and learning environment.
“Lots of the distance learning courses that PET offers are related to health and these courses are popular – prisoners are definitely interested in being healthier. We have courses in substance abuse and understanding addiction, counselling, science and health, and lots of courses on sports and fitness, from gym instructing to yoga,” says Cooney.
Peer-to-peer learning can help. Many prisons have health promotion classes but being short-staffed makes this more difficult. However, some prisons use prisoners themselves to promote health education.
“They are trained and supervised by health care staff and run groups to encourage healthy lifestyle choices,” says Cooney.
People in prison are more likely to smoke than the general population but smoking is now banned in many EU countries’ prisons.
“People entering prison are given help to stop smoking and prisoners are also involved as peer supporters – encouraging others to stop smoking,” says Cooney.
One of the most popular courses funded by PET in England and Wales is Nutrition for Physical Activity.
“It can be difficult to stay healthy in prison. In some prisons, it is hard to get access to the gym, exercise or time in the open air,” says Cooney.
Education in prisons can create a safer environment for both inmates and staff, and create opportunities for self-reflection.
“Courses such as Yoga & Meditation, Forgiveness & Healing, Creative Writing and Women’s Empowerment Aid can help to change behaviours and provide safe spaces within unsafe environments,” says Professor Renford Reese, founder of the Prison Education Project, the largest volunteer-based prison education programme in the U.S.
Long-term prisoners experience an extra complication, because of the length of their time inside.
“Education will offer a connection with society and, if they can take a longer course, it will give their brain the necessary exercise, since it has been proven that doing time is not favourable to your intelligence,” says Bakker.
Boosting inmate’s self-esteem vital for preparing for life outside
Engaging in adult education or prison work programmes while locked up prepares people for work once they are released.
Education can give people a voice and open up doors to a better future, which in turn promotes good health.
“This is important in building confidence and self-esteem, because being able to support oneself is beneficial financially and mentally,” says Reese.
Education is vital in order to prepare inmates to become productive members of society and help them to stay away from crime.
“Taking part in courses can fill purposeful hours during the day that allow prisoners to cultivate interests they may have, help them address daily challenges and focus on career development,” says Reese.
Working towards gaining employment can boost hope, purpose and mental well-being. Vocational courses, such as business start-up, construction and plumbing are popular to prepare for a profession and steer an individual away from crime by offering a chance to earn a salary.
“Vocational skills that can be translated into careers outside such as welder, electrician, heating-, ventilation- and air-conditioning technician, and construction are popular. Computer training programmes are also crucial, as inmates who haven’t had access to a computer or the internet for many years may be at a disadvantage when attempting to return to the workforce,” says Reese.
Lack of funding, shortage of staff hamper education support
One of the main issues facing education inside is lack of funds. It varies from country to country. Countries that organise their education through the Ministry of Education have the broadest curriculum and access to funds, since this follows mainstream education.
For instance, in the UK the public funding for education in prisons is around £130 million annually.
“This sounds like a lot but there is a high prison population in England, so this works out at an average of just €1,600 per prisoner annually,” says Cooney.
“The funding comes from central government but next April, the system is changing. Individual governors – the people who are responsible for managing the prison – will have their own budget for education, will be able to make more choices about what they provide and can decide what their prison needs,” she adds.
In the EU, prisoners can apply for grants to pay for course materials through different charities. Part of the money being invested in prison education comes for the budgets of programmes in the European Commission’s administration like the ERASMUS+ presently being implemented.
There are also investments made by other donors in project-based activities, and many NGOs that work within prisons.
The US has a different system however. Private prisons in the U.S. are run by corporations and this may not be the ideal solution for the long-term health of prisoners, the experts note.
“Unlike public prisons, which aim to rehabilitate and correct criminal behaviour, private prisons may not have as much of an incentive to focus on investing in programmes that support rehabilitation,” says Reese.
In addition, private prisons lack standards or evaluations, which raises concerns of quality and the real needs of individuals.
Because of the lack of funding, receiving a quality education seems to be out of reach for much of the prison population in the U.S.
“There needs to be resources allocated to making these programmes accessible, as well as providing the materials needed to make them successful,” says Reese.
The prisoners’ own economic situation dictates their well-being too. Within the EU, most inmates are entitled to free health care. However, this is not the case in the U.S, where the health care of a prisoner is left down to the individual.
“It is also a critical issue that 70-90% of individuals who are released from US prisons and jails each year are uninsured, many of whom have at least one chronic health condition, such as high blood pressure or diabetes,” says Reese.
Long-term benefits from education inside undeniable
Investing in education and health inside prisons provides a great benefit to society in the long run.
“The main reason why inmates re-offend is that they re-enter society without many skills, which translates to an inability to find and maintain work. From a moral perspective, prison education gives this population an opportunity to thrive, regardless of their past,” says Reese.
Ideally prisoners should have plenty of education support during their time inside to reduce boredom, offer opportunities for future and help them to stay physically and mentally strong.
“The best way to make this work is an holistic approach in which education is part of a broader range of activities that prepare the offender for their release, and do not just offer education and nothing alongside. For education to be most successful, you need a development-friendly prison and not just a retributive closed environment,” Baker notes.
Each prison should offer courses that prepare for life outside, help to build the individual’s life without crime and support their rehabilitation back into the community. Staff training in supporting inmates’ educational needs is also vital.
If education works well in prison, it helps people to reach their full potential and helps the society as a whole by reducing crime and creating meaningful opportunities for ex-convicts.
“It is a key part of successful resettlement. Improving prison education transforms people’s lives,” Cooney sums up.