The efficacy of exercise referral as an intervention for Irish male prisoners presenting with mental health symptoms

• DOI: https://doi.org/10.1108/IJPH-12-2016-0073
• Published date: 11 June 2018
• Pages: 109-123
• Date: 11 June 2018
• Author: Shay O’Toole,Jim Maguire,Pearse Murphy
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

The efficacy of exercise referral as an

intervention for Irish male prisoners

presenting with mental health symptoms

Shay O’Toole, Jim Maguire and Pearse Murphy

Abstract

Purpose –The use of exercise as an intervention to improve health in the general population is well

documented. The purpose of this paper is to explore whether an exercisereferral scheme can be an effective

health promotion tool for male prisoners in Ireland, presenting with mental health symptoms.

Design/methodology/approach –This mixed methods study with a pre- and post-interve ntion design

was conducted in Mountjoy Prison, Dublin, which has a capacity for approximately 790 prisoners. Reliable

and validated symptom assessment scales were used to assess levels of depression, anxiety, stress,

self-esteem and anger a mongst a sample of 40 prisoners pre- an d post-intervention. The scal es used were

the Depression, Anxiety and Stress scale or DASS-42 (Lovibond and Lovibond, 1995), the Novaco Anger

Scale (Novaco, 1994), the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the Zung Self-Rated

Anxiety Scale (Zung, 1971). Semi-structured interviews were also conducted with a subset of the

participants post-i ntervention to furthe r test and contextualis e the symptom ratings. Th e data gathered

from the self-rating scales were imported into SPSS 22 for statistical testing for significance. Wilcoxon’s

signed-rank test was then used to measure significance of changes. Thematic analysis was performed on

the qualitative data.

Findings –In the post-intervention, significant levels of improvement were achieved in the levels of

depression, anxiety (DASS), anxiety (Zung), stress, anger, and self-esteem for 29 of the 30 prisoners who

completed the study. The incidence of normal mood scores rose from 33 to 90 per cent after the intervention;

the incidence of extremely severe scores for anxiety changed from 40 to 7 per cent, severe stress scores

changed from 27 to 3 per cent, normal stress levels rose from 17 to 73 per cent, marked anger ratings

reduced from 40 to 3 per cent and low self-esteem levels reduced from 20 per cent of participants pre-

intervention to 7 per cent post-intervention. In the main, participants perceived the experiences and

outcomes of the intervention positively.

Research limitations/implications –There are some limitations to the design of this study. Operational

circumstances within the prison at the start of this study prevented the authors from accessing a larger

sample. A control group would add greatly to the study but this was not possible within a single prison

setting. The possible influence of extraneous variables such as increased attention and social contact, and

more time out of one’s cell may have contributed to improved symptom scores as much as the exercise

intervention in this study. This possibility was recognised from the outset but the authors proceeded because

the aim was to test if an exercise referral package (and all that inevitably goes with that) would make a

difference for symptomatic prisoners.

Practical implications –The organisation and smooth running of the intervention and the positive results

therein underpinned the practicality of this project. The significantly positive results contribute new knowledge

to the profile of Irish male prisoners’mental health.

Social implications –This study could be the found ation for a larger study or se t of studies which

should include a control group and one or more female prisoner cohorts. The impact of positive

changes in prisoners’mental health on the pris on staff and environment c ould also be researched .

This type of study could lead to important social implications in relation to its impact on

prisoner rehabilitation.

Originality/value –This study was the first of its kind to explore the effectiveness of exercise referral as a

health promotion intervention for Irish male prisoners presenting with mental health symptoms.

Keywords Mental health, Anxiety, Physical activity, Self-esteem, Anger, Mood, Exercise referral,

Mental health in prison, Physical exercise

Paper type Research paper

Received 6 December 2016

Revised 31 March 2017

Accepted 5 June 2017

Shay O’Toole is a Nurse at

Mountjoy Prison, Irish Prison

Service, Dublin, Ireland.

Jim Maguire is a Lecturer and

Pearse Murphy is the Head,

both at the Department of

Nursing and Health Science,

Athlone Institute of Technology,

Athlone, Ireland.

DOI 10.1108/IJPH-12-2016-0073 VOL. 14 NO. 2 2018, pp. 109-123, © Emerald Publishing Limited, ISSN 1744-9200

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