Well-being programmes in prisons in England and Wales: a mixed-methods study

• DOI: https://doi.org/10.1108/IJPH-03-2021-0021
• Published date: 13 August 2021
• Date: 13 August 2021
• Pages: 259-274
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Mary Turner,Nigel King,Dara Mojtahedi,Viv Burr,Victoria Gall,Graham R. Gibbs,Lara Flynn Hudspith,Chelsea Beatrice Leadley,Tammi Walker

Well-being programmes in prisons in

England and Wales: a mixed-methods study

Mary Turner, Nigel King, Dara Mojtahedi, Viv Burr, Victoria Gall, Graham R. Gibbs,

Lara Flynn Hudspith, Chelsea Beatrice Leadley and Tammi Walker

Abstract

Purpose –In the past decade, therehas been growing awareness of well-being and itsimportance and

an increase in the developmentof activities or programmes aimed at improvingwell-being. The purpose

of this studyis to investigate what well-being programmeswere being offered to prisoners in England and

Wales andwhat benefits and other outcomes wereexperienced.

Design/methodology/approach –The study used a mixed-methodsexploratory design in two phases.

Phase 1 was a questionnairesurvey of all adult prisons inEngland and Wales, completed by prison staff.

In Phase 2, a sampleof survey respondents took part in in-depthinterviews.

Findings –The programmesidentified in Phase 1 included physical activities,creative arts, mindfulness,

horticulture, reading and animal-assisted activities. Prison staffreported a range of universally positive

outcomes shared by all programmes, including enthusiasm from prisoners, enjoyment of the activities

and being able to do somethingdifferent from the usual prison routine. However,in Phase 2, interviewees

rarely mentioned direct health and well-being benefits. The impetus for programmes was varied and

there waslittle reference to national policy on healthand well-being; this reflected thead hoc way in which

programmes are developed,with a key role being played by the Well-being Officer, where these were

funded.

Originality/value –The literature on well-beingprogrammes in prisons is limited and tends to focus on

specific types of initiatives, often in a single prison. This studycontributes by highlighting the range of

activitiesacross prisons and elucidating the perspectivesof those involved in running such programmes.

Keywords Prisoners, Mental health, Prison, Well-being, Mixed methods, Well-being programmes

Paper type Research paper

Background

In the past decade, both in the UK and around the world, there has been growing

recognition of the importance of well-being and an increased focus on programmes or

initiatives [1] that seek to reduce stress and improve well-being. Such programmes are

likely to be particularly beneficial in custodial settings. It is well-established that people in

prison have much poorer physical, mental and social health than the population at large

(Prison Reform Trust, 2019). A disproportionate number of people in prison are from socially

disadvantaged backgrounds and being in prison long-term is known to accelerate ageing

by about 10 years, so that the health of a 50-year-old in prison is equivalent to that of a 60-

year-old in the wider community (Hayes et al., 2012). Furthermore, there are

disproportionately high rates of suicide and self-harm amongst both male and female

prisoners in England and Wales (Ministry of Justice, 2020). There is, therefore, a strong

argument that well-being programmes can be beneficial both for individuals in prison and

for Her Majesty’s Prisons and Probation Service (HMPPS), as they have the potential to

impact positively on the rates of suicides and self-harm and contribute to safer custody for

all. Indeed, HMPPS’s Business Plan 2018–2019 (HMPPS, 2018) makes clear that issues

related to well-being are a priority,both by improving partnership working to better meet the

Mary Turner, Nigel King,

Dara Mojtahedi, Viv Burr,

Victoria Gall,

Graham R. Gibbs, Lara

Flynn Hudspith and

Chelsea Beatrice Leadley

are all based at the School

of Human and Health

Sciences, University of

Huddersfield,

Huddersfield, UK.

Tammi Walker is based at

the Centre for Applied

Psychological Science,

Teesside University,

Middlesbrough, UK.

Received 15 March 2021

Revised 7 June 2021

29 June 2021

12 July 2021

Accepted 12 July 2021

This research was funded by

the Strategic Research

Investment Fund from the

School of Human and Health

Sciences at the University of

Huddersfield.

DOI 10.1108/IJPH-03-2021-0021 VOL. 18 NO. 3 2022, pp. 259-274, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 259

needs of prisoners with complex mental health needs and by connecting prisons more

strongly to local communities, enabling local community organisations to develop well-

being programmes for people in prison.

Academics have been debating the concept of well-being for decades (Ryff, 1989). Dodge

et al. (2012) contend that previous research has focussed on dimensions and descriptions

of well-being rather than definitions.They propose a definition of well-being as: “the balance

point between an individual’s resource pool and the challenges faced [...]. In essence,

stable well-being is when individuals havethe psychological, social and physical resources

they need to meet a particularpsychological, social and/or physical challenge” (p. 230).We

adopted this approach to defining well-being, as it develops the more dynamic ideas of

positive functioning and flourishing (Keyes, 2002;Seligman, 2012) and enabled us to

investigate both the hedonic and eudaimonic aspects of well-being. A key insight, that

definition of Dodge et al. (2012) uses, is that well-being is a form of dynamic equilibrium

between the resources –psychological, social and physical –that people can draw upon

and the life events or challenges they face. In operationalising this definition for our study,

we were careful to focus on the range of different resources that prisoners could bring to

bear that would include skills and abilities, relationships and mood and confidence. We,

thus, distinguished well-being from the challenges that might perturb it and the actions and

activities that might result from an improvement in prisoners’ resources. At the same time,

we were aware that many of the dimensions used to measure the resources thatgive rise to

well-being are severely limited in a prison setting, for example, autonomy, environmental

mastery and realisation of potential. Thus, when designing the questionnaire, although we

made some suggestions as to the resources that prisoners might use to balance the

challenges they might meet, we also left it open for respondents to suggest other resources

they had detected and indeed, challenges they thought prisoners had to deal with or had

overcome. We chose not to share our definition of well-being with study respondents, but

instead assumed a level of shared understanding of the concept and left it open to

respondents to interpret it as they wished.

Prisons in England and Wales and internationally,have implemented a variety of well-being

programmes, although it is likely that these are under-reported in the academic and grey

literature. Activities such as yoga, nature-based programmes –primarily animal-based

therapy but also horticulture (Moeller et al.,2018)–and creative arts programmes are

designed to improve the well-being of prisoners. However, our searches revealed a very

limited body of literature, both in terms of prison location and initiative type. A small number

of studies report on programmes in one or more English and Welsh prisons, including yoga

(Bilderbeck et al.,2015), horticulture (Baybutt et al.,2018;Farrier and Kedwards, 2015)and

shared reading (Billington et al., 2016). Two systematic reviews/meta-analyses included

programmes in UK prisons but focussed only on the effects of peer-based programmes on

mental health (South et al.,2014) and on yoga/meditation (Auty et al.,2017). Although

digital health and mental health interventions are now available, for example, through

mobile devices delivering interactive interventions for depression and anxiety, we found no

evidence that these have been trialledin custodial settings.

Research from the UK and elsewhere such as Australia (Heard et al.,2013) and the US

(Toews et al.,2018) suggests that such programmes can be effective in improving well-

being. Nevertheless, the systematic reviews cited above report the quality of research as

poor in many cases. It is often difficultto establish how many prisons were approached, and

therefore information about responserates is lacking. Existing research has tended to focus

on single programme types and insome cases may have studied only one prison, although

again this can be unclear. In general, therefore, there appears to have been no systematic

attempt to document which prisons are currently offering well-being programmes, the

nature of these programmes and their perceived effectiveness. This study was developed

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