Women’s experiences of prison-based mental healthcare: a systematic review of qualitative literature

• DOI: https://doi.org/10.1108/IJPH-09-2021-0091
• Published date: 24 February 2022
• Date: 24 February 2022
• Pages: 181-198
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Ann-Marie Bright,Agnes Higgins,Annmarie Grealish

Women’s experiences of prison-based

mental healthcare: a systematic review of

qualitative literature

Ann-Marie Bright, Agnes Higgins and Annmarie Grealish

Abstract

Purpose –The rate of female committalsto prison has grown rapidly in recent years. Women in prison

are likely to have trauma historiesand difficulties with their mental health. This paper aimsto synthesise

the findings of qualitative literatureto gain a deeper understanding of the experiences of women in the

contextof prison-based mental health care.

Design/methodology/approach –A systematic search of five academic databases, Cumulative Index to

Nursing and Allied Health Literature, Applied Social Sciences Index and Abst racts, Psychological Information

Database (PsycINFO), Excerpta Medica DataBASE (EMBASE) and Medline, was comp leted in December

2020. This study’s search strategy identified 4,615 citatio ns, and seven studies were included for review.

Thomas and Harden’s (2008) framework for thematic synthesis wa s used to analyse data. Quality appraisal

was conducted using the Joanna Briggs Institute Checklist for Qualit ative Research (Lockwood et al., 2015).

Findings –Four analyticthemes were identified that detail women’s experiencesof prison-based mental

health care: the type of servicesaccessed and challenges encountered; a reduction in capacityto self-

manage mentalwell-being; the erosion of privacyand dignity; and strained relationshipswith prison staff.

There is a paucity ofresearch conducted with women in the context of prison-based mental health care.

The findings suggest there isa need for greater mental health support, including the needto enhance

relationshipsbetween women and prison staffto promote positive mental health.

Originality/value –To the best of the authors’knowledge, this is the first systematic review conductedon

the experiencesof women in the context of prison-based mental healthcare.

Keywords Mental health, Women prisoners, Prison, Serviceprovision, Qualitative synthesis,

Women’s experiences

Paper type Research paper

Introduction

Since 2000, the number of women in prison has increased by approximately 53%, resulting

in a worldwide female prison population estimated at 714,000 (Walmsley, 2017).

Internationally, prison populations and committal rates vary. The USA has seen a 700%

increase in female incarceration between 1980 and 2019, with approximately 222,455

women in prison and jail between the years 2018 and 2019 (Carson, 2020;Zeng, 2020).

However, Australia saw a 10% reduction of women in prison from 2019 to 2020, which may

be the result of pandemic restrictions implemented in various states and territories

(Australian Bureau of Statistics, 2020). In the UK, women account for 4.1% of the overall

prison population (World Prison Brief, 2021), where the average female prison sentence is

11.3 months (Ministry of Justice, 2019), and in Ireland, the average duration of prison

sentences are three months or less (Irish Prison Service, 2019a). In the UK, it is estimated

that 73% of women serving sentences of 12 months or less are reconvicted within a year of

release (Prison Reform Trust, 2021). The effectiveness of short prison sentences has been

Ann-Marie Bright is based

at the Department of

Nursing and Midwifery,

University of Limerick,

Limerick, Ireland.

Agnes Higgins is based at

School of Nursing and

Midwifery, Trinity College

Dublin, Dublin, Ireland.

Annmarie Grealish is based at

the Department of Nursing

and Midwifery, University of

Limerick, Limerick, Ireland

and Florence Nightingale

Faculty of Nursing, Midwifery

and Palliative Care, King’s

College London, London, UK.

Received 3 September 2021

Revised 25 November 2021

5 January 2022

10 January 2022

Accepted 11 January 2022

©Ann-Marie Bright, Agnes

Higgins and Annmarie

Grealish.Published by Emerald

Publishing Limited. This article

is published under the Creative

Commons Attribution (CC BY

4.0) licence. Anyone may

reproduce, distribute, translate

and create derivative works of

this article (for both commercial

and non-commercial purpose s),

subject to fullattribution to the

original publication and

authors. The full terms of this

licence may be seen at

http://creativecommons.org/

licences/by/4.0/legalcode

Funding: This research did not

receive any specific grant from

funding agencies in public,

commercial or not-for-profit

sectors.

DOI 10.1108/IJPH-09-2021-0091 VOL. 19 NO. 2 2023, pp. 181-198, Emerald Publishing Limited. , ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 181

debated as they are less effective at reducing reoffending whencompared with suspended

or community sentences (O’Donnell, 2020;Gasc

on, 2020). Indeed, the prison has a negative

impact on women in the context of mothering, homelessness and employment (O’Ma lley and

Devaney, 2016;Powell et al., 2017;Prison Reform Trust, 2021) and with only two wome n’s

prisons in Ireland and 12 in the UK, many women are detained far from home, impacting on

the visitation of children and families (Irish Prison Service, 2021;Ministry of Justice, 2021a).

Mental health problems are overrepresented in the female prison population; approximately

80% have a mental health diagnosis (World Health Organisation, 2021). Women in prison

are five times more likely to experience mental health difficulties than women in the general

population (Tyler et al.,2019). Prevalence rates for psychotic illness among women in

prison are estimated at 3.9%, major depression at 14.1%, alcohol misuse at 10%–24%,

drug misuse at 30%–60% (Fazel et al.,2016) and post-traumatic stress disorder at 21.1%

(Baranyi et al.,2018). Women in prison are susceptible to self-harm, with approximately

30% engaging in self-harming behaviours (Ministry of Justice, 2017;Irish Prison Service,

2020;Ministry of Justice, 2021b). In addition, women in prison are up to 20-times more likely

to die by suicide and 36 times more likely to die by suicide one-year post-release when

compared with those in the general population (Fazel and Benning, 2009;Pratt et a l., 2010).

Women often experience domestic, physical, emotional and sexual abuse prior to

imprisonment giving rise to complex and often unresolved trauma tha t may be criminogenic

(Gunter, 2012;Alves et al., 2016). A correlation exists between trauma and the development of

mental health difficulties (Karlsson and Zielinski, 2 018;Jewkes et al., 2019), which are factors

for a range of adverse outcomes in prison and on release, including being victims of violence

and assault (Caravaca-S

anchez et al.,2014)and reoffending (Baillargeon et al.,2009).

Recently, there has been an increasedcall for gender-specific mental health care in prisons

(Public Health England, 2018). Internationally, gender-specific care is advocated for in the

Bangkok Rules (United Nations Office on Drugs and Crime, 2012), whereas the Kyiv

Declaration made recommendations to review policies and services to meet the needs of

women in prison (United Nations Office on Drugs and Crime, 2009). Mental health services

have adopted trauma-informed approaches (Muskett, 2013;Department of Health, 2020),

which should also inform prison-basedmental health care.

A recent meta-synthesis by Ratcliffe and Stenfert Kroese (2021) provides an overview of

women’s experiences of forensic settings in the UK but does not include prison settings.

Other systematic reviews of mental health interventions for prisoners tend to focus on

medication and psychotherapy (Fazel et al., 2016), CBT and mindfulness-based therapy

(Yoon et al.,2017) and interventions for early adults (Givens et al.,2021), but neglect to

consider gender-specific differences or make gender-specific recommendations. Given

that the rate of women being sentenced to prison is growing more rapidly than for men

(Central Statistics Office, 2019), there is a greater need to focus on the female prison

population. Therefore, this review aims to synthesise findings from qualitative research

conducted with women in prison to identify the state of the evidence in this area and gain a

deeper understanding of prison-based mental health care from women’sperspectives.

Methods

This systematic review is reported in accordance with the preferred reporting items for

systematic reviews and meta-analyses statements (PRISMA) (Page et al.,2021). The study

protocol is registered with the international prospective register of systematic reviews

(PROSPERO) (CRD42021240407). A population, concept and context (PCC) framework

was used to guide the selection of terms used in the search strategy and to formulate the

following research question:

RQ1. What are the experiences of womenin prison in the context of prison-based mental

health care?

PAGE 182 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 19 NO. 2 2023