Medication Management and
Practices in Prison for People
with Mental Health Problems:
A Qualitative Study
Robert A. Bowen, Anne Rogers and Jennifer Shaw
ABSTRACT
Background
Common mental health problems are prevalent in prison and the quality of
prison health care provision for prisoners with mental health problems has
been a focus of critical scrutiny. Currently, health policy aims to align and in-
tegrate prison health services and practices with those of the National Health
Service (NHS). Medication management is a key aspect of treatment for pa-
tients with a mental health problem. e medication practices of patients
and sta are therefore a key marker of the extent to which the health practic-
es in prison settings equate with those of the NHS. e research reported here
M M  P  P 41
considers the inuences on medication management during the early stages of
custody and the impact it has on prisoners.
Methods
e study employed a qualitative design incorporating semi-structured in-
terviews with 39 prisoners and 71 sta at 4 prisons. Participant observation
was carried out in key internal prison locations relevant to the management
of vulnerable prisoners to support and inform the interview process. emat-
ic analysis of the interview data and interpretation of the observational eld-
notes were undertaken manually. Emergent themes included the impact that
delays, changes to or the removal of medication have on prisoners on entry to
prison, and the reasons that such events take place.
Results and Discussion
Inmates accounts suggested that psychotropic medication was found a key and
valued form of support for people with mental health problems entering cus-
tody. Existing regimes of medication and the autonomy to self-medicate estab-
lished in the community are disrupted and curtailed by the dominant practic-
es and prison routines for the taking of prescribed medication. e continuity
of mental health care is undermined by the removal or alteration of existing
medication practice and changes on entry to prison which exacerbate prison-
ers’ anxiety and sense of helplessness. Prisoners with a dual diagnosis are like-
ly to be doubly vulnerable because of inconsistencies in substance withdraw-
al management.
Conclusion
Changes to medication management which accompany entry to prison ap-
pear to contribute to poor relationships with prison health sta, disrupts es-
tablished self-medication practices, discourages patients from taking greater
responsibility for their own conditions and detrimentally aects the mental
health of many prisoners at a time when they are most vulnerable. Such prac-
tices are likely to inhibit the integration and normalisation of mental health
management protocols in prison as compared with those operating in the wid-
er community and may hinder progress towards improving the standard of
mental health care available to prisoners suering from mental disorder.
Introduction
Mental health care provision in prisons constitutes an important system of men-
tal health world wide. However, there has been long standing criticism of the
care of prisoners with mental health problems and those at risk of self-harm and

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