A retention and recruitment crisis, a funding deficit, a dilapidated estate and spiralling violence against staff. Sound familiar? The prison service is a close competitor with the NHS for gloomy headlines and horror stories. But maybe there is a glimmer of hope in the white paper just announced by the government on prison safety and reform, which has a significant interest in health. We would like to think that the BMA's submission had a part to play in shaping its vision.
After all, many aspects of poor health impact on reoffending, especially mental health and substance misuse. The government recognised the principle of equivalence of care between community and the secure environment. My role as BMA rep for GPs in the secure environment has allowed me to advocate for 700 doctors who struggle to achieve this: we often work in converted Victorian cells with overstretched officers who bring a fraction of the booked patients. We are regularly asked to cancel urgent patients who need to go out to hospital due to lack of escorts: "is it the cancer patient or the dialysis today, doc?". Our submission was frank about the pressing need for accountability for DNAs, and the benefits of co-commissioning of a joined up service.
And the prisons are awash with abused drugs, both illicit and 'prestige' prescribed meds, many of which we feel obliged to prescribe as they have been initiated by community GPs or psychiatrists, and our patients may be at risk of suicide if they are withdrawn. We are particularly affected by the over prescribing of mirtazapine, usually a third line antidepressant, which is associated with a roughly 5 fold excess rate of suicide. We have continual battles over clonazepam for unconfirmed epilepsy, and pregabalin for atypical neuropathic pain, such as for healed fractures. Such sedatives are associated with deaths particularly in combination with other sedatives, antipsychotics and methadone, that we have to appear in coroners court to explain. The white paper plans to measure the 'distance travelled' in substance misuse by wider drugs testing and also in improvements in mental health. This is impressively ambitious, but only time will tell if it is achievable and if it will go any way to reducing instances of natural deaths and suicides, which have risen by 30% in the last year alone.
In the meantime, the BMA aims to equip those on the frontline by connecting GPs on an online forum (contact [email protected] if interested) and educational events such as the Prison GPs conference.
Dr Alex Bunn is the BMA GPC representative for secure environments.