Provision and Needs for the Health and Wellbeing of Women in Prison: A UK Case Study

This qualitative case study investigates the provision and needs for the health and wellbeing of women in prison in the UK. The study suggests that follow-on research with female inmates is needed to analyze what is actually happening to women in prison and see if it matches the government’s and the public’s perceptions and expectations.

Small case study, Provision and Needs for the Health and Well-
being, of Women in Prison [UK], a Thematic Analysis
This qualitative small case study investigated the perception of the provision
and needs concerning the Health and Well-being, for women in prison (UK).
. It Initial data was collected, through convenience sampling, via an online,
structured interview. These data were analysed using deductive thematic
analysis (TA). The online survey was completed by 2 participants (1 female
and 1 male), both of whom had met the inclusion criteria. Analyses
suggested that their perception of the well-being provision for women in
prison (UK) matches government legislation. This suggests follow-on
research with female inmates (current or recent past), to analyse what is
actually happening to women in prison and see if it matches the
government’s and the public’s perceptions and expectations.
Introduction
We explored the main issues facing women in prison (UK). First, we report on the
number of women in prison (UK) and why they have to be there. . Next, what are the
specific rights by law for women in prison includes both physical and mental health
aspects (collectively, well-being). Finally, some side issues including rights for trans-
gender prisoners and babies/pregnancy and serving time in prison. The main aim of
this study is to identify how women must be treated in prison (according to law) and
the comparison of the same it with what members of the general public (with no
prison experience) perceive what is happening to/for women in prison. Hopefully this

should lead to avenues for future research and interventions to improve / maintain
provision and the transparency of information concerning the well-being of women in
prison.
The current women prison population is about 3.2 million (males about 10 million)
and most women are sent to prison to serve a short sentence for theft rather than for more
serious crimes, such as violence against the person, robbery, sexual offences, drugs, and
serious motoring offences and others (GOV. UK, 2020).
According to UK law, women have specific human rights, these include protection
from bullying and racial harassment. being able to get in contact (on demand) with a
solicitor and access to appropriate healthcare - including support for mental health
conditions (GOV. UK, 2020). Mainly with respect to the rights of transgender there
lies the various discussions regarding the rights of trans-sexual prisoners and
depending on transitional stage and starting/ target gender, which sort of prison they
should be in (male or female).
This is very complex, as outcomes must satisfy the person and other inmates (PAS,
2021). Another issue is that it is estimated that 1-50 convicted males, self-identify as
trans-gender, this could reflect that people who are identified as the transgender are
recognised as a problem and get special privileges. Finally, the problem of convicted
women who are also mothers of young children/babies and recognising that both the
mother and child have human rights. 66% of women prisoners are mothers of
children under the age of 18, and each year it is estimated that more than 17,700
children are separated from their mothers by imprisonment(Nagy, (2020)). Only 5 per

cent of children remain in their own home once their mother has been sentenced,
also a lot of prisons have mother and baby units (Howard League, 2016).
Analytical Approach
This research project comprises of the epistemologically approach which is how
knowledge is created leads in creating a a social-constructionist view. This perspective
looks at meaning and experience, both are believed to be socially derived
and maintained and thus not inherent, ( Amineh & Asl, 2015). Deductive
Thematic Analysis has been utilized to examine the data in this report. Starting
with a research question and analysis of data leading to embedded theory
(Roberts, 2019). Pattern recognition methods which use the non-numerical written
data’s coded themes and subthemes. This permits a comprehensive and in-
depth examination of the participants unique experiences, (Clarke & Braun, 2016;
Kiger & Varpio, 2020).
Analysis originates whilst becoming acquainted with the evidence as endorsed by
Clarke and Braun (2016). The structured interviews were transcribed and were
analysed using Thematic Analysis. Conceptually interconnected codes were
gathered within careful themes (Clarke & Braun, 2016). A thematic map was
developed to support the classification and assemblance of codes into innovative
themes. . These themes were evaluated.

Aims of the study
1. To investigate the current provision for the health and wellbeing needs, of
women in prison (UK).
2. To investigate if the perception of the health and well-being provision for
women in prison (UK), matches public perception.

Method
Design
The research design for this project is qualitative. Qualitative methodology is useful for
measuring, raking, categorizing, identifying patterns, and to collate in depth sensitive data
from participants using online / virtual interviews. The structured interviews were transcribed
and analysed using deductive Thematic Analysis. Rather than relying on a set of limited
questions to extract categorised, minimal choice responses with little or no room for
explanation, qualitative research relies on the participants to provide a more comprehensive
account of their perceptions and experiences (Jackson, Drummond & Camara, 2007). Thus
while addressing the aims of the given study the qualitative approach stands the appropriate
approach.
Participants
This study was a small case study comprising of the aspects of prison experience and good
physical/mental health). The male participant was 23, student and single (no children). The
female participant was 27, employed/student and partnered (1 child).
Materials
The material used to facilitate this study was an online questionnaire (Appendix A),
part one included an ethics statement and participants characteristics and part two
was the structured interview schedule. In order to develop the interview schedule, the
importance of the area of concern needs to be taken care of. And hence It is therefore

important to highlight the research confidentiality, the right to withdraw and that the research
will be anonymised and the duration of storage and the signposting of supportive services.
Procedure
The online survey was delivered by email, took between 15-30 minutes to complete,
and was returned by email to the research student for analysis. Once the survey was
completed participants were thanked for taking part.
Ethical considerations
All Ethical considerations have been considered, regarding this research and approved. Ethics
approval was sort and granted for the purposes of this study via the University department of
Psychology. Participants who expressed an interest in taking part were contacted by the
research student.

Results
The themes and sub-themes identified in the transcripts .
Table 1. Thematic Map of Research with themes and subthemes identified
The perception of provision and needs for the Health and Well-being, of Women in prison
[UK].
# Main Themes Sub Themes
1 Prison experience a) You, family or friends
b) Media
2 Why put women in prison. a) General Crimes
b) Domestic Crimes
3 Perception of how you would be
treated in prison.
a) How you perceive
b) What you actually think happens
4 What is the purpose of prison? a) Punishment or rehab?
5 Women’s health and well-being
in prison.
a) Preventing vs Treating
b) Gender Issues
c) Mental health issues identified
d) Causation, imported or caused by
prison
6 What needs improving and other
issues raised
a) Prisoners’ Rights
b) Sentencing, motherhood and
pregnancy
c) Trans-gender issues
Theme 1: Prison experience
a) Both participants had no prior prison experience (part of the inclusion criteria)
b) Media influence on perception of prison life:
“Orange is the New Black” (Male, p2)
“Criminal Minds - Special Victims Unit – NICS (Female, p1)
Theme 2: Why put women in prison?

“They could have committed drug or property offences. Also, they may have been
sentenced for violence against a person or robbery” (Male, p3)
Unlike men, women also conduct different crime which includes various criminal
activity like theft, partnering in theft, robbery, murder, offence against meaning with
respect to aggression, child abduction and revenge and many more. These are
some of the reason which leads to conduct crime by women where law is equal and
when they found guilty then they get different punishment according to seriousness
of crime.
“Perhaps mostly due to domestic violence, and what may seem self-defence”
(Female, p2)
Theme 3: Perception of how you would be treated in prison.
a) Expectation
“I would still expect to be treated with respect and not be discriminated against. I
would expect my religious beliefs to be respected as well as my cultural precepts.
Furthermore, my wellbeing should still be important, and I would expect to take part
in education and activities aimed at rehabilitation. “ (Male, p2)
“Perhaps how I look may affect how I would be treated due to the colour of my skin
and religion. So, unless I do not find a group that look like me, I assume I would be
treated unfairly.” (Female, p2)
b) Reality (perception of)

“In some respects, they wouldn't match but in general I think these are rights that
prisoners should have.” (Male, p3)
“I fear the reality and expectation may be quite similar.” (Female, p2)
Theme 4: What is prison for?
Punishment/Rehab
“prison is the sharp end of our justice system and ultimately protects the public from
dangerous individuals. It is also the act of punishment for the crimes they have
committed.” (Male, p4)
“Not much to do with rehabilitation, but rather a reinsertion of power by the elites.”
(Female, p2)
Theme 5: Women’s mental health in prison.
a) Focus on Preventing or Treating
“Preventing health problems” (Male, p4)
“I believe inmates should be provided with the same level of care as those outside of
prison, and so health would be just as prioritised as all other important aspects in the
outside world.” (Female, p2)

b) Gender issues
“There is likely to be gender differences however in general preventing and treating
health problems are still fundamentally the same.” (Male, p4)
“They are designed to complement existing national and international health
standards and guidance for women in prison. Also, the measures reflect fairly
wellbeing of men and women separately.” (Male, p4)
“I was unaware that standard in healthcare was gender specific. Within the UK, I
believe that equality in this retrospect is achieved, especially between gender.
Perhaps not to much when comparing class, ethnicity, or those kind of segregated
topics.” (Female, p2)
d) Mental health issues identified
“Anxiety, depression, and self-harm are fundamental issues that women may
experience, and prisons may exacerbate these issues.” (Male, pp 5-6)
“They may be feeling anxious or worried, depressed, sleep problems, weight or
appetite changes etc. These are common signs of mental health problems”. (Male,
pp 5-6)

“I feel everyone has a tendency to slip into a mental health or physical health crisis.
Going into prison could therefore be a gateway to this. It does not necessarily mean
that everyone that goes into prison experienced mental or physical health issues. It
could just be a stressor that affects and or increases such issues.” (Female, p3)
e) Causation, imported or caused by prison
“I believe prisons can lead to these health issues especially mental health
issues”…... “these also occur outside of prison.” (Male, p5)
“I would not say created by being in prison, but perhaps assisted for some people
who may not have had issues outside of prison.” (Female p3)
Theme 6: What needs improving and other issues raised
Rights
“They would get essential health care but in reality, it probably isn't sufficient.” (Male,
p8)
Motherhood/pregnancy and prison

“Depends on the crime but I do think certain provisions should be put in place for
pregnant women in prison…. I agree with them on some aspects as they allow the
mother and baby to live together in a peaceful safe place.” (Male, p8)
Trans-gender issues
“Their full wellbeing should be taking into account and ensuring that they still get
equal treatment to other inmates.” (Male, p8)
Covid-19
It is also worth noting that this study has been completed during a pandemic and
responses to research and interviews has been severely undermined. This has also restricted
the possibility of doing face-to-face interviews and enlisting more candidates directly by
approaching on campus.

Discussion
The analysis of data collected in this research, suggested that our two student
participant’s expectations/perception of treatment by prison and prison officers is
roughly in line, with that which legislation suggests. That is mainly that our human
rights are and should be respected for women, regardless of status.
What stood out from this research is why women and people in general are in
prison: “Not much to do with rehabilitation, but rather a reinsertion of power by the
elites.”, which could be understood as social control by the elite ‘privileged’ class
over an oppressed general public. This also includes the ‘keep them in their place’.
(Almeida, 2019).
Also, the female respondent, who self-declared as being ‘black’ and stated: “Perhaps
how I look may affect how I would be treated due to the colour of my skin and
religion. So, unless I do not find a group that look like me, I assume I would be
treated unfairly.” This strongly suggests that dependent on the colour of your skin
and religion (eg. Islamic), you may encounter a negative bias in the prison service.
The issues of trans-gender and young mothers in prison had bland/no responses
and indicated either lack of care or knowledge of these issues. This includes the
interest, was a difference in gender response as to why women are in prison: male,
“They could have committed drug or property offences. Also, they may have been
sentenced for violence against a person or robbery”. Female, “Perhaps mostly due

to domestic violence, and what may seem self-defence”. Through this, it includes the
understanding about effective response towards dealing with better impact of
learning and understanding the needs of health and wellbeing to women in prision.
Issues raised by this research, is that it was a very small sample size and although
it collected a deep insight, it lacks generalisability to a larger target population. To
improve and advance this research. This research also suggested further avenues
of research including looking at female ethnic and religious diversity concerning
treatment in prison. Women in the prison are more often show the affected factor
which is proportional aspect that is related with the mental health, suicide, self-
harm, drug independence and other health need which is compared with the men
with the concept with prison. The future recommendation within this to focus on
the context that provide brief summary which is development of wellbeing and
resilience among women in imprisonment.
As per the above discussion, it is well analysed that the research process is well
conducted in order to analyse the women in the context with prison and their
wellbeing. Therefore, the research process is well conducted with the thematic
analysis that help to produce the data and information which is related with the
achieved knowledge that is related with the chosen topic. Therefore, the law,
reality and expectation show the match with the chosen topic which provide follow
the log that is based in information.

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Appendices :
Appendix A: Raw questionnaire
Single case, semi-structured interview: Health and Well-being, for
Women in prison in England, a Thematic Analysis
Questions for an interview with one or more participants:
Introductory statements:
 This interview is about a socially sensitive topic (health and
wellbeing of women in prison), are you happy to proceed?
 If at any point you feel uncomfortable, indicate you want to stop
and also state if you want all data concerning you, destroyed.
 Data collected will be stored safely, with limited access; before
being destroyed after use.
1. Participant Characteristics (can include rather not say):
 How would you describe your gender?
 How old are you?
 Employed or student?

 Married / live-with partner or single
 Any children?
 Any experience with the prison service (if yes, please outline)?
 Have any of your family or friends had any experiences with the
prison service (if yes, please outline)?
 How would you describe your physical health?
 How would you describe your mental health?
 Have you a favourite TV series or movie concerning prisons?
2. Main body of interview (The interviewee can be asked to
expand points from their responses):
 For what reasons do you think women end up in prison?
 How would you expect to be treated if you received a prison
sentence?
 Considering your last answer, do you think reality and expectation
may not match?

2a. How would you describe the purpose of imprisonment?
 In terms of health and wellbeing, should prison’s primary focus be
on preventing health problems or treating health problems?
 Are there gender differences in the health and wellbeing
challenges that prison presents?
2b. What do you understand by ‘gender specific’ standards in
healthcare?
 What do you understand by physical health issues?
 What do you understand by mental health issues?
 Do you think mental and physical health issues are pre-existing
and imported into prison?
 Do you think mental and physical health issues are primarily
created by being in prison?
 What are the main issues for women regarding mental health and
wellbeing?
 What are the main signs for women having mental health and
wellbeing problems?
 How serious do you consider the following:
Depression

Self-harm
Risk of suicide
Substance abuse
Sexual health
Pregnancy
Diet
Weight control
 Who do you think is responsible for women’s wellbeing in prison?
 Who should provide women with primary, physical healthcare?
 Who should provide women with primary, mental healthcare?
 How should contact occur between health professionals and
women prisoners?
3. Most of what you have said is probably based on ideals, what do
you think is the real provision for women in prison and how should
it be improved?
4. Some other areas for consideration:

 Do you think anything you have said or think, should be
considered as mitigating, before giving a custodial sentence (eg.
should a pregnant women/young mother be sent to jail)?
 What do you think of mother and baby units in prisons?
 What wellbeing provisions should the prison service provide for
full or partial trans-gender prisoners?
Appendix B. Responses to surveys (x 2)
Male Participant
● This interview is about a socially sensitive topic (health and
wellbeing of women in prison), are you happy to proceed?
● If at any point you feel uncomfortable, indicate you want to stop
and also state if you want all data concerning you, destroyed.
● Data collected will be stored safely, with limited access; before
being destroyed after use.

Participant Characteristics (can include rather
not say):
● How would you describe your gender?
Male
● How old are you?
23
● Employed or student?
Student
● Married / live-with partner or single
Single
● Any children?
No
● Any experience with the prison service (if yes, please outline)?
No
● Have any of your family or friends had any experiences with the
prison service (if yes, please outline)?

No
● How would you describe your physical health?
I would say I have good physical health.
● How would you describe your mental health?
I would say I try to take care of my own mental wellbeing as its very
important to health. At the moment my mental health is in good
condition.
Have you a favourite TV series or movie concerning prisons?
Orange is the new black
Main body of interview
1.1For what reasons do you think women end up in prison?
They could have committed drug or property offences. Also they may
have been sentenced for violence against a person or robbery.

1.2 How would you expect to be treated if you received a prison
sentence?
I would still expect to be treated with respect and not be discriminated
against. I would expect my religious beliefs to be respected as well as
my cultural precepts. Furthermore, my wellbeing should still be
important, and I would expect to take part in education and activities
aimed at rehabilitation.
1.3 Considering your last answer, do you think reality and
expectation may not match?
In some respects, they wouldn't match but in general I think these are
rights that prisoners should have.
2.1 How would you describe the purpose of imprisonment?
I would say prison is the sharp end of our justice system and ultimately
protects the public from dangerous individuals. It is also the act of
punishment for the crimes they have committed.

3.1Prison In terms of health and wellbeing, should prison’s
primary focus be on preventing health problems or treating
health problems?
Preventing health problems
3.2 Are there gender differences in the health and wellbeing
challenges that prison presents?
There is likely to be gender differences however in general preventing
and treating health problems are still fundamentally the same.
3.3 What do you understand by ‘gender specific’ standards in
healthcare?
They are designed to complement existing national and international
health standards and guidance for women in prison. Also the measures
reflect fairly wellbeing of men and women separately.
3.4 What do you understand by physical health issues?
Physical health issues would be anything such as an illness or injury that
effects your body directly.

3.5What do you understand by mental health issues?
Health impacts on the mind and the wellbeing of an individual
psychologically and emotionally.
3.6 Do you think mental and physical health issues are pre-
existing and imported into prison?
No I believe prisons can lead to these health issues especially mental
health issues.
3.7 Do you think mental and physical health issues are
primarily created by being in prison?
No, these also occur outside of prison.
3.8 What are the main issues for women regarding mental
health and wellbeing?
Anxiety, depression, and self-harm are fundamental issues that women
may experience, and prisons may exacerbate these issues.

3.9 What are the main signs for women having mental health
and wellbeing problems?
They may be feeling anxious or worried, depressed, sleep problems,
weight or appetite changes etc. These are common signs of mental
health problems.
3.10 How serious do you consider the following:
Depression
Self-harm
Risk of suicide
Substance abuse
Sexual health
Pregnancy
Diet
Weight control

These are all important for an individual’s mental health, however in
particular substance abuse, self-harm, and depression are of key
importance in preventing mental health problems.
4.1 Who do you think is responsible for women’s wellbeing in
prison?
The medical and mental health care and ultimately its the government's
responsibility to ensure prisoners are kept in good health whilst in
prison.
4.2 Who should provide women with primary, physical
healthcare?
It should be the job of the prisons to provide this.
4.3 Who should provide women with primary, mental
healthcare?
This should again be provided by the prison.
4.4 How should contact occur between health professionals and
women prisoners?

Should be carried out by the healthcare team in a safe and secure
manner.
4.5 Most of what you have said is probably based on ideals,
what do you think is the real provision for women in prison
and how should it be improved?
They would get essential health care but in reality, it probably isn't
sufficient.
5. Some other areas for consideration:
5.1 Do you think anything you have said or think, should be
considered as mitigating, before giving a custodial
sentence (eg. should a pregnant women/young mother be
sent to jail)?
Depends on the crime but I do think certain provisions should be put in
place for pregnant women in prison.
5.2 What do you think of mother and baby units in prisons?
I agree with them on some aspects as they allow the mother and baby to
live together in a peaceful safe place.
5.3 What wellbeing provisions should the prison service
provide for full or partial trans-gender prisoners?

Their full wellbeing should be taking into account and ensuring that they
still get equal treatment to other inmates.
FEMALE PARTICIPANT
I have answered the characteristics part and also 9 of your questions.
Participant Characteristics (can include rather not say):
• How would you describe your gender? Female
• How old are you? 27
• Employed or student? Employed & Student
• Married / live-with partner or single Married
• Any children? 1 Child
• Any experience with the prison service (if yes, please outline)? No
• Have any of your family or friends had any experiences with the prison
service (if yes, please outline)? No
• How would you describe your physical health? Relatively healthy
• How would you describe your mental health? Relatively healthy
• Have you a favourite TV series or movie concerning prisons? Criminal
Minds/Special Victim Unit/NCIS

Main body of interview
• For what reasons do you think women end up in prison? Perhaps
mostly due to domestic violence, and what may seem self-defence
• How would you expect to be treated if you received a prison sentence?
Perhaps how I look may affect how I would be treated due to the colour
of my skin and religion. So, unless I do not find a group that look like me,
I assume I would be treated unfairly.
• Considering your last answer, do you think reality and expectation may
not match? I fear the reality and expectation may be quite similar.
• How would you describe the purpose of imprisonment? Not much to do
with rehabilitation, but rather a reinsertion of power by the elites.
• In terms of health and wellbeing, should prison’s primary focus be on
preventing health problems or treating health problems? I believe
inmates should be provided with the same level of care as those outside
of prison, and so health would be just as prioritised as all other important
aspects in the outside world.
• Are there gender differences in the health and wellbeing challenges
that prison presents? I’m not so sure I would know the answer to this,
sorry.

• What do you understand by ‘gender specific’ standards in healthcare? I
was unaware that standard in healthcare was gender specific. Within the
UK, I believe that equality in this retrospect is achieved, especially
between gender. Perhaps not to much when comparing class, ethnicity,
or those kind of segregated topics.
• What do you understand by physical health issues?
• What do you understand by mental health issues?
• Do you think mental and physical health issues are pre-existing and
imported into prison? I feel everyone has a tendency to slip into a mental
health or physical health crisis. Going into prison could therefore be a
gateway to this. It does not necessarily mean that everyone that goes
into prison experienced mental or physical health issues. It could just be
a stressor that affects and or increases such issues.
• Do you think mental and physical health issues are primarily created by
being in prison? I would not say created by being in prison, but perhaps
assisted for some people who may not have had issues outside of
prison.
• What are the main issues for women regarding mental health and
wellbeing?
• What are the main signs for women having mental health and
wellbeing problems?

• How serious do you consider the following:
Depression
Self-harm
Risk of suicide
Substance abuse
Sexual health
Pregnancy
Diet
Weight control
• Who do you think is responsible for women’s wellbeing in prison?
• Who should provide women with primary, physical healthcare?
• Who should provide women with primary, mental healthcare?
• How should contact occur between health professionals and women
prisoners?
• Most of what you have said is probably based on ideals, what do you
think is the real provision for women in prison and how should it be
improved?