The Oral Health and Psychosocial Needs of Scottish Prisoners and Young Offenders: Main Report 2019

In March 2005, the Scottish Executive Health Department’s ‘An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland’ (Scottish Executive, 2005) was published in response to the two consultations documents, ‘Towards Better Oral Health in Children’ (Scottish Executive, 2002) and ‘Modernising NHS Dental Services in Scotland’ (Scottish Executive, 2003). The two main areas of the Dental Action Plan were to focus on the improvement of oral health of the Scottish population and to identify specific priority groups needing additional support to improve their oral health. Prisoners were identified as a group of individuals requiring enhanced support to achieve and maintain their oral health.
By 2007, the Prison Healthcare Advisory Board recommended the responsibility for the healthcare of prisoners including oral health should be transferred from the Scottish Prison Service to NHS Scotland and specifically to the NHS Boards in which the prisons were located (Prison Healthcare Advisory Board, 2007). In August 2010 a legislative amendment to enable the transfer of responsibility was passed by the Scottish Government, and by October 2011 the memorandum of understanding ensured that the responsibility of healthcare in prisons became the responsibility of the NHS Boards (NHS Scotland, 2011). The common purpose of this policy was to ‘improve prisoners’ access to an appropriate range and quality of health services based on their needs.’ The intention being to ensure equity in healthcare delivery and access. In order to achieve this aim, partnership working was highlighted as of central importance, with continuous professional education for all those working within the prison sector.
The health of prisoners has been described as ‘poor’, reflecting marked health inequities associated with the so-called cliff-edge of inequalities (Aldridge et al., 2018). The first Health Promotion Strategy to promote health among prisoners in Scotland, ‘The Health Promoting Prison’ was published in 2002 (Scottish Prison Service, 2002). Later, in 2008, the Scottish Government’s ‘Equally Well’ (Scottish Government, 2008) report of the Ministerial Taskforce on Health Inequalities highlighted the need to put in place a programme to improve the oral health of prisoners. Therefore, by 2012, the publication of ‘Better Health, Better Lives for Prisoners’ (ScotPHN, 2012), a framework to support a new partnership between the SPS and NHS Boards was published. This framework promoted the adoption of a ‘whole prison approach’ focussing on three key elements for [1] developing health promotional policies, [2] promoting a healthy prison environment and [3] the promotion of prevention, health education and other health promotion initiatives to address the health needs of people in prison. Oral health was placed as a central and integral part of ‘Better Health, Better Lives for Prisoners’.
In 2011 a survey of the Oral Health and Psychosocial Needs of the Scottish Prisoners and Young Offenders was conducted by the Scottish Oral Health Improvement Prison Programme in conjunction with NHS Boards (Freeman et al., 2013). The results of the 2011 SOHIPP report led to the development of the ‘Mouth Matters’ oral health promotion intervention for people in custody (Freeman et al., 2014). This Scottish Government, national oral health initiative aimed to promote oral health improvement for people in prison in Scotland supported by the NHS Boards’ oral health improvement teams. The Mouth Matters Guide for Trainers was specifically designed to support the health professionals, prison staff and support workers to meet the detailed oral health needs of the Scotland’s prison population.
In 2017 the SPS announced its intention for all prisons in Scotland to be smoke free by the end of 2018 (Scottish Prison Service, 2017) and to support this policy NHS Health Scotland published a Smoke-free prisons pathway and highlighted ‘peer support’ as a key step in the pathway (NHS Health Scotland, 2018). At this time and following a qualitative exploration of the participants’ oral health concerns (Freeman et al., 2013) the Mouth Matters intervention adopted the concept of the ‘peer support model’ to develop a peer oral health mentoring intervention in Scottish Prisons. SOHIPP in collaboration with NHS Forth Valley and HMYOI Polmont developed the Mouth Matters Peer Oral Health Mentoring Programme. With Anne Crowe, NHS Education Scotland an SQA level 5 award in Oral Health Improvement Mentoring (Scottish Qualification Authority, 2018) was achieved in 2018, for those undertaking the peer mentoring training. Therefore, Mouth Matters was considered as an important peer support intervention to support the smoke-free prisons agenda and was included as a key initiative for Smoke-Free Prisons by NHS Health Scotland (NHS Health Scotland, 2018).
The 2011 Oral Health and Psychosocial Needs of the Scottish Prisoners and Young Offenders, thus, serves as a benchmark for the assessments of quality, appropriateness and accessibility of dental health care within Scottish prisons following Scottish Government and SPS policy changes between 2011 and 2020. The 2019 Oral Health and Psychosocial Needs of the Scottish Prisoners and Young Offenders is both timely and appropriate to: 1) assess the health and oral health of people in custody, 2) identify the effect of healthy public policies on their oral health and psychosocial health status and 3) serve as a benchmark for future assessments of the quality, appropriateness and accessibility of dental health care within the Scottish prisons.