Improving Services for Imprisoned Women with Severe Mental Illness (IP-SIS)

Background There is an important gap in existing physical healthcare provision for women with Severe Mental Illness (SMI), including racially minoritized women, in prison and on release to mainstream primary care. Women in such settings tend to have complex mental health problems, often with comorbid physical health problems.

Aspects of the prison regime can be a barrier to addressing the health needs of women: low prison staffing levels and time available out of cell.

Little is known about how imprisoned women with SMI use primary care services, to what extent services are meeting their health care needs, and how these services are experienced by different racial groups.

Aims and objectives 1.To explore the range of primary care services delivered to imprisoned women with severe mental illness (SMI) in England and describe what is working well and the barriers to accessing care 2.

To develop a framework for use in women s prison services to support the primary care of racially minoritized women with SMI. Methods and timelines This qualitative research project comprises of three phases across 6 female prisons in England.

Purposively sampling across all phases will be used a to ensure that the perspectives of women and staff from a range of different prison groupings are included.

Phase 1 (Months 0-6): Semi-structured telephone/online interviews with primary care practitioners and prison staff (4 in each prison) to explore current provision and potential inequalities of physical and mental health services for imprisoned women with SMI across ethnic groups in women s prisons.

Phase 2 (Months 4-14): Six focus groups, one in each prison, with 5-6 imprisoned women with SMI from a range of ethnic groups in each group.

Discussion will include access to and experience of primary care services for mental and physical health problems whilst imprisoned and on release.

Phase 3 (Months 12-16): Six online consensus groups, one in each prison with 5-6 prison healthcare and non-clinical staff.

The aim is to develop a culturally and racially sensitive framework to understand the barriers and facilitators to providing primary care for women with SMI from different ethnic groups both within prison and following release. The PPIE lead for the study is a co-applicant and has lived experience of prison.

They have recruited, and will continue to facilitate, a racially and ethnically diverse lived experience advisory group (LEAG).

The LEAG is a group of six women, all former prisoners with SMI, who contributed to the application and will be involved in every phase and the dissemination activities.

Anticipated impact The need for improving the physical health for people with SMI is one of the five clinical areas of the Core20PLUS5, a national NHS England approach to inform action to reduce healthcare inequalities.

This research will directly address this area by illustrating the experiences of imprisoned women with SMIs and identify intersectional and differential needs, including those of racially minoritized women.

We will develop a culturally and racially sensitive framework for prison primary care services to aid future service planning and address health inequalities.