APEX-Prisons Study - Addressing Psychosocial and Existential Wellbeing in Prisoners with Serious Health Conditions and their Close Persons (perspectives from family, fellow prisoners, staff).

In England and Wales, increasing numbers of prisoners aged 50 and older face a rising burden of chronic health issues and complex needs, marked by widespread vulnerability, mental health problems, substance misuse, and trauma.

Ageing prison infrastructure, overcrowding, and a security-focused approach hinder effective healthcare delivery, and staff burnout and turnover are high.

Being in prison negatively affects psychosocial and existential well-being, leading to a loss of meaning and purpose which can be compounded by serious ill health.

However, little is known about the psychosocial and existential support needs of prisoners with serious health conditions, despite the financial and ethical implications of their incarceration.

Families of prisoners feel excluded from care provision, but there is a lack of evidence regarding their experiences when the prisoner is living with ill health.

Urgent research is needed to understand the experiences of prisoners with serious health conditions and their close persons and to develop recommendations to address organisational barriers and improve support.

Aim: To explore the lived experience of male prisoners with serious health conditions and their close persons, focusing on psychosocial and existential well-being, to inform the provision of equitable and compassionate care at operational and policy levels.

Objectives are to: Explore the psychosocial and existential well-being of male prisoners with serious health conditions and their close persons. Identify barriers to and facilitators of psychosocial and existential well-being across three prisons.

Co-design practice and policy recommendations for improving care with national stakeholders and identify future interventions.

Study Design This five-year qualitative study comprises two phases: Phase One: Focused Ethnography Using a focused ethnographic approach, I will conduct c.1080 hours of participant observation and 40-60 in-depth, qualitative interviews with prisoners with serious health conditions, close persons, fellow prisoners, and staff in three diverse prisons.

Preliminary agreements with prison Governors are in place.

Daily life observations will explore experiences of serious health conditions, healthcare, psychosocial and existential support, and the prison regime from multiple perspectives. Interviews will explore, compare and contrast experiences across participant groups.

Following principles of Experience-Based Co-Design, Phase One findings will be developed into a short, animated film, highlighting key themes and challenges.

Phase Two: Developing Recommendations and Guidance I will hold a national stakeholder workshop, involving influential professionals from organisations like HMPPS, MOJ, prison healthcare providers, and Commissioners. Findings will be presented through the short film and a written summary.

We will co-design recommendations for practice and policy change, resource allocation within the prison system, and identify potential future interventions.

Anticipated Impact Prisoners & close persons: Improved person-centred care Improved access to emotional and practical support Improved coping skills Prison staff (custodial & healthcare): Increased staff confidence in providing psychosocial support Fewer incidents and complaints Improved staff retention and job satisfaction NHS & Local Authorities: Improved understanding of the needs of prisoners with serious health conditions Improved collaboration with prison healthcare to effectively coordinate care Dissemination Dissemination will include open-access publications, a short film launched at the Good Grief festival, blogs, conference presentations, webinars, and a Prison Radio Association podcast.