Knowingly Bearing Witness to Pain, and Being with Neglect on Repeat: Prisoners’ and Prison Staff Experiences of Health and Harm in Prison
Year: 2026
Type: article
Abstract: This article explores prison health, healthcare, and harm. The provision of healthcare in prisons is convoluted, as it combines practice and problems across a prison’s approach to care, custody, commissioning, purchasing, regime, and staffing, and requires an appreciation for the prisoner-patient group’s health and illness needs. At present, there are unmet physical and mental health needs in prisons, and concerning levels of healthcare-associated harm experienced by people residing in prison. People in prison are dying years before they should compared to their counterparts in the community as a result of these unmet needs. We describe the complexities of safely delivering healthcare in prison and the emergent harms when healthcare fails those in custody. This (ill)health and (in)justice landscape could be improved, and avoidable healthcare-associated harm should not occur. This article utilises our original qualitative prison data created with 55 prisoner-patients and prison staff interviewees to further understand avoidable healthcare-associated harm in prisons and to make recommendations for future prison healthcare. We evidence how the population experiences both acute and chronic healthcare needs which are not always recognised or supported; where acute care management takes precedence over long-term health conditions; and where security priorities take precedence over timely intervention for life-threatening issues. Hierarchies regarding care and neglect arise, and the principle that prison care should be equivalent to community care is rarely said to be achieved or even attempted. We find systemic failures across varied forms of healthcare, including a lack of emergency response, absent follow-up after hospital discharge, physical health being relatively neglected, unsupported mental illness, medication mismanagement, and issues at transition points (prison to prison, prison to community, and community to prison). Healthcare provision in prison is perceived to be negatively impacted by tensions amongst personnel and pervading security concerns, as well as by poor intra-prison communication. Healthcare responses could be typified as “too little, too late”; for example, appointment delays and cancellations causing avoidable harm. Staff report disillusionment, and prisoners describe disparaging responses from staff members; epistemic injustice is at play, whereby prisoners’ claims to pain or illness and medication need are enveloped in suspicion and risk concerns first and foremost. To align with this special issue, we end with suggestions for intra-prison healthcare improvement for the coming decade and beyond.
Source: Social Sciences
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,172
OpenAlex ID: W7225611761