Prisoners: health in prison

Note: where possible, figures below will be updated following publication of the 2024 SPS Prisoner Survey.

Alcohol

The latest Scottish Prisoner Survey was published in 2020 by the Scottish Prison Service and represents people in custody in Scotland during 2019. It is a voluntary, self-completion survey, so the questionnaire or sections of it may be left unanswered. It gathers data on key health and care issues. The response rate for the most recent survey was 30% (Prisoner Survey 2019). 

• In 2019, four in ten prisoners who completed a questionnaire reported being drunk at the time of their offence (40%), an increase of one percent since 2017 and five percent since 2015. Almost one in five (19%) reported that drinking affected their ability to hold down a job, similar to the figures for 2017 (18%) and 2015 (19%). Nearly one fifth (19%) were worried that alcohol would be a problem for them when they get out (no change from 2017 but up from 17% in 2015). Almost one third of prisoners (33%) admitted that their drinking affected their relationship with their family, up from 32% since 2017 (Prisoner Survey 2015, Prisoner Survey 2017, Prisoner Survey 2019) 

The Scottish Prisoner Survey 2019 included the 10-item questionnaire, the Alcohol Use Disorders Identification Test (AUDIT). This is a validated screening tool developed by the World Health Organisation which measures Alcohol Use Disorders. AUDIT scores range from 0-40; 0-7 represents low risk drinking or abstinence, 8-15 represents a medium level of alcohol problem (‘hazardous’ drinking), 16-19 represents a high level of alcohol problem (‘harmful’ drinking) and 20-40 warrants further diagnostic evaluation for alcohol dependence (‘possibly dependent’) (Parkes et al. - Prison health needs assessment for alcohol problems; 2010). Questions relate to the year prior to the date of the survey; for some prisoners this may refer to a period they were in prison, whereas for others this may refer to a period they were in the community. 

The following statistics are from data provided by SPS from the prisoner surveys (in 2017 and 2019), the Scottish Health Survey in 2021; analysed by Public Health Scotland. 

Key points:

• Among prisoners who completed the 2019 AUDIT assessment, 16% reported drinking alcohol twice or three times a week, with 18% reporting drinking alcohol four or more times weekly (representing little change from the 2017 survey, which recorded 18% for both indicators)). 

• 45% of prisoners who completed 2019 AUDIT assessment reported drinking seven or more drinks (on a typical day where they do drink alcohol), with 38% reporting they drink six or more drinks on one occasion at least weekly. This represents no significant change from the 2017 survey where 47% reported drinking seven or more drinks on a typical day, and 41% reporting drinking six or more drinks on one occasion at least weekly. 

• Additionally, the AUDIT questionnaire from the Scottish Prisoner Survey 2017 is available with the results grouped into drinking risk categories (AUDIT-Prisoner-Survey-2017.xlsx). Among prisoners who completed the 2017 AUDIT assessment, 63% had an alcohol use disorder. Just under one third (31%) were classed as possibly alcohol dependent, 27% were hazardous drinkers and 6% were harmful drinkers. There are no directly comparable figures on the general population in Scotland, but figures published from 2019 and 2021 in the Scottish Health Survey indicate less than 2% of the general population were classed as possibly alcohol dependent or harmful drinkers. (Scottish Health Survey 2021) 

Drug Misuse

The Scottish Prisoner Survey 2019 found that 45% of prisoners reported being under the influence of drugs at the time of their offence. Four in ten prisoners (39%) said they had used illegal drugs at some point while in prison and around one quarter (28%) reported using illegal drugs in prison in the month prior to the survey. The three most commonly reported drugs taken in prison in the previous month were: cannabis (50%), subutex (45%) and benzodiazepines (46%), all of which have decreased in terms of usage since 2017 (see the ScotPHO Drug misuse: availability and prevalence page). 

Prevalence

From 2009/10 to 2018/19, Addiction Prevalence Testing (APT) was conducted across all Scottish prisons annually. During one month of the year, prisoners arriving in custody were tested for the presence of illegal drugs. Similarly, those leaving custody during the month were tested to assess progress towards the reduced or stabilised offender outcome. The figures below are from 2018/19 (SPS Addiction Prevalence Testing Stats Final 2018/19 (262Kb)): 

• Of the 1,017 tests carried out when entering prison in 2018/19, 75% (compared to 80% in 2017/18) were positive for drugs (which included drugs prescribed as part of a treatment programme), and 71% (78% in 2017/18) were positive for illegal drugs (including illicit use of prescribed drugs). The illegal drugs most commonly detected when entering prison in 2018/19 were cannabis (44%) (54% in 2017/18), benzodiazepines (33%) (42% in 2017/18) and opiates (29%) (28% in 2017/18). 

• Of the 522 tests carried out at prisoner liberation in 2018/19, 26% (31% in 2017/18) were positive for illegal drugs. The illegal drugs most commonly detected when leaving prison were buprenorphine (12%) (14% in 2017/18), opiates (8%) (8% in 2017/18) and benzodiazepines (6%) (7% in 2017/18). 

APT data was not collected from 2019/20 onwards because it was acknowledged that the process was not taking account of the changing trends in drug use, and this was limiting the impact of APT in monitoring substance use and associated interventions. Due to this, SPS suspended APT to enable a review to be carried out with a view to improving the validity of testing and its connection to subsequent monitoring, intervention and action.  

Alcohol and Drug Treatment Waiting Times for clients in prison

The latest data on waiting times for referrals to prison-based specialist drug and alcohol treatment services can be found on the Public Health Scotland website.  

As reported in the June 2024 publication, between 1 January and 31 March 2024, 861 referrals to prison-based specialist drugs and alcohol treatment services were made - 80% were for people seeking help for problem drug use, 6% for problem alcohol use, and 14% for problem use of both alcohol and drugs 

Of the waits (from referral to first treatment) completed in this period, 94% had a wait of 3-weeks or less, and 71% commenced treatment within 1-week of referral.  

Opioid Substitution Therapy (OST) Drug Prescribing 

The Scottish Health in Custody Network (Prison Care) collects data twice yearly on the number of prisoners prescribed opiate replacement/substitution therapies by prison establishment. As at July 2021, 30.8% of prisoners were prescribed an opioid substitution therapy. (Prison Health Information Dashboard) 

Key points:

• Of the prisoners in custody in Scotland on 14 July 2021, 21.9% (1,512) were prescribed Methadone, 4.7% (323) were prescribed Espranor, 3.1% (214) were prescribed Buvidal, 1.1% (73) were prescribed Subutex / Buprenorphine, and 0.1% (5) were prescribed Suboxone. 

• The highest percentage of prisoners being prescribed any of the above therapies was observed in HMP Greenock (43.9%), followed by HMP Perth (40.7%) and HMP Kilmarnock (38.4%), with the lowest percentage of prisoners prescribed any of the above therapies being observed in HMP/YOI Polmont, HMP Dumfries and HMP Glenochil (10.2%, 13.1% and 17.5% respectively). 

• The highest percentage of prisoners prescribed Methadone was observed in HMP Greenock (37.2%), followed by HMP Kilmarnock (31.7%) and HMP Edinburgh (29.2%), with the lowest percentage of prisoners prescribed Methadone being observed in HMP Dumfries, HMP Castle Huntley and HMP/YOI Polmont (6%, 6.6% and 8.4% respectively) 

National Naloxone Programme Scotland 

The National Naloxone Programme Scotland monitoring report 2021/22 and 2022/23 and accompanying data tables show that: 

• Take-home naloxone (THN) kits are supplied to prisoners on release from custody. 

• In 2022/23, 1,929 take-home naloxone kits were issued in prisons upon release. This was a 14% increase compared to 2021/22 (1,690). A cumulative total of 12,412 THN kits were issued in prisons from 2011/12 to 2022/23. 

• The percentage of opioid-related deaths occurring within four weeks of prison release (or hospital discharge) was 1.6% in 2022, a reduction from 9.8% during the 2006-2010  baseline period and lower than any of the preceding 5 years. This reduction coincides with the introduction of the National Naloxone Programme in 2011 and distribution of kits to 'at risk' prisoners on liberation. It should however, be noted that the figures are based on small numbers. 

The Public Health Scotland website contains further publications on the Naloxone programme within Scotland. 

Drug-related deaths

The National Drug-Related Deaths Database for Scotland collects detailed information on the “nature, health and social circumstances of individuals who have died a Drug-Related Death.” Data for 2018 is presented in the National Drug-Related Deaths Database (Scotland) Report, released in 2022. This report shows that:    

• Where known, around half (51.6%) had ever been in prison. 

• Where known, 18.9% had been in police custody in the six months prior to death. 

It should be noted that information was not available for all analysed cases and so these figures may underestimate contact with the criminal justice system. 

Tobacco Use

In 2017 the Prisoner Survey  found that 68% of prisoners smoke (down from 72% in 2015). 

SPS introduced a smoke free prisons policy on 30 November 2018 to protect and improve the health and well-being of both individuals in custody and staff. Vaping is still allowed. The Prisoner Survey 2019 found that 60% of prisoners use e-cigarettes or ‘Vape’ while in prison. In the general population as of 2022 15% of adults currently smoke, and 10% use e-cigarettes, up from 11% and 5% respectively in 2021 (Scottish Health Survey 2021, Scottish Health Survey 2022). 

Dental Health

Severe dental decay in male prisoners was three times that of the general population (28% compared to 10%) whilst for women prisoners it was 14 times greater (42% compared with 3%) (Jones CM et al, 2004 (558Kb)).  The Oral-Health-Survey-of-Scottish-Prisoners report (2019) showed an increase in mean dental decay compared to a survey carried out in 2011. 

The mean number of filled teeth in the prison population has been estimated to be 4.09 (Prison population: physical health care needs); the Scottish Adult Oral Health Survey recorded the mean number of filled teeth in the general population as 10.6 (Scottish Adult Oral Health Survey). 

Blood Borne Viruses

From epidemiological studies, it is estimated that 19% of the Scottish prisoner population are Hepatitis C positive (Taylor et al, 2012), compared to less than 1% among the general population (Blood borne viruses and sexually transmitted infections. Scotland 2017). 

Asthma

Over one in ten (12%) prisoners were recorded as having asthma in 2007, higher than expected after adjustment for the age/sex structure of the prison population (7.8%) and over double the prevalence in the general population as a whole (5%) (Graham L, 2007). 

Scotland’s general population was recorded as having an asthma prevalence of 6.5% in 2022/23 (PHS General Practice Disease Prevalence, 2023) The prison population was recorded as having 7.97% prevalence of asthma / chronic airway disease (Prison population: physical health care needs, 2022). 

Diabetes

In 2020, it was reported that 5.5% of the general population of Scotland had diabetes (McGurnaghan, 2020), signifying an increase from the previously recorded general population prevalence of 3.5%.(Graham L, 2007). 

The prevalence of diabetes in Scottish prisoners has been estimated at 3% from a prisoner survey, and 1.87% from a data linkage analysis respectively (Prison population: physical health care needs, 2022), so uncertainty remains over the exact prevalence of diabetes in Scottish prisons. 

Epilepsy

In 2019, 3% of prisoners were estimated to have epilepsy from a survey of 353 prisoners (Prison population: physical health care needs, 2022), compared to 1% of the general population (Epilepsy services in Scotland: A new report - Epilepsy Scotland), and 2.1% recorded previously (Graham L, 2007). Note that confirming epilepsy in the prison population presents challenges, with large discrepancies between self-reported and medically confirmed diagnoses (Health and Healthcare in Prison: a Literature Review, 2020). 

Coronary Heart Disease

1.95% of prisoners were recorded as having Coronary Heart Disease in 2020 (Prison population: physical health care needs, 2022). This is lower than the prevalence in the general population, recorded as 3.6% in 2022/23. (PHS General Practice Disease Prevalence, 2023). 

Mental Health

National level data on the mental health needs of people in prison are not routinely collected in Scotland. In September 2022 the Scottish Government published the results of a quantitative modelling exercise to estimate the proportion of Scotland's prison population with mental health needs, undertaken as part of a wider health needs assessment programme. The results estimated that 15% of the prison population had a long-term mental health condition, 17% a history of self-harm, 30% a current alcohol use disorder, 16% symptoms of anxiety and 18% symptoms of depression. Prevalence was higher in the remand population, in younger age groups, and in women relative to men, except for alcohol use disorder and depression. Inpatient forensic services were disproportionately used by the female prison remand population for the treatment of a psychotic disorder (Prison population: mental health needs, 2022). 

Similarly, in the 17th SPS Prisoner Survey, people in prison reported a diagnosis of: depression 39%, anxiety/panic disorders 29%, post-traumatic stress disorder (PTSD) 11% and schizophrenia 4% (SPS Prisoner Survey, 2019). 

This points to high mental healthcare needs for a substantial proportion of the prison population. In the 2023/24 annual report, HM Inspectorate of Prisons in Scotland singled out the “the management of clearly mentally unwell prisoners” and access to metal health care as areas of significant concern. (HMIPS – HM Chief Inspectors Annual Report) 

The Scottish Government published a social care modelling study (Prison Population: social care needs, 2022) which highlighted a large degree of uncertainty regarding the prevalence of social care needs in Scotland’s prison population. Different methodologies yield estimates ranging from around 3% to 13%, with the preferred central estimate being 7-10%. 

Prisoners with longer sentences, women, and those in older age groups are all more likely to have social care needs; and variability of social care needs within individual prison establishments is likely to fluctuate more than total social care requirements across all prisons. 

For information on young people in custody, the Prisoner Survey 2017, Young People In Custody report and the HMIPS Report on Expert Review of Provision of Mental Health Services at HMP YOI Polmont contain further details.