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Healthier prisons: The role of a prison visitors' centre

Article in International Journal of Health Promotion and Education · January 2009

DOI: 10.1080/14635240.2009.10708152

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 12 Healthier prisons: the role of a prison visitors’ centre

Healthier prisons: the role of a prison visitors’

centre
By James Woodall, Rachael Dixey, Jackie Green and Caroline Newell,
Faculty of Health, Leeds Metropolitan University

Key words: prisoners’ families, prison visitors’ led authors in the area to question whether promoting
centre, health promotion, evaluation. health in prison is a contradiction in terms (Smith
2000), an oxymoron (McCallum 1995, de Viggiani
2006) or simply incompatible (Greenwood et al.
Abstract 1999). These latter debates are outside the scope of
this paper, which instead will focus on the ways in
Since the inception of the prison as a ‘setting’ for
which a visitors’ centre can enhance the health of
health promotion, there has been a focus on how the
prisoners, their families, and the prison staff.
health of those men and women who spend ‘time
In the UK, the Government’s strategy ‘The
inside’ can at least be maintained and if possible,
Health of the Nation: a strategy for Health in
enhanced, during their prison sentence. This
England’ (Department of Health 1992) was one of the
paper presents findings from a mainly qualitative
first government documents specifically to mention
evaluation of a prison visitors’ centre in the UK. It
prisons as a place to tackle ill health. Following the
reports experiences of prisoners’ families, prisoners,
regime change in 1997, the Labour Government also
prison staff, the local community and the ways in
mentioned prisons as a setting for improving mental
which the visitors’ centre has contributed positively
health and general well-being, in ‘Saving Lives: Our
to their health and well-being. In addition, key
Healthier Nation’ (Department of Health 1999).
stakeholders were interviewed to ascertain the role
Only in 2002 however, with ‘Health Promoting
this visitors’ centre has in policy frameworks related
Prisons: A Shared Approach’ (Department of Health
to re-offending. The findings from this evaluation
2002) was a fully elaborated strategy produced,
underscore how the visitors’ centre improved
which focussed on developing policies and practices
the quality of visits, and contributed towards the
throughout prisons which would promote the health
maintenance of family ties through the help and
of all prisoners and staff, which would provide health
support it provides for families and prisoners.
education and health services, and which moved
The paper concludes by suggesting that visitors’
towards a social model of health underpinned by
centres are an essential part of a modern prison
International Journal of Health Promotion & Education Volume 47 Number 1 2009 12-18

the concept of ‘decency in prisons’. This document

service helping to address the government’s health
was translated into a Prison Service Order (PSO
inequalities agenda.
3200) which, according to Baybutt et al. (2007) was,
‘a crucial step forward for health promoting prisons,
Introduction embedding as it did a commitment to health within
the offender management system’ (p242).
The aim of this paper is to present an evaluation of There appears to be political will, therefore, to
a prison visitors’ centre and to locate those findings tackle health promotion within prisons, at the same
within current debates about strategies for promoting time as general concern, expressed for example in
health within prisons, reducing re-offending, media reports, of widespread ‘crisis’ and serious
fostering family ties, and tackling health inequalities. issues within the penal system. The putative 37%
The settings approach to health promotion has rise in prison suicides in 2007 compared with 2006
focussed attention on institutions such as schools, has led pressure groups such as the Howard League
workplaces, hospitals, and by extension, on prisons. for Penal Reform to say that this is the ‘human cost
This focus has also enabled a discussion about the of the prison crisis’ (Woodward 2008). The Prison
seeming contradiction between prison being places Reform Trust has related the rise to the increase in
of punishment and correction, and their role in the numbers of those with existing mental health
enhancing the health of a group of people who are problems being held in prison, and to the general
literally a ‘captive audience’. This itself raises issues increase in the prison population, leading to
about voluntarism, equal rights (i.e. the right of overcrowding. As of 1st February 2008, there were
prisoners to receive the same standards of health 76,545 male and 4,453 female prisoners in UK gaols,
input as the general public), and the tension between according to the National Offender Management
‘punishment’ and ‘rehabilitation’. This paradox has Service (NOMS 2008). The UK has one of the
 Healthier prisons: the role of a prison visitors’ centre 13

highest imprisonment rates in Europe (Baybutt et of Leeds Initiative’, and all are positioned in the
al. 2007; Smith et al. 2007) and recent government voluntary sector.
approaches have been to suggest building ‘super The ‘Jigsaw Project’ is the Healthy Living
jails’ or titan gaols to deal with overcrowding, rather Centre project which is centred on the existing
than to reconsider sentencing policy, or to renew prison visitors’ centre; the two entities are now
efforts to tackle the causes of crime. Given the ever conflated as the Jigsaw Visitors Centre, but for
increasing prison population and the unlikelihood brevity, ‘the Centre’ or the Visitors’ Centre will be
of this changing in the foreseeable future, it is used throughout the rest of this paper. The aim of
imperative to consider how the health of those men the project were to: improve health and wellbeing,
and women who spend ‘time inside’ can at least be improve access to health information, provide a safe
maintained and if possible, enhanced, during their and friendly building with welcoming facilities, act
prison sentence. Prison visitors’ centres can arguably as a bridge between the local community and the
play a valuable role in this. prison, build local capacity, develop partnerships and
Historically prison visitors’ centres have had a raise awareness of the issues surrounding prison life.
limited role in the provision of services and support The Centre is located next to Her Majesty’s Prison
for prisoners’ families. Currently, there is a wide (HMP) Leeds, an imposing Victorian category B
variation between the services, facilities and funding local gaol with approximately 1,300 inmates. In HMP
provisions for prison visitors’ centres in the UK Leeds’ inspection in 2005, 80% of its prisoners were
(Loucks 2002). However, prison visitors’ centres white and 50% under the age of 30; about a third were
are a valuable way of improving the experience of serving two to four years, with approximately 4%
visiting a prison and can provide valuable support serving life (HM Chief Inspectorate of Prisons 2005).
for prisoners’ families. Light and Campbell (2006) The Centre for Health Promotion Research
describe prisoner’s families as ‘the still forgotten at Leeds Metropolitan University undertook an
victims’ of imprisonment, facing financial evaluation of the Jigsaw Visitors Centre in 2005/06
difficulties, emotional issues and problems visiting and reported in April 2006 (Woodall et al. 2006).
prisons. They note that when the first systematic
study of prisoners’ families was published (Morris
1965), the prison population was 30,421, and argue Methodology
that it is essential that prisoners’ families are
included in the current debate on prison numbers. Data was generated using a combination of interviews,
Salmon (2005) suggests that approximately 150,000 focus groups and questionnaires with a range of user
children a year have a parent imprisoned, and others groups. Annual reports, project proposals, previous
will have a sibling or other relative in custody. evaluation reports and promotional material includ-
However, very few services exist specifically to help ing newsletters and newspaper articles were collected
prisoners’ children and families. The small number from the Centre for analysis.
of women’s prisons means they are more likely to be
Prisoners’ Families

International Journal of Health Promotion & Education Volume 47 Number 1 2009 12-18
far from the woman’s home, and prisoners’ families
generally, have an average five hour round trip to Twenty semi-structured interviews with prisoners’
visit their relative. 45% of prisoners lose contact with families were carried out. Prisoners’ families were
their families while imprisoned, and 22% of married asked to take part in a short interview by members of
prisoners experience a breakdown in that marriage the research team as they arrived in the Centre prior
due to imprisonment. Little is known about what to visiting. The interview schedule focussed broadly
occurs after release, but it is likely that families will on:
experience difficulties in resuming their previous • their experience of using the Centre;
relationships (Salmon 2005). Visitors’ centres can • benefits of the Centre, both for them personally,
provide a source of support for these families and their children and the person they are visiting;
also help to maintain relationships through making • access to information and services;
visiting easier and more ‘user-friendly’. • views about what is working well as well or are
When, in 1999, the New Opportunities Fund not working well in the Centre;
launched its Healthy Living Centres grant • recommendations for the Centre.
programme, Leeds (UK) took the opportunity to A fundamental concern was ensuring that
tackle disadvantage and to improve health across potential interviewees were able to give informed
the city. Seven successful bids included one for consent free from any pressure or perceived
the existing prison visitors’ centre, to upgrade the pressure. It was explained prior to interview that
buildings, reconnect to the local community, and the researchers were independent of the prison and
to develop a programme of activities centred on the the Jigsaw Visitors’ Centre. The researchers ensured
health of prisoners’ families, prisoners and staff. that they approached all parents or carers prior to
The seven projects sit within the health and well- speaking to any children, but many parents refused
being strategy developed by the ‘Health Partnership access. Only three interviews were completed
 14 Healthier prisons: the role of a prison visitors’ centre

with children. With permission, interviews with Other key stakeholders

prisoners’ families (including children) were tape- The views of key partners associated with the Centre
recorded. The visitors’ comments book in the Centre and other stakeholders were sought by:
was also analysed. • two semi-structured interviews with representa-
tives from the local Primary Care Trust;
Prisoners • an interview with a representative from Action
Acknowledgement was given to the fact that those for Prisoners’ Families (the national federation of
in a prison environment may feel under some services supporting families of prisoners);
pressure to participate in research activities. To • interviews with two representatives from
avoid this and ensure that individuals were able to the National Offender Management Service
make decisions about whether or not to participate (NOMS);
freely, it was emphasised that participation or refusal • a focus group with the Jigsaw Visitors’ Centre
to participate carried no reward or disadvantage to management committee.
their stay in prison.
Two focus groups were carried out with 17
Data analysis
prisoners. One focus group was conducted with
prisoners on an alcohol awareness course (specifically
The qualitative data were analysed thematically as
for Muslim prisoners organised by the Centre); the
outlined by Pope, Ziebland and Mays (2000), with
second group were prisoners invited to attend a
two researchers coding and analysing the emerging
Centre management meeting. It is recognised that
themes. Responses to closed questionnaire questions
the participants may not be fully representative of
were analysed using the statistical computer package
prisoners within HMP Leeds, but all had contact
SPSS.
with the work of the Jigsaw Visitors Centre and were
prepared to be part of a focus group discussion. No
prison staff or Centre staff were involved in these Findings
focus groups, ensuring that prisoners were able to
comment openly on the service. This section will present the findings derived
from the various data collection methods outlined
Prison staff previously. The findings from each group will be
Thirty-one qualitative, self-completed and discussed separately.
anonymous questionnaires were completed during
a promotional event held in the Centre. A range of Prisoners’ Families
staff including Administration workers, Operational During 2004-05, 16,052 visits were made by
Support Grade staff, Prison Officers and Senior prisoner’s families to the Centre, with 890 children,
Officers completed questionnaires eliciting their in a typical month, supervised by qualified play work
International Journal of Health Promotion & Education Volume 47 Number 1 2009 12-18

experiences of using the Centre. In addition, three staff. For many of the prisoners’ families interviewed
purposively sampled semi-structured interviews as part of this evaluation, visiting prison caused some
were carried out with senior prison staff involved form of strain and many articulated the physical and
closely with the Centre. financial implications of keeping in touch with a
prisoner. The majority found visiting an emotional
The local community and stressful experience:
“There can be a lot of tension having to come up here…
An on the street survey was conducted in the main
every time I’ve come to visit he’s just cancelled it, he
shopping area closest to the Jigsaw Visitors Centre.
can’t face it somehow”.
The questionnaire was designed to capture people’s
A distinct number of interviewees judged that
awareness of the services available for local people at
the Centre had a crucial role in the maintenance of
the Centre. The questions were read to respondents
family ties. Being less anxious, stressed or frustrated
and responses entered by the researchers. A non-
by the process of visiting meant that the quality of
probability convenience sample of forty-six local
the visit had improved, thus easing communication
residents participated.
between the prisoner and themselves. Families
recognised and valued the support they had been
Jigsaw Staff given and identified different types of support
A focus group was held with Centre staff, to explore they had received during their time at the Centre.
the aims, functioning and constraints of the Centre. This support seemed to vary upon the family’s
A SWOT analysis was held as part of this meeting. circumstances and their previous experiences of
Discussions were also held with staff during the prisons and the criminal justice system. However,
course of the evaluation, and observation was carried from the analysis of interview data with prisoners’
out by the researchers. families a typology of support emerged:
 Healthier prisons: the role of a prison visitors’ centre 15

1. Bureaucratic support the attitudes and approaches of some uniformed staff

A minority of families who come into the Centre during visits. Prison staff were criticised for being
use the facility only out of necessity to collect the unsympathetic and intrusive which potentially
relevant documents to enable them to go into the undid the positive work of Centre.
prison to visit. Their interaction with staff and
other families was limited and their knowledge of Prison Staff
service provision in the Centre was poor or non-
The findings from prison staff showed that they too
existent.
benefited from the Centre.
2. Functional support Many prison staff suggested that the Jigsaw
Many saw the Centre in functional terms – to Visitors’ Centre absorbs requests and queries from
provide warmth, shelter, food and drink before a prisoners’ families which would otherwise have to
visit, a place to prepare themselves before going be dealt with by specific prison departments. One
into the prison visiting room itself. Families prison manager commented:
“A lot of the questions that are asked here (Jigsaw
using the Centre for this purpose seemed to have
Visitors’ Centre) if they didn’t come here they would
acquired more knowledge of the services and
go to the departments inside (the prison), you would
facilities available within the Centre by reading
automatically up the work load of the departments…
promotional materials.
it’s like general visit questions, what times, what can
3. Stress reducing support I bring, it just takes a lot of pressure off the front end
The majority of those interviewed perceived of our organisation.”
the Centre not only as a place to collect visiting Furthermore, many prison staff felt that the work
documents or as a place to come for more of the Centre had created a positive atmosphere
functional purposes, but as an environment during visits:
which would reduce the emotional stress “It improves the atmosphere on visits. The visitors aren’t
associated with visiting. Interview data suggested stressed out when they go up to visits, which then
that mechanisms such as advice from Centre staff, rubs off onto prisoners…it’s transferable it is, it does
leaflets and written information and peer support actually happen because there is a lot of information
all contributed to lowering anxiety levels. that comes out of the Visitors’ Centre which puts
people’s minds at rest…it transfers right through the
4. Visitor support plus additional service provision system.”
There were a number of interviewees who used Prison staff commented that if uniformed staff
the Centre not only for support during visiting ran the Centre it would operate less effectively,
time, but also as a resource for Citizens’ Advice, as their principles of working prioritise security,
counselling or utilising other facilities such as control and strict organisation. Employing Centre
searching the internet. staff, with skills in working with communities, was
felt to provide more independence, compassion and

International Journal of Health Promotion & Education Volume 47 Number 1 2009 12-18
Prisoners empathy for prisoners and prisoners’ families.

All prisoners unanimously felt that visits were an

important part of their prison life, where contact with The Community
family and friends was perceived as an important During 2004-05, 1,511 visits were made by local
buffer for reducing prison-based stressors, such as community members to the Centre. This represents
solitary confinement. The majority of prisoners 7.4% of total visits. The on-street survey showed a
appreciated that the experience of visiting was general lack of awareness regarding the Centre and
difficult for their families, emotionally, physically the services it provides for local people. Most of the
and financially. Some prisoners discussed the respondents did not provide a particular reason for
difficulty of families travelling from different parts why they did not use the Centre, but those that did
of the country for very short visits, and the economic answer provided the following reasons;
implications this had on the family’s finances. • unaware that the facility existed for local people;
However, some prisoners seemed less sensitive to the • the Centre was too far to travel;
demands placed on their families visiting. • individuals would prefer to use other local
Most prisoners recognised the importance of community centres;
family ties for both their own mental well-being • the stigma of using a community facility attached
and in also having support on release from custody. to a prison.
Imprisoned fathers noted the importance of keeping Possibly the most successful use of the Centre
links with their children and described how visits by local people was that of a local youth group,
and ‘special’ family visits (especially at Christmas) which was grateful for the accommodation offered,
organised by the Centre were important ways of and which did not seem to be affected by the issues
maintaining their role as a father. Prisoners discussed above, such as stigma.
 16 Healthier prisons: the role of a prison visitors’ centre

Key Stakeholders Discussion of the Findings

The stakeholders interviewed for this evaluation
fell into two broad groups, those clearly involved The quality of the Centre’s service described in this
with the work of the Centre (e.g. members of the evaluation goes beyond the norms found in other
Management Committee) and those aware of the prison visitors’ centres (Loucks 2002; Hartworth
work but with a less direct role (e.g. Primary Care and Hartworth 2005). Jigsaw was judged in our
Trust staff). Although the views of these two groups evaluation to be an outstanding example of a Visitors’
could potentially differ, analysis of the transcripts Centre. Staff pay attention to how things are done
revealed no major differences. The findings are as well as what is done. The staff provide an open,
therefore presented for the whole group. flexible, proactive and participative approach in
an organisation which responds rapidly to change.
Effective team work would seem to be one of the
The NOMS agenda
key ingredients of the Centre’s success, with a team
It was perceived that the Visitors’ Centre was that has defined goals understood by all, individuals
contributing towards the National Offender with clear roles and responsibilities, clear leadership
Management Services’ (NOMS) agenda to reduce re- and direction, positive group dynamics, open
offending. Both in discussion with representatives communication, and leaders with vision.
from NOMS, and other strategic partners, it was felt McEvoy et al. (1999), Cunningham (2001) and
that the Centre was contributing to NOMS in three Loucks (2004) all suggest that families visiting
key areas: prisons need to be able to overcome many barriers
in terms of physical, financial and emotional strains.
1. ‘Pathways’ to resettlement Other studies have suggested that well run, co-
It was suggested that the Centre contributes ordinated visits which provide advice and support for
towards some of the ‘pathways’ outlined in families help to reduce anxiety and stress and in turn
regional and national strategy documents for improve the mental well-being of family members
reducing re-offending. A Visitors’ Centre may not (Hairston 1991). Indeed, there was strong evidence
‘have all the answers’ to reducing re-offending that the Jigsaw Visitors’ Centre improved the quality
but it may contribute indirectly to areas such as of visits, and contributes towards the maintenance of
drugs and alcohol: family ties through the help and support it provides
“We know that some partners are placed under pressure for families and prisoners. The Centre had helped
to bring drugs into prison so in a sense the Centre children prior to going into visits and also during
may have a role in actually helping people avoid visiting time through the facilitated play areas run by
being pressurised to do that.” experienced and qualified staff. McEvoy et al. (1999)
suggests that children can be restless, troublesome
2. Increasing public confidence and perceptions in and bored during visits, whereas the play resources
the criminal justice system provided by the Jigsaw Visitors Centre were reported
International Journal of Health Promotion & Education Volume 47 Number 1 2009 12-18

The Centre contributes to the broader aims of by families to reduce these effects.
NOMS by increasing public confidence in the A positive family atmosphere has been reported
criminal justice system: by prisoners, families and prison staff during visits.
“Now if you go to visit a prison and you go through a As in other research (Wedge, 1995, cited in Boswell
Visitors’ Centre then a lot of your impression of 2002), special family visits were emphasised as being
the criminal justice system will be based on that important for children and prisoners, giving the
interaction. Improving public confidence in the prisoner an opportunity to re-establish his role as a
criminal justice system in its honesty, integrity and father. The continuation of these family visits should
its reliability is all about improving engagement with be encouraged, as it known that prisoners worry about
law abiding society.” not seeing their family and relationships breaking
down (Lester et al. 2003). Without special visits,
3. Engaging with the voluntary and community prisoners may also find it difficult to re-establish
sector their parental role on release (Social Exclusion Unit
The voluntary and community sector was 2002) and children may begin to experience their
described as an important partner for delivering father as a stranger. Situations like this can lead
the NOMS agenda. It was felt that the Centre to permanent rather than temporary severance of
engages with prisoners, prisoners’ families and family bonds, and cause feelings of stress and anxiety
other small voluntary and community providers for the prisoner and child (Hairston 1998). The
in a way which would be difficult for large public implications for health are obvious, for prisoners,
sector organisations such as NOMS and the their children and their partners.
Prison Service to do. A theme with prison staff was the supportive
environment which the Jigsaw Visitors’ Centre
has created – staff working closely with prisoners
 Healthier prisons: the role of a prison visitors’ centre 17

reported less confrontation after visits due to centres; the positive impact on prisoners’ families,
prisoners being more relaxed and less anxious. This prisoners, prison staff and the local community
was felt to be as a direct result of the work being have all been highlighted by this evaluation. The
done with families at the Jigsaw Visitors’ Centre. In Centre’s work toward re-integrating offenders
turn, the stress experienced within the workplace by and reducing re-offending, helping to maintain
officers may be reduced; the Prison Service is faced family relationships and focussing on the health of
with higher sickness rates among staff than other prisoners and their families suggest that they are an
public services. Reduction in confrontation between essential part of a modern prison service and also help
prisoners and staff may make the prison easier to address the government’s health inequalities
to run and more able to operate positive regimes agenda.
(Light 1993). The Visitors’ Centre, staffed by a small
number of community-oriented workers provided References
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Address for Correspondence

James Woodall
Centre for Health Promotion Research
Leeds Metropolitan University
Faculty of Health
Room G08 Queens Square House
Civic Quarter
Leeds LS1 3HE
[email protected]
0113 8124436 ◆

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