How peer educators are improving health and conditions in Irish prisons

In 2009, the Red Cross started a programme in Ireland to train volunteer prisoners on community-based health and first aid. Following the course, the volunteers implemented a range of projects to improve health and conditions in prison – from hand-washing to improving take-up of HIV testing to reducing violence. PRI’s Executive Director was impressed by the results of the programme which were presented to an international audience at the WHO Health in Prison conference in Portlaoise last week.

It’s not often that you see a serving prisoner giving a demonstration of hand-washing technique to a room full of public health officials. But this is exactly what happened at the World Health Organisation (WHO) Health in Prison conference held in Portlaoise, Ireland, on 2-3 October.

The theme of the event, co-hosted with Public Health England and the Irish Prison Service, was Prisoner Empowerment. Prisoners from a number of Irish prisons proved emphatically that health and hygiene inside prisons had been vastly improved by enabling and empowering prisoners to change their living environment.

The role of the Red Cross was key to this remarkable success story. Ireland is the first country in the world to introduce this project in prisons, using volunteer inmates as the drivers for change. Piloted in Wheatfield Prison in 2009, the programme has now been extended to all fourteen prisons in Ireland. Volunteer prisoners are trained by the Red Cross in a course on community-based health and first aid, for a period lasting 4-6 months. Having completed the course, the volunteers, supported by the Red Cross and prison staff implement a range of projects to improve the health and well-being of prisoners.

A number of prisoners gave their personal accounts of the project to the conference. In one prison, Red Cross volunteers raised awareness among the prison population of the need to introduce better hygiene procedures to reduce the spread of flu and other infections. They introduced a new cleaning system on each landing, initiated an anti-litter campaign and taught thorough hand-washing techniques to all prisoners. They handed out questionnaires to identify the main health issues for prisoners – in this case, smoking, diet and mental health. An action plan was drawn up to address them through training and awareness-raising campaigns.

In another prison, one of the most successful projects was to reduce the stigma around HIV and AIDS and increase use of the tests. Initially, very few prisoners were tested and there was a great deal of ignorance about HIV and AIDS. The volunteers set up an awareness-raising project; distributed information leaflets and encouraged prisoners to take the HIV test. They ensured strict confidentiality was maintained. As a result of the campaign, 470 prisoners were tested over a few days – a massive result. A similar screening programme for TB followed.

Talking about the implementation of the programme in a third prison, the volunteer explained that before it began, he had thought his life was over. Serving a life sentence and with nothing to lose, he had given up, taking drugs and fighting the system from within the prison. Yet he was persuaded to become a volunteer and participated in a campaign to reduce violence inside the prison. This resulted in an amnesty for weapons, which was extremely successful. Before the campaign, home-made weapons were used in 97% of assaults, a figure that was substantially reduced as a result of the campaign which resulted in many weapons being handed in anonymously. It was followed up with a further campaign to develop peaceful ways to deal with anger, fear, stress and stereotyping. This directly helped prisoners manage stress better, and staff and families could see the benefit for themselves.

In their presentations to the conference the prisoners (and one ex-prisoner who had been released the previous day but made a long journey back to give his presentation) were totally persuasive of the value of prisoner empowerment. The opportunity to take control of an important aspect of everyday life in prison had given them self-respect and confidence, and improved the health and well-being of the prison as a whole. As one of them commented: ‘It means a lot to prisoners to have a voice. If we ask for something, we get an answer.’

The conference was devoted to the theme of prisoner empowerment in improving health services inside prisons, recognising the need to involve prisoners in identifying needs and appropriate services. Participants gave many examples of good practice in public health interventions, particularly for drug users, those with blood borne diseases and for women prisoners. But while prisoner empowerment was a common theme for the conference, there was also a strong emphasis on the need for continuity of care ‘through the gate’ to protect offenders, their families and communities after release. Dr Eamonn O’Moore, Director for Health and Justice, Public Health England summed up the theme of the conference in suggesting that while prisons can be public health institutions, they are part of a whole system approach. ‘Prisoners are part of the solution and peer educators are far more effective in sustaining change before and after release’.