Younger prisoners facing health care crisis as access to key appointments and specialist care is denied

Increasingly overcrowded prisons and staffing challenges have ingrained a health care crisis for younger prisoners in England and Wales with the specific needs of children and young adults in custody being systematically and dangerously overlooked.

The warning comes as new findings from the Nuffield Trust think tank reveals serious health impacts of violence in prison on young people. It finds high numbers of missed medical appointments and admissions for poisoning and injury affecting young people in prison similarly to other prison population groups.

Young men in prison (under 25 years old) are missing around 45% of outpatient appointments, this is significantly higher than young men of the same ages in the general population (29%).

Missed medical appointments, which in the adult prison estate is often down to a shortage of prison escorts, can have serious implications for at risk groups. Neurodivergent conditions such as ADHD are more common in prison and are associated with higher admissions for violence among young adult males.  

Recent reports have warned that the prison estate in England and Wales could run out of space imminently. There has also been high-profile media coverage of violence at Cookham Wood young offender institution which is now in emergency measures.

Growing up inside: Understanding the key health care issues for young people in young offender institutions and prisons, the third Nuffield Trust report looking at health care access for prisoner population groups, finds:

• Young adult males were more than twice as likely to be admitted to hospital because of poisoning or injury, than young people in the general population (42% versus 18%), with head injuries being the most common reason for admission, some severe enough to be classified as traumatic brain injuries.
• Diagnoses of attention deficit hyperactivity disorder (ADHD) are three times more likely for those admitted to hospital than for young adults in the general population (6% vs 2%). The Nuffield Trust is calling for better training of prison staff to support younger prisoners with neurodiversity.
• Some 60% of hospital admissions for young adult males in custody where a diagnosis of ADHD was flagged were due to injury or poisoning - significantly higher than for young adult males admitted without a diagnosis of ADHD (41%).
• More broadly, a mental health diagnosis was present in 39% of hospital admissions by young adult males in prison compared with 31% in the same group in the general population.

Throughout its prison health care series, the Nuffield Trust has called for better recording of healthcare and ethnicity data for specific groups in prisons to understand why key health care access is being denied, the risks to prisoners and to better enable staff to provide appropriate care.

Nuffield Trust Senior Fellow Dr Miranda Davies, who leads the research programme on prison health care, said:

“Scores of prisoners missing medical appointments are storing up problems for the future, putting significant pressure on prison staff and NHS services and putting prisoners at unnecessary risk. Repeatedly we are seeing tragedies and below-par health care provision becoming ingrained across the prison estate.

“Young adults in prison are much more likely to be admitted to hospital as a result of violence and self-harm. Many young adults in prison have neurodivergent needs, but staff are struggling to provide tailored support or are not equipped with the specialist skills for these alongside mental health challenges as space in the prison estate becomes squeezed.”