In this chapter, we present the methods undertaken and the results obtained from conducting a survey to further understand the alcohol services provided in male remand prisons across England, Wales and Scotland and how the COVID-19 pandemic has affected them. A short online survey was distributed to all prison governors of male remand prisons in England, Wales and Scotland. The survey questions were largely closed questions with simple ‘yes’ or ‘no’ responses, but some open-ended questions were included to obtain a more in-depth understanding in specific areas. Out of the 55 prison governors invited to take part in the survey by e-mail, 17 completed the survey.
Background
During 2020 and the subsequent years that followed; the COVID-19 pandemic was seen to have a monumental impact across the world.83 It affected every aspect of society from the increased demands on the healthcare system, the negative effects on employment and businesses and the adverse effects on mental health, with individuals being left isolated from friends and family.83,84 The prison population was not spared from the impact of the pandemic, and both positive and negative implications associated with the prisoner and prison staff mental health outcomes have been reported.85,86 Prisons across the world immediately went into lockdown.87 This left prisoners being unable to maintain contact with their family and friends and they often found themselves isolated and confined to their cells for extended periods of time, in order to minimise the risk of a COVID-19 outbreak within the prison.85,88 Although in one study this was argued to have led to a reduction in the cases of self-harm being reported,86 it was also said to contribute to the deepening of the pains of imprisonment in another.89
As expected there has been an outpouring of research projects focusing on the different impacts of the pandemic, across different populations. There have been examples of research focusing on the impact of COVID-19 within the prison setting.85–89 However, to date there has been no research which has specifically focused on the impact to the alcohol treatment services, which were routinely available to prisoners pre pandemic. Although the APPRAISE feasibility study commenced in 2019, the data collection and the follow-ups spanned across the pandemic years of 2020 and 2021. The restrictions imposed caused a significant impact on the research study. The study’s recruitment process was significantly affected by the prisons going into lockdown, with Scotland’s recruitment having to be halted before reaching the desired target sample. In addition, the follow-ups were hampered by being unable to be undertaken face to face and often it proved difficult to confirm the location of prisoners, with court dates and release dates being postponed as a result of the pandemic.
As the world started opening up again and restrictions began to ease, it felt salient to conduct a survey, within the APPRAISE study, that explored the impact of the COVID-19 pandemic on prisons and the availability of the alcohol treatment services. The purpose of the survey was to give more context to the delays experienced in the APPRAISE study, but also to establish the wider implications of the lockdown on services for alcohol within the prison. As the APPRAISE study focused on male remand prisoners, the survey sought to include all prisons within England, Wales and Scotland that held male remand prisoners. The alcohol treatment services that worked within the prison and were the intervention workers used to deliver the APPRAISE intervention (CGL) were largely unable to complete the data collection due to the pandemic. This impacted hugely on the data collected and hence the findings of the study. Therefore, we anticipated by undertaking this survey it would help us to understand what the prisons did in relation to alcohol services throughout the pandemic, and to fill in the gaps in our data that the research team were not able to complete.
Aims and objectives
The aim of conducting the survey, as a component of the APPRAISE study, was to further understand the alcohol services that are currently provided in male remand prisons across England, Wales and Scotland and how the COVID-19 pandemic has affected their delivery.
The specific objectives to achieve the above aim were:
- to establish what alcohol services are currently provided within male remand prisons
- to explore the prison governors’ understanding of alcohol brief interventions
- to understand how the COVID-19 pandemic has impacted the services available in male remand prisons
- to identify whether the impact of the COVID-19 pandemic upon services could be avoided in the future.
Methods
Survey design
The survey was developed to ask questions related to the delivery of alcohol brief interventions and other alcohol treatment services, within the prison setting, in order to ascertain what services the prison currently provided. Questions were largely closed, with ‘yes’ or ‘no’ responses, but did include some open-ended questions to obtain a more in-depth understanding in specific areas. The latter part of the survey asked participants whether services were affected by the COVID-19 pandemic and, if so, what could be done to ameliorate this in the future. The survey also provided participants with the opportunity to say whether there was anything that was not asked that they wished to express around the impact of the pandemic. The survey finished by asking whether any participants would be willing to engage with the research team in the context of a future study in remand prisons. It was made clear that this response was in no way binding, but simply a way of gauging an initial expression of interest for planned future work.
The survey was distributed online using the JISC tool (www.onlinesurveys.ac.uk/), which was used to both develop and distribute the survey. By using an online platform it ensured that the survey was accessible across a wide geographical reach and that participants did not need to return hard copies, avoiding a pitfall for completion. In addition, by using the online platform it also allowed the survey data to be transferred to SPSS for analysis, which avoided security being compromised by surveys being returned and entered by hand. JISC also allowed the scheduling of e-mail reminders to be sent to prospective participants reminding them about completing the survey.
Setting
The primary setting of the APPRAISE study was two specific remand prison sites in England, Wales and Scotland. However, to get a broader range of responses across different remand prisons the survey component was extended to invite all prison governors, across England, Wales and Scotland, working within prisons with men on remand to take part in the survey.
Sampling and recruitment
As the contact details for prison governors are freely available online, online searches were conducted to obtain the e-mail addresses of all of the governors, across the UK. E-mails were then sent to each prison governor which included a link to the online survey, alongside an information leaflet. The information leaflet was used to explain the purpose of the survey and what the participants’ responses would be used for.
Consent
The survey asked all participants to provide their informed consent, before completion, via a consent form built into the start of the survey. It stated that participation was voluntary and that participants did not have to answer any questions that made them feel uncomfortable. It also reassured participants that all personal details, such as names and places, would be removed, in order to ensure they were not identifiable from their responses. In addition, participants were informed that they could withdraw their consent at any point during the survey and could even withdraw their responses following its completion. It was stated that participants could withdraw their responses, for up to 2 weeks, following the completion of the survey, by contacting the lead researcher and hence the respective contact details were supplied.
Data analysis
Analysis of the survey data took place once all surveys were anonymised. SPSS was employed to analyse the survey data obtained. As the survey primarily consisted of yes or no responses the data analysis mainly consisted of percentage calculations. For the more open-ended questions, simple thematic analysis was undertaken to ascertain qualitative statements, which could be used to draw conclusions and answer the survey’s objectives.
Data management
All contact with prospective participants was undertaken electronically, along with the creation of all necessary research materials. Any data collected was stored in accordance with GDPR 2016/679. The exported data were stored in a shared folder on a secure network drive which was only accessible by the research team. All identifiable information was removed from the survey results, in order to protect the identity of participants. A password-protected database was stored in a secure network folder at Teesside University, which contained the prison names and the survey IDs, in order to assist the removal of a participant’s responses, if they requested to remove themselves from the study. This file was securely deleted once the survey had concluded and the survey withdrawal period had closed. Teesside University acted as the data processor and data owner. Data and research materials were also stored in a Microsoft Teams group which was only accessible to members of the research team and was used to upload, store and circulate all relevant study files and documents securely.
Ethics
Although the APPRAISE study obtained ethical clearance from the University of Edinburgh, a separate ethics application was submitted to Teesside University ethics within the school of Social Sciences, Humanities and Law, for this survey component – 7 October 2021 (2021-6427). Ethical clearance was also obtained from HMPPS on 21 December 2021 (HMPPS 2019-2240) via an amendment to the original approval of the overall APPRAISE study. Participants were notified that their survey responses would be confidential, and only if they disclosed something which indicated a risk to them or someone else would it potentially be necessary to breach confidentiality. In this case the procedure involved the project supervisor being informed, and if deemed appropriate the project supervisor would take further action based on the safeguarding protocol. However, confidentiality did not need to be broken across any of the included participants.
Results
Obtained sample
Out of the 59 prisons in the UK, successful e-mail invitations were sent to 55 governors inviting them to take part in the survey by e-mail; 17 completed the survey. Difficulties were encountered during this part of the research process due to the apparent turnover in staff undertaking the prison governor role. Many e-mail invitations were returned as not being able to be delivered and more investigating had to be carried out.
Governors were asked to disclose the capacity of their prison and, from those who answered, the smallest prison held 577, and the largest 1600.
Findings
The findings of the survey are presented below in relation to the objectives discussed above. The response rate of 17 out of 55 completing the survey needs to be borne in mind when considering the study findings. It may be that those prisons that were more engaged in alcohol services responded and as such self-selected.
Current alcohol services within male remand prisons
The survey showed a wealth of knowledge on the different services offered within prisons with men on remand. The survey gathered information on both the service providers and the services offered. These services included:
- Alcoholics Anonymous (AA) sessions: 58.8% (n = 10).
- NHS services: 35.3% (n = 6).
- Psychotherapy/Counselling/11 support: 29.4% (n = 5).
- In-cell work packs: 23.5% (n = 4).
- Smart recovery: 17.6% (n = 3).
- Support services via community partners: 11.8% (n = 2).
- Group work: 11.8% (n = 2).
- Detox services: 11.8% (n = 2).
- Substance misuse services: 5.8% (n = 1).
- CJSW Addictions team: 5.8% (n = 1).
The above services are provided by a broad range of providers. These included: NHS services, AA sessions, Change Grow Live, DART (drug and recovery team), Inclusion team, criminal justice social worker (CJSW) Addictions team, Chaplaincy support, Scotland and Midlothian Offender Recovery Service (EMORS), Dfodol, trained prison staff, SPS, Forward Trust, Drugs Action, Turning Point and third-sector services. The most frequently mentioned provider was NHS services (n = 10, 41.2%).
Governors’ understanding of alcohol brief interventions
All governors were asked about their knowledge of alcohol brief interventions. When initially asked, 82.4% (n = 14) stated that they did know what the intervention was.
The survey then asked all governors if to the best of their knowledge their prison delivered alcohol brief interventions. Ten (58.8%) said that they thought their prison did deliver the intervention. Within the survey they were then given some information on what the intervention entails and asked again if they knew if they were delivering them. This time, more governors declared that they think they are delivering the intervention (n = 11, 64.7%). This shows that the knowledge of the intervention helped with making a decision about whether alcohol brief interventions are being delivered.
One of the questions at the end of the survey asked those who wished to, to leave an e-mail address if they were interested in taking part in any future trial around alcohol brief interventions. For this question, 64.7% (n = 11) did express this interest, showing an interest in developing their alcohol provisions further.
The impact of the coronavirus disease discovered in 2019 pandemic upon services available in male remand prisons
The pandemic undoubtedly affected the alcohol services within the prisons with men on remand in England, Scotland and Wales and that were included in the overall APPRAISE study (HMP England and HMP Scotland). The survey also established this, with 15 of the 17 prisons (88.2%) answering yes to ‘did the pandemic impact alcohol services within your prison?’.
The impact on services was answered in an open question, with governors giving detailed responses to the question of how services were impacted. A summary of some of the service impact is as follows:
- group sessions being suspended
- face-to-face sessions being suspended
- services suspended – being unable to attend the prison
- staffing issues
- interventions being reduced
- a lack of resources.
The majority of governors mentioned the services that entailed group sessions being affected (n = 8, 47.1%). This and all of the barriers were due to not being able to see the men face to face and the social distancing measures in place. The conditions imposed on the prison by government to stop the spread of the COVID-19 virus and keep the men and staff safe meant staff and organisations other than prison officers and healthcare staff were unable to enter the prison. There were some prison governors who mentioned an attempt at using telephone support but due to staffing pressures this was unsuccessful too. Staff numbers were limited due to isolation rules or being vulnerable or (potentially) contagious.
This has shown that although there are some services being carried out with in-cell packs, most alcohol services rely on face-to-face intervention work, mostly in groups, and carried out by outside organisations.
Interestingly, we asked the prison governors about ‘other services’ delivered in the prison and whether or not these were impacted by the pandemic. In this instance, 100% (n = 17) answered ‘yes’. The reasons for impact were all the same as those mentioned above in relation to the disruption to alcohol services. While the majority of services mentioned were related to drugs and smoking, there were also other services disrupted, such as health care, therapeutic services, gambling support, education, religious services, the gym and, importantly, the overall regime of the prison.
Best practice to avoid any future disruption to services
When asked whether the disruptions due to the pandemic would have a long-term effect on the prison, there was a divide between responses, with 41.2% (n = 7) stating they felt it would, and 58.5% (n = 10) stating no, they would not. Those that felt the affect would be felt for a long time had different reasons for this. However, most responses discussed that this was from the fact that there was a long gap in services, and the impact of that having a long-term effect, for example, not having treatment and falling more unwell. One governor discussed the DART team not having access to the prisoners, which ultimately led to fewer services now being delivered, and these have not yet been fully increased back to pre-pandemic levels. All of those who responded stated they were unable to say when they thought this long-term affect would end, but one governor predicted ‘years to come’.
Every governor who answered the survey had an opinion on how best to avoid a future disruption. First, we gave options as to what they thought would lead to less disruption should a pandemic arise in the future. The most favoured appeared to be something tangible for the prisoners to work on in their cells:
- online sessions: 76.5% (n = 13)
- workbook/paper sessions: 82.4% (n = 14)
- staff continuing interventions but wearing full personal protective equipment (PPE): 70.6% (n = 12).
PPE featured heavily in some of the open-ended questions and was considered a barrier to overcoming further disruption if not dealt with more quickly in a future pandemic.
Other suggestions given by those who returned the survey included comments about better provisions for in-cell phones, or in some circumstances the praising of purple visits which allowed video calls. This highlighted some good that came from the learning of the COVID-19 pandemic and new innovations. Aside from comments regarding a better, more appropriate use of technology should this ever happen again, one governor commented on the services being seen as ‘essential’ and therefore not something that is withdrawn in the same way it was in 2020.