The aim of this paper is to present an evaluation of a prison visitors' centre and to locate those findings within current debates about strategies for promoting health within prisons, reducing re-offending, fostering family ties, and tackling health inequalities. The settings approach to health promotion has focussed attention on institutions such as schools, workplaces, hospitals, and by extension, on prisons. This focus has also enabled a discussion about the seeming contradiction between prison being places of punishment and correction, and their role in enhancing the health of a group of people who are literally a 'captive audience'. This itself raises issues about voluntarism, equal rights (i.e. the right of prisoners to receive the same standards of health input as the general public), and the tension between 'punishment' and 'rehabilitation'. This paradox has led authors in the area to question whether promoting health in prison is a contradiction in terms (Smith 2000), an oxymoron (McCallum 1995, de Viggiani 2006) or simply incompatible (Greenwood et al. 1999). These latter debates are outside the scope of this paper, which instead will focus on the ways in which a visitors' centre can enhance the health of prisoners, their families, and the prison staff.
In the UK, the Government's strategy 'The Health of the Nation: a strategy for Health in England' (Department of Health 1992) was one of the first government documents specifically to mention prisons as a place to tackle ill health. Following the regime change in 1997, the Labour Government also mentioned prisons as a setting for improving mental health and general well-being, in 'Saving Lives: Our Healthier Nation' (Department of Health 1999). Only in 2002 however, with 'Health Promoting Prisons: A Shared Approach' (Department of Health 2002) was a fully elaborated strategy produced, which focussed on developing policies and practices throughout prisons which would promote the health of all prisoners and staff, which would provide health education and health services, and which moved towards a social model of health underpinned by the concept of 'decency in prisons'. This document was translated into a Prison Service Order (PSO 3200) which, according to Baybutt et al. (2007) was, 'a crucial step forward for health promoting prisons, embedding as it did a commitment to health within the offender management system' (p242).
There appears to be political will, therefore, to tackle health promotion within prisons, at the same time as general concern, expressed for example in media reports, of widespread 'crisis' and serious issues within the penal system. The putative 37% rise in prison suicides in 2007 compared with 2006 has led pressure groups such as the Howard League for Penal Reform to say that this is the 'human cost of the prison crisis' (Woodward 2008). The Prison Reform Trust has related the rise to the increase in the numbers of those with existing mental health problems being held in prison, and to the general increase in the prison population, leading to overcrowding. As of 1st February 2008, there were 76,545 male and 4,453 female prisoners in UK gaols, according to the National Offender Management Service (NOMS 2008). The UK has one of the highest imprisonment rates in Europe (Baybutt et al. 2007; Smith et al. 2007) and recent government approaches have been to suggest building 'super jails' or titan gaols to deal with overcrowding, rather than to reconsider sentencing policy, or to renew efforts to tackle the causes of crime. Given the ever increasing prison population and the unlikelihood of this changing in the foreseeable future, it is imperative to consider how the health of those men and women who spend 'time inside' can at least be maintained and if possible, enhanced, during their prison sentence. Prison visitors' centres can arguably play a valuable role in this.
Historically prison …