Pharmacy behind bars – the challenges

crichards150x150 By Cathryn Richards, Head of Pharmaceutical Services, HMP Swansea

Being a prison pharmacist has its own set of challenges but challenges tend to reap their own rewards. Most of the time I feel like I’m making a positive difference to the lives of some of the most vulnerable in society.

I work in a Category B prison holding 445 adult male prisoners with the majority being Welsh.

Prisoners often arrive at the prison emaciated by drugs and alcohol, weak physically and mentally. It’s essential that they benefit from immediate pharmaceutical care. This is why I have written many Patient Group Directions; these enable nursing staff to administer certain drugs 24/7 to provide emergency medical care without a doctor being present.

Administration of medicines by pharmacists and nurses occur within a strict prison regime, with a Prison Officer always being present.

Levels of drug use are high amongst offenders; 64% of prisoners reported having used drugs in the four weeks before custody. Poly-substance misuse is common; 54% with alcohol problems also reported a problem with drugs, and 44% said they had emotional or mental health issues in addition to their alcohol problems.

Prisons hold people with a wide range of mental and emotional disorders; 72 per cent of male sentenced prisoners suffer from two or more mental health disorders. Armed-forces veterans, who are sometimes coping with post traumatic stress disorder, also form a sizeable proportion of the population, eight per cent at the present. The prison population profile, however, is changing; people aged 60+ are now the fastest growing cohort.

Half of all sentenced prisoners are not registered with a GP and this causes problems on entry and discharge. I produce information for prisoners on discharge so that a Discharges Medicines Review (DMR) can be carried out in their community pharmacy.

As regards physical heath, the prisoners are more likely to suffer from epilepsy, asthma, liver disease (including Hepatitis C) and heart disease. The majority of these diseases are linked to excess alcohol and smoking. Pharmacy staff provide counselling to prisoners on medicines and health promotion, but, as more than half of adult prisoners have no educational qualifications, it is challenging but extremely rewarding.

There are many challenges to working in prison pharmacy but there is much we can do to overcome these challenges by providing our patients with the support they need, from Patient Group Directions to counselling. Also, we are not facing these challenges alone. Pharmacists work as part of a multi-disciplinary team. Consultants, GPs, pharmacists and nurses work closely together to treat the patient non-judgementally. This is important in a prison environment to achieve the best outcomes.

If you are interested in finding out more about prison pharmacy, or if you are a prison pharmacist yourself looking for more information and support, take a look at the Royal Pharmaceutical Society’s Secure Environment Pharmacist Group.