Women’s Health in the Justice System
Lilly Lewis, Women’s Involvement Advisor, One Small Thing
In the next in her series of blogs Lilly Lewis, One Small Thing’s Women’s Involvement Advisor, discusses the challenges women impacted by the justice system face when accessing healthcare services. She also reflects on her recent work on One Small Thing’s podcast series on women’s health, and new research highlighting the prevalence of brain injury amongst women in contact with the justice system.
I recently read the new investigation report into healthcare in prisons by the Health Services Safety Investigations Body, and was surprised by some of what is revealed about the state of healthcare in prisons. The report revealed a 43% DNA (Did Not Attend) rate for medical appointments. This was really surprising to me. This high figure reflects the difficulty prisoners face in accessing healthcare. Possible reasons for missed appointments include miscommunication, understaffing, or lack of priority given by prison officers. The challenge of securing a timely appointment and the barriers within the prison system contribute to this significant rate, highlighting the need for improved healthcare access and better coordination to ensure inmates receive necessary medical care.
For women in prison, the biggest barriers accessing healthcare include insufficient healthcare staff, limited appointment availability, and inadequate communication between the women in prison and healthcare team. Additionally, prison policies, overcrowding, and staff priorities can hinder timely access to being able to attend appointments. These obstacles can lead to delayed treatment, worsened conditions, and overall neglect of women’s health while in prison. From my own personal experience of being in prison, there was a real lack of care from most of the officers when I was feeling unwell and was struggling with the menopause. My symptoms were often not believed or were minimised.
Women leaving prison also face significant health barriers, including homelessness, which often prevents access to any healthcare. We are seeing women leaving prison with tents. Without housing, many struggle to register with a GP or obtain prescribed medications. The lack of continuity in care leads to untreated physical and mental health conditions. Additionally, the stress of release with limited social support and resources exacerbates health challenges, making it difficult for women to reintegrate into the community and maintain their well-being. With the introduction of Probation Reset and early release schemes, there could be additional stress for women when coming back into the community. Lack of medical care upon release could also lead to women using street drugs if they aren’t able to easily access their regular medication they had in prison.
To ensure women’s health needs are addressed both whilst they are in prison and upon release, key changes are needed. Prisons must prioritise gender-sensitive healthcare services, including mental health and reproductive care, and support with the menopause. More staff and resources are needed to enable services to run smoothly. Improved communication between healthcare providers and prisoners is essential. Upon release, women should have access to housing and through the gate services to support them into community healthcare, including registration with a GP and continuity of prescribed medications. Comprehensive support services, including mental health support and counselling, are crucial for successful release back into the community. Lack of this support can increase likelihood of recall for those women who find themselves re offending or breaching licence conditions.
“Healthcare for women impacted by the justice system should be more gender-responsive and trauma-informed. This means recognising the impact of past abuse and trauma, and ensuring care and dignity. ”
Training healthcare providers on gender-specific issues and incorporating women’s voices in care planning is crucial for effective support. Working with those with lived experience is essential to ensure a more trauma informed approach is used when working with women around their healthcare whilst in prison and upon release.
At the end of 2024 I hosted an episode in One Small Thing’s latest podcast series on women’s health. This was a great opportunity to further explore some of the health barriers women face when impacted by the justice system. A key issue, which I was not aware of before, is the prevalence of brain injury amongst women impacted by the justice system. Brainkind recently released a report which found that 80% of women in the criminal justice system in Wales may be living with a brain injury. In the episode I spoke to Stephanie Bechelet and Thea Arch from Brainkind about this important research, as well as their wider work on brain injury for women who have experienced domestic abuse.
It was particularly shocking to learn that justice-involved women experience higher rates of brain injuries compared to the general population. Most of these injuries are linked to physical abuse by a partner, with reports highlighting that strangulation can also lead to brain injury due to a lack of oxygen reaching the brain.
I think that it has taken so long to recognise brain injuries in women in the justice system due to the symptoms being very similar to anxiety, stress, and PTSD which are all conditions seen in women who have faced domestic abuse. Stigma also plays a role in under reporting, particularly in cases of domestic abuse, as women will often downplay the level of abuse they have faced to protect the abuser and specifically if they have children. The justice system has traditionally focused on managing offending behaviour rather than addressing underlying causes, like trauma or injury. Women in the justice system also face systemic failures in healthcare access, leaving their injuries undiagnosed. These factors have contributed to the lack of research and awareness until now.
“Understanding the impact of brain injury when working with women in the justice system is so important.”
Brain injuries can affect memory, decision-making, and behaviour, which may contribute to offending and responses to rehabilitation. Without recognising these injuries, women could be misjudged as uncooperative or unwilling to engage.
Addressing brain injuries can improve health outcomes, see better rehabilitation efforts, and reduce re-offending. It also ensures a trauma-informed approach, acknowledging the role of domestic abuse and other factors that contribute to these injuries.
One Small Thing is currently researching women’s health in the justice system and seeking views from practitioners who work with women. What are the barriers to accessing health services, and what needs to be in place to effectively meet the health needs of women in contact with the justice system?
Written by: Lilly Lewis, Women’s Involvement Advisor at One Small Thing
