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Written by Judy White, Yorkshire and Humber Regional Health Trainer Lead based on an interview with Geof Dart and with the permission of Jamal, a health trainer champion at Moorlands Open Prison. Jamail’s findings have been published by the Altogether Better Programme, click here to download a copy.

Jamal is a health trainer champion currently resident at Moorlands Open Prison near Doncaster. Jamal moved to Moorlands a few weeks ago to complete the last phase of his sentence. Before that he was at Everthorpe prison near Hull. His story is told by Geof Dart who works at Everthorpe as a PE instructor but who is currently on secondment to the Yorkshire and Humber Improvement Partnership where he is working to develop health trainers and health trainer champions in all thirteen penal institutions in the region.

Geof trained the first health trainer champions in offender settings in the region, when he was at Everthorpe. Jamal was picked out as someone who was already a prisoner mentor and who would be conscientious and reliable. Jamal jumped at the chance of undertaking the training which was a ten hour course accredited with the Royal Society of Public Health.

What prisoners can do to improve their diet whilst in prison is somewhat limited, but they do have opportunities to improve their fitness as all prisons have gyms and many have developed other physical activity options. Jamal was one of four health trainer champions at Everthorpe. Their role is to chat to other inmates about the options available, ‘sign post’ them, encourage them, and accompany them if that’s appropriate. The prison has started ‘Walk to Fitness’ classes and a gym session specifically for health trainer champion clients who don’t have the confidence to go to the gym when other inmates are there.

Jamal talked to Geof about one particular client who he was proud to have helped. George (not his real name) was doing nothing to keep fit, but Jamal got him interested and told him about the Walking to Fitness class. George wasn’t confident enough to go along on this own, so Jamal went with him three times – he then felt confident enough to continue and is now going twice a week. Jamal kept a check on him and is really proud that he was able to help George make this behaviour change, particularly as in the prison setting it involves extra commitment to arrange to have exercise time together and its unusual for inmates to do something for nothing.

When Jamal was transferred to Moorlands he asked if he could continue to work as a health trainer champion. The challenges are different as it is an open prison and most inmates work outside the prison, so are around less and have less time available for other activities. But the gym manager is supportive and together he and Jamal are setting up a service. The gym manager and three other staff have trained as health trainer champions, and given most inmates are only at the prison for a short term before release, they will provide most of the service rather than offenders. They have set up sports and fitness classes and a stop smoking service and there is a health care worker on site.

Jamal wants to continue as a health trainer champion on his release and is interested in training as a health trainer. He is already in touch with the health trainer service in his home town, Bradford, where a pilot is just getting underway, working with the Probation Service to employ ex offenders as health trainers to work with offenders, ex offenders and their families. Jamal will have to keep out of trouble for several months before he could apply to be a health trainer, but could continue to work voluntarily as a health trainer champion upon his release.

Developing a health trainer service in prisons in Yorkshire and Humber

So far health trainer champions are only operational in Everthorpe and Moorlands Open prisons but Doncaster has trained staff who have just completed training prisoners and health trainer champions will soon be operational. Staff have also been trained as trainers of health trainer champions at Full Sutton where a course for prisoners is full and will complete in March and Hull where again a course is about to start. Leeds prisons (Armley, Wetherby and Wealston) are taking a slightly different approach and have set up a ‘health reps project’. Lindholme, Moorlands (closed), New Hall, and Wolds, have trained staff, but training prisoners and setting up a service has been delayed due to staff shortages. There are no plans to set up a service at Wakefield which is a category A prison where most inmates are sex offenders, but there are health trainers who go into the prison from the Wakefield District PCT Health Trainer Service. Hull PCT also have a health trainer who works within Hull Prison. These health trainers are all trained to Level 3.City and Guilds.

Collecting the evidence

Where health trainer champion/ health trainer services are operating, data is collected on the clients and what outcomes they achieve. This will be entered into the national health trainer Data Collection Recording System. It will then be possible to draw off reports and map progress in relation to behavioural change outcomes.

Why offenders are a priority group

Offenders have an excessive burden of chronic illness, especially mental health problems, infections with blood borne viruses, sexually transmitted diseases and dependence on drugs and alcohol; compared to their peers in the community:

  • 90% of all prisoners have a recognisable mental health problem, substance misuse problem or both
  • 66% of all prisoners admit to using drugs (other than alcohol) in the imprisonment.
  • 24% of prisoners reported having injected drugs- of these 20% were infected with Hep B and 30% Hep C.
  • 8% of a representative sample of prisoners tested positive for Hep B
  • 7% for Hep C, 0.3% male prisoners are HIV Pos. and 1.2% females are HIV Positive.
  • Over 80% of prisoners smoke
  • The rate of suicide and self harm in prison is higher than in the community
  • 20% of women prisoners ask to see a doctor each day.
  • 38% will be homeless on release
  • 47% were in debt at the time of sentencing
  • 50% have poor reading levels
  • 80% have poor writing skills

Meeting policy priorities

Working with offenders meets policy priorities within the NHS to reduce health inequalities and target ‘hard to reach’ groups and within the National Offender Management Service which prioritised offender health.

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