• health policy & practice

Cardiff Prison is a Victorian city centre establishment that opened in 1832. It has the operational capacity for up to 820 adult men (Wales has no women’s prisons) and is a category B local remand prison with training and resettlement functions. There is an on-site healthcare facility, with an outpatient clinic area and inpatient beds.

Providing healthcare to an imprisoned population presents unique challenges, especially when managing a stigmatising and potentially life-threatening condition such as epilepsy. Prisoners are four times more likely to have seizures than the general population,¹ yet they engage much less with healthcare.² Mental health difficulties are certainly more common among prisoners,³ including learning disabilities and dissociative (non-epileptic) seizures. Substance misuse and drug addiction are prevalent within secure environments, leading to high levels of addiction, overdose, trading, bullying and manipulative self-harm. Abuse of prescription medications is also very common, especially of pregabalin, gabapentin, benzodiazepines, tramadol and sedating antidepressants, as well as methadone. The monetary street value of a 300 mg pregabalin tablet outside of prison is mostly between £1 and £7,⁴ but there are no formal price data from prison. Clinicians frequently feel pressured to prescribe these drugs, which can give an opiate-like euphoric high and can enhance the high when used alongside opiates. However, in overdose, they can cause sedation, ventilatory failure and death.

A 30 min hospital appointment from prison is costly in time and resources, taking half a day for two escort officers, …