Introduction
Waverley Care's Prison Link Project works with prisoners who are living with hepatitis C and approaching liberation from HMP Barlinnie.
The project offers holistic support before, during and after liberation to remove the uncertainty people face when returning to the community.
This support, funded by AbbVie, enables individuals to better manage their health, clear hepatitis C and move forward with their lives.
Read on to find out more about the project in its first year...
Around 1 in 5 prisoners in
Scotland is living with
hepatitis C.
Among the general population,
it's 1 in 150...
Hepatitis C and the prison context
Hepatitis C is a blood borne virus that affects the liver.
The condition can lead to serious liver damage and liver cancer but, thanks to effective treatments, it can now be cured.
Across Scotland an estimated 36,000 people are living with hepatitis C - 40% of whom are undiagnosed. The majority of new infections are linked to injecting drug use.
Prisons are an important location for prevention and support efforts:
- An estimated 1 in 5 prisoners in Scotland are living with hepatitis C - compared to 1 in 150 among the Scottish population
- The Scottish Government's Blood Borne Virus Framework identifies testing for hepatitis C in prisons as a priority
While hepatitis C testing and treatment within prison is now well established, Waverley Care service users with a history of time in prison highlighted that the transition to community support remains a frequent stumbling block:
· lack of practical support for recently released prisoners e.g. accommodation, financial support, accessing recovery services
· managing health is not the priority and individuals fall away from specialist hepatitis C care and support
This feedback is consistent with wider concerns about continuity of care as people move between prison and community settings, as highlighted by the Royal College of Nursing and the Scottish Public Health Network.
The approach
Waverley Care's Prison Link Worker, Billy, is embedded within the Blood Borne Virus (BBV) Team at HMP Barlinnie.
Individuals are generally referred to the project directly through the BBV Team, or through Waverley Care's Community Projects Team.
Referrals from Community Projects will include service users who have recently been liberated from prison or are otherwise involved in the criminal justice system (e.g. individuals under Community Payback or Drug Treatment and Testing Orders).
The Prison Link Worker provides:
· Pre-release support – individuals are supported to develop a liberation plan that addresses housing, money and health needs, and connects them into relevant support outside of prison.
· Support on release – individuals are supported to understand more about hepatitis C and to manage behaviours and negative thinking which can be a barrier to accessing support and treatment. Individuals are linked into peer support and other services offered by Waverley Care’s community projects.
· Partnership working with local support agencies - the Prison Link Worker has established relationships with a range of community agencies that support people recently released from prison who have a history of addiction. This is to support referrals to and from the service, and to identify individuals at risk of hepatitis C so that testing can be offered.
The approach aims to join up a prisoner’s healthcare, specifically related to hepatitis C, in a way which hasn’t happened before. As a result, individuals are enabled to better manage their health, clear hepatitis C and move forward with their lives.
The results
In initial planning, it was estimated that the project would support 50 service users in year one. The following figures summarise our activities:
45 – Total number of service users to access the service
38 – weekly clinics offered by the Prison Link Worker
6 – individuals to clear hepatitis C during the year (13% of service users)
192 – one-to-one interventions delivered totaling 221 hours of support
12 - hepatitis C education and testing sessions conducted with partner agencies, reaching over 100 people
45 - hepatitis C tests conducted through links with partner agencies, of whom 11 were diagnosed with hepatitis C
A majority of the 192 interventions have been directly linked to hepatitis C (managing health, accessing appointments, treatment support).
However, 12% of interventions relate to issues beyond hepatitis C that could potentially disrupt individuals' engagement (drug and alcohol support, benefits/welfare, housing etc).
At the end of the first year, 22 service users were engaged in the service:
13 in assessment process - consultant and specialist nurse appointments to check if individuals are ready for treatment
4 awaiting treatment - individuals are considered ready to start treatment in terms of their physical and mental health
1 completed treatment - following treatment, a further test is required to confirm that hepatitis C has been cured
3 in post-treatment support - following completion of treatment, continuing support is required to reduce risk of re-infection
1 has moved on from service - completed post-treatment support and ready to move forward with their life
One notable issue to arise during the first year of the project has been the relatively high proportion of service users who are co-infected with hepatitis C and HIV - 19% of the people we've worked with are living with both conditions. This is linked to a recent rise in HIV cases among people who inject drugs in the Glasgow area.
In response to this increase, NHS Greater Glasgow and Clyde (NHS GGC) has prioritised engaging people in HIV treatment, before addressing hepatitis C co-infection. Our service is well placed to provide additional support to individuals living with hepatitis C and HIV, linking them into our existing community services, and building on relationships with HIV specialists at NHS GGC.
Given the chaotic background of the service users we are working with in HMP Barlinnie, and the delay to hepatitis C treatment for individuals also living with HIV, the results in terms of getting people ready for, into and through hepatitis C treatment are very encouraging.
Case Study: Colin
Colin* is living with hepatitis C and HIV. Over the past five years, he's been in and out of prison three times and was referred into the Prison Link Service as he neared liberation from HMP Barlinnie in early 2017.
We met up with him to hear his story…
* Name has been changed to protect individual's identity.
Next steps
The impact of the work in the first year has demonstrated the clear potential to expand the pilot work at HMP Barlinnie to other prisons.
Following discussions with NHS GGC and the Scottish Prison Service, the work has, since October 2017, expanded to support prisoners approaching liberation from HMP Low Moss.
Opened in 2012, Low Moss has purpose built healthcare facilities, with dedicated spaces where we hope to be able to offer additional support moving forward.
We continue to engage with partners at HMP Barlinnie to address challenges presented by the age of facilities - particularly the lack of space for group support.
In order to support further development, a number of actions have been taken:
· Continued engagement with Scottish Government to highlight findings of work to date
· Participated in AbbVie hepatitis C roundtable event - highlighting contribution that prison work can make to hepatitis C elimination goals
· Possible funding streams are being investigated
If you would like to find out more about the project, including opportunities to link with partner agencies, contact:
Claire Fuller | claire.fuller@waverleycare.org | 0141 332 2520
Photo Credits:
HMP Barlinnie - Neil Mitchell/Shutterstock
Colin's Story - Halfpoint/Shutterstock
HMP Low Moss - Andrew Lee
All other images - Waverley Care
