"It was really poor prior to the pandemic. It got really bad after": A qualitative study of the impact of COVID-19 on prison healthcare in England.

BACKGROUND: The impact of COVID-19 has been exceptional, particularly on the National Health Service which has juggled COVID affected patients alongside related staff shortages and the existing (and growing) health needs of the population. In prisons too, healthcare teams have been balancing patient needs against staffing shortfalls, but with additional strains unique to the prison population. Such strains include drastic lockdown regimes and prolonged isolation, the need to consider health alongside security, known health inequalities within prisoner groups, and an ageing and ethnically diverse population (both groups disproportionately affected by COVID). The aim of this paper is to contribute to emerging research on the impact of COVID-19 on prison healthcare. METHODS: We conducted 44 in depth interviews (over phone or video) across three groups: prison leavers, healthcare staff and decision makers, between July and December 2021. Framework analysis was undertaken. RESULTS: Three themes were found. First, we found that Covid-19 had a significant impact on prison healthcare which involved reduced access and changes to how healthcare was delivered. This affected the health of prisoners by exacerbating existing conditions, new conditions being undiagnosed and mental health needs increasing. Second, the pandemic impacted on healthcare staff through creation of stress, frustration and exhaustion due to minimal staffing levels in an already under-resourced system. Third, an emerging conflict was witnessed. People in prison felt neglected regarding their healthcare needs but staff reported doing the best they could in an unprecedented situation. Healthcare staff and decision makers felt that prison healthcare was seen as a poor relation when compared with healthcare in the community, with no extra resource or staffing for Covid-19 testing or vaccinations. CONCLUSION: The Covid-19 pandemic has significantly impacted almost all aspects of prison healthcare in the UK. This includes delivery of healthcare by staff, receipt of it by people in prison and the management, planning and commissioning of it by decision makers. These three groups of people were all affected detrimentally but in vastly different ways, with some participants describing a sense of trauma. Health needs that were exacerbated or went unmet during Covid urgently need to be addressed in order to reduce health inequalities. In order for welfare and wellbeing to be maintained, and in some cases repaired, both prisoners and staff need to feel heard and recognised.

"I Don't Know How, But I'll Figure It Out Somehow": Future Possible Selves and Aspirations in "At-Risk" Early Adolescents.

Fostering positive future selves in mid-adolescence has shown promising results in reducing problematic behaviour, though little work has been done outside the United States or with younger children. We explored the link between future selves and delinquency in a younger sample of boys ( Mage = 12, SD = 0.73, N = 126) in the United Kingdom, at the nascent stage of self-identity and anti-social behaviour. Participants, who varied in degree of self-reported delinquency and risk, described their short- and long-term possible selves and strategies to achieve them. Unlike findings for older samples (14+), we found no association between delinquency and future selves. Exposure to criminogenic risk revealed some differences regarding the nature of future selves. Those with delinquency and higher risk had fewer strategies for reaching goals. Findings are discussed in relation to self-identity theory and the timing and nature of interventions for children of this age.