Tattooing in Scottish Prisons

A healthcare needs assessment

Dona Milne, Specialist in Public Health

Needs assessment objectives:

• To describe the current population in Scottish prisons and the disease burden related to blood borne viruses

• To identify current tattooing practices and associated risks/potential risks

• To elicit stakeholders views: prisoners, staff and management

• To consider evidence of effective interventions to reduce risks related to tattooing in prison

• To recommend potential interventions to reduce risks associated with tattooing

Methods – epidemiological/comparative• BBV Surveillance reports

• SPS Prisoner Survey

• Prevalence studies

• Clinical case reports

• Published and grey literature search on effective interventions (limited)

Methods - corporate

Four prisons identified:• interviews were conducted with a Hall Manager,

Health Centre Manager, and one each of hepatitis C specialist staff and prison officers

• a one to one interview was completed with a tattooist and a focus group of prisoners who had obtained a tattoo whilst in prison

• A short survey of prison doctors (25 approx) was completed to identify the frequency of clinical complaints related to tattooing

• Literature review on effective interventions

SPS Annual Prisoner Surveys reported tattooing activity amongst prisoners:

• 55% prisoners reported having a tattoo with 19% reporting receipt of a tattoo in prison (2007)

• 54% prisoners reported having a tattoo with 18% reporting receipt of a tattoo in prison (2008)

Prison Type of Establishment

Tattooing rate

Edinburgh Closed, local, remand and short-stay

22%

Inverness Closed, local, remand and short-stay

25%

Perth Closed, local, remand, short and

long-stay

21%

Shotts Closed, national long stay

28%

Tattooing activity

• Reasons for getting a tattoo

• Tattooing equipment

• Sharing and cleaning equipment

• Perceived risks from tattooing

Staff views on tattooing activity

• Prison doctors

• Prison Officers

• Health care staff

And responses to interventions…..

Intervention Prisoners Prison officers Prison medical staff

Total

Numbers of each survey group

17 8 7 32

Confiscate gun components

4 5 9

Increase punishment/better security

1 1 2

Educational materials such as leaflets and posters

9 7 7 23

Addictions services provide cleaning materials and equipment

8 2 5 15

Provide training on health and safety

1 1 2

Discussion groups/induction

7 1 8

Local education project 2 1 3

Increase staff knowledge 2 2

Provide a prison tattoo service

12 5 6 23

Conclusions

• Prevent tattooing in prisons• Educate prisoners on the risk of tattooing in

prison• Provide access to cleaning materials and tattoo

equipment• A multi-faceted approach

But what can be done in the prison environment?

Recommendations

• review existing health promotion materials on tattooing in prisons with Scottish prisoners to ensure the relevance of the final materials

• information on risks from tattooing in prisons should be featured in staff training and prison induction sessions

• prisoner survey amended to seek information on when prisoners got a tattoo within prison, to better assess current tattooing activity within prisons

• Sterilisation materials or facilities should be made available to prisoners providing tattoos, either through health care or addictions staff

• The Scottish Prison Service health care standard on blood borne virus prevention, care and treatment should be updated to reflect the inclusion of the above approaches within prison health care services

• SPS should consider a tattoo room pilot in a long stay establishment

Work by C plus and prisoners in Edinburgh

Prison Public Health

Don’t forget the community links….

• Lothian tattooing incident 2010

• Unlicensed tattooist

• Young women under 16

• Common link – tattoo parties