A mixed methods study about health problems and drug use in Belgian prisons during 2021-2022

Negative effects of imprisonment on quality of health and drug use are well known. Although the interference between social- psychological- and physical aspects of health seem obvious, in many prison settings an overall approach with respect to drug use is lacking. A mixed methods study collected data during 2021-2022 in five Belgian prisons. People in prison were randomly invited for a quantitative survey about drug use, violence, social contacts, loneliness, anxiety, depression and sleep. The survey was carried out in 13 languages using tablets. In total, 280 responses were analysed. Next, respondents of the survey that used illicit drugs were invited for an in-depth interview about personal insights on support needs of drug use and social-, physical- and emotional well-being (N = 38). Besides, persons released less than 1 year ago and who used illicit drugs (N = 12) were interviewed. Drug use and symptoms of anxiety, depression, sleep problems, loneliness, suicidal attempts and violence are 2 to 8 times higher in prison compared to community. Drug use inside prison was more prevalent (p < 0.05) among people with a prison history. Respondents also mentioned the negative influence of drug use on physical, social and emotional health. Severe depression symptoms and the occurrence of suicide attempts were more reported among people who used drugs in prison in the past month. Although most respondents indicated having received visits during the past month, lack of social contacts and dependence on others were strongly present during the interviews. The results suggest that the prison context affects the interconnection of biopsychosocial health aspects as a whole to such an extent that the likelihood of drug use increases. This finding is essential to address the needs of people in prison in a more holistic way. Enlarging this scope in prison policy and more specific treatment initiatives enables increasing equity in care and will improve both security and health outcomes. KEY MESSAGES: • The results support an expansion of treatment initiatives that have been already implemented but in which the interconnection of the biopsychosocial health aspects with drug-use should be integrated. • This study supports the idea to develop a more holistic prison policy by adding drug use, physical, social and mental health to the main concern of security.