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Many prisoners share socially excluded backgrounds and experience poor mental health in prison. The sometimes fatal experience of prison increases the risk of self-harm and continuing exclusion and mental health problems for many. Furthermore, constructive prison outcomes are unlikely without good mental health. Despite this background, few prison research studies have attempted to capture the dynamic effect upon the individual of both pre-prison and prison experience. This thesis, therefore, aims to identify correlates of prisoners' mental state within both an epidemiological and qualitative-psychosocial perspective. The literature, health and social background data (n = 409), and GHQ-12 mental state data within a case-control study (n = 861), show that prisoners experience a nexus of interconnected problems. Consistent with the literature, being on remand and being in prison for the first time were associated with poor mental state. Remorse and variables related to personality type, specific offence and regime characteristics also had significant associations with poor mental state. Conversely, a beneficial association was found from having had a previous sentence, and also from two counter-intuitive and previously unreported 'typical' social exclusion-related prisoner characteristics, viz. being unemployed prior to prison and having a 'history of drug use'. Professionals (n = 60), however, use alternative constructs for interpreting the mental state of prisoners, and as a consequence, 'atypical' and remorseful prisoners may possess hidden morbidity and need. From these findings and a narrative of the 'lived' prison experience, entry-into, or exclusion-from a socialised prison identity is proposed as a critical mediating factor for prisoners' mental state. This 'adaptation' hypothesis suggests that for many prisoners, prison may paradoxically create, maintain and reinforce an 'invulnerable' shared identity. This identity is based upon offending and common preprison social experience, and adaptive prison socialisation and solidarity is predicated upon it. These identity socialisation factors appear to be protective of mental state. However the institutionally specific qualities of this shared 'prisonized' identity will work against preparation for life outside prison, given that successful integration within society requires different identity attributes. The prison identity dynamic may be further reinforced upon release by public opinion (n = 306), which is intolerant of prisoners, presents an obstacle to their reintegration into society, and potentially strengthens offending identities and behaviours. Whilst prisons are now mandated to address prisoners' needs, their institutional constraints may ultimately make them both pathogenic for those excluded from the shared prison identity, and unfit for the purpose of rehabilitation for those included within it. |
