In March 2006 the HSE published the results of an 18-month long process evaluation and treatment outcome study of female drug-using prisoners admitted to the Dóchas Centre, Mountjoy Prison, Dublin.1  Dr Catherine Comiskey, the principal investigator, presented the main findings of the study in the offices of the Women’s Health Council.   

The aim of the study was to model the care pathway of the women and to discover whether their experiences in the Dóchas Centre had a positive or negative impact on their lives.  Forty drug-using women admitted to the Dóchas Centre between May 2003 and January 2004 were recruited to take part in the longitudinal survey.  The women were interviewed within one month of committal and again six months later. Qualitative interviews were also conducted with eight participants working in a number of capacities with women who had been in prison.  

Of the original cohort of 40 women who participated in baseline interviews, outcome data was obtained for 39 women and 27 women completed a second interview.  The women ranged in age from 16 to 43 years; 23 had children under the age of 18, most of whom did not live with their mothers. The majority of the women had completed their education by the age of 15.  The main findings of the report are outlined below.    

The study measured key variables, including drug use, accommodation, health, psychosocial functioning and involvement in crime before the women were admitted to the Dóchas Centre, during their imprisonment and after their release.  The strongest positive outcomes were in the area of crime.  There was a significant reduction in the overall proportion of women committing crimes between baseline interview and six-month follow-up.   The one exception to this was the crime of soliciting, with results at follow-up indicating a slightly increased incidence. 

There were varying improvements in the extent of drug use among the sample population.  The most positive of these was a significant reduction in the levels of heroin use.  On average, the women who were using heroin at recruitment stage were using it at least once a day.  At six-month follow-up this had reduced to twice a week.  Slight reductions were also noted in the numbers of women using cocaine, non-prescription methadone and ecstasy.  The physical and mental health of the women showed only minor improvements at follow-up and, in some cases, there was evidence of deterioration. Of particular concern was the finding that three of the women interviewed had attempted suicide since leaving prison.  

One of the main findings of this study was that the women were exposed to considerable risks upon their release from the Dóchas Centre.  The women’s experiences on release included overdose, gang rape, prostitution, homelessness and polydrug use.   Of the 22 women who were released from prison during the six-month follow-up period, only seven returned home and did not report any trauma.  Three of the original cohort of 40 women died during the six-month follow-up period. All three of these women had been released from the Dóchas Centre.  This finding demonstrates the real and significant risks associated with the period following the release of female drug-using prisoners.  

The majority of women who were interviewed at six-month follow-up felt that the time which they spent in the Dóchas Centre had been of some help.  The ways in which the prison helped varied for each woman and included assistance with drug treatment, educational opportunities and a break from the stress of their lives.  Despite these positive experiences, the women expressed a number of negative criticisms of the services they received. Over half of the women had concerns at the time of their release relating to, for example, a lack of suitable accommodation, money worries, concerns surrounding their children and a fear of returning to drug use.  The women were asked whether they had received help with these issues upon being released.  Of the 20 women who answered the question, only three had received assistance.   In addition to this, only four of the 27 women interviewed at follow-up stated that they had had any contact with social welfare services while in prison.  Finally, 16 of the 22 women who were released during the time between baseline interview and follow-up were not given advanced indication of their release date, which had implications for the women’s vulnerability to risks upon release.   

A key finding that emerged from the qualitative interviews with the eight participants who worked with women who had been in prison was the lack of co-ordination between the various in-reach services to the women’s prison.  These participants felt that, while the current range and number of agencies providing in-reach services was sufficient, the lack of integration between the services often resulted in poorer outcomes for the women.  They stressed the need for appropriate accommodation that took into account the specific requirements of drug-using women who had been in prison. 

The findings of the study indicate that the women experienced some positive effects in their lives in the six-month period between recruitment and follow-up interviews. It is unclear whether the improvements noted in the report can be attributed to the Dóchas Centre or to the stage which the women were at in their drug-using careers.  The authors suggest that further longitudinal information on the women and their care processes would be required in order to clarify this.  

1. Comiskey CM, O’Sulllivan K and Cronley J (2006) Hazardous journeys to better places. Dublin: Health Service Executive