Reconceptualising harm reduction in prisons

Although many countries have successfully introduced harm reduction initiatives within their prison systems, overall progress in this area remains slow and incongruent to policy and practice in the community. Despite international and national pressure that prisons incorporate harm reduction techniques equivalent to those in the community, many have resisted their implementation. Within the prison environment, the conflicts and contradictions between punishment and security measures and treatment and harm reduction initiatives manifest themselves most acutely. Prisons are extreme settings which amplify drug-related harm. Employing the risk environment framework put forward by Rhodes (2002), this chapter examines the various ways in which prisons can be defined as high risk environments for drug-related harm and how this harm is shaped by multiple environmental factors. It critically analyses the current harm reduction initiatives in prisons including health promotion and education, drug substitution therapy, bleach and disinfectant distribution and needle exchange and argues that these interventions have been pre-occupied with risk factors, human rights and behaviour change at the individual level. This neo-liberal perspective has ignored the various levels of structural constraints which have limited individual prisoners in accessing harm reduction. The risk environment approach helps us to reconceptualise harm production and reduction by shifting the focus and responsibility from individuals to social, political, economic situations and structures. However, it is also important within this analysis to identify and explore the processes and resources which promote health, resilience and well-being and help to create enabling environments for the reduction of drug-related harm in prisons.