Peer support for health, social care, and educational needs in adult prisons: a systematic scoping review

Objectives: Prisoners face inequalities relating to health and social care and educational needs. Peer support (prisoners providing support to other prisoners) is used in addition to professional support to address needs. It is not clear how effective or cost-effective peer-support services are, how they are implemented or experienced, or how best to evaluate such schemes. This review aimed to evaluate the following: 1. Outcomes and economic outcomes that have been studied for prison peer support, and data sources used. 2. Effectiveness and cost of prison peer support. 3. Implementation and experiences with prison peer support.

Study design: A rapid systematic scoping review (registered on International Prospective Register of Systematic Reviews: CRD42022351592) that focussed on peer support within adult prisons.

Methods: The search included six databases, grey literature databases, handsearching journals, and reviewing reference lists (June 2022). Studies were screened, and data were extracted. Narrative synthesis was used to analyse findings.

Results: Seventy papers were included (qualitative: 30, quantitative: 21, and mixed-methods: 19). No studies measured cost/cost-effectiveness. A range of methods were used to measure effectiveness (e.g., surveys, routinely collected data), implementation, and experience (e.g. interviews, surveys, observation). There was evidence of some positive effects (e.g., disease detection, mental health). Factors influencing peer support in prisons included individual, service, and organisational factors. Benefits (for prisons/prisoners/staff) and challenges (e.g., burden, exploitation) were identified.

Conclusion: Prison peer support services are internationally used to address public health. Future research could robustly evaluate effectiveness and cost effectiveness. Attention should be given to potential risks and barriers affecting implementation.