An Interview with the Prison Dietitian: Dietitian’s Week 2022

This week is Dietitian’s Week, 20th to 24th of June. This week is to celebrate and help raise the voice and visibility of this crucial and often overlooked role within the NHS. We sat down with Fran, known online as ‘the prison dietitian’. As her online name states, Fran, is a registered dietitian, who just so happens to work in the UK’s largest prison for men.

Why did you want to become a dietitan?

“I was always a huge foodie and I always wanted to work in the NHS too. I liked helping people, but I was a bit squeamish so decided a job with less physical contact was probably more of an appropriate career for me! I stumbled across dietetics when my mum had to see one for gestational diabetes support. My interest and love grew from there.”

What’s one thing that has surprised you about working in a prison?

“It’s not a scary atmosphere. The thing that actually shocked me the most was some of these men’s backstories. From the outside it’s very easy to look at a person who may be ‘bad’ for committing a crime, but when you meet the men and have more understanding, it’s a far more complex world. Some of these men come from poverty, abuse, trauma, and deprivation.

The men as well are very respectful of healthcare professionals. They always start by calling me ‘miss’ until they get to know me a bit more and start calling me Fran. I prefer that!”

What is health anxiety like in the prison?

“There is a lot of health anxiety. Particularly during COVID. The men were in their cells for 23 and ½ hours a day. That’s a lot of time to think, notice small things and start to worry about them.”

For prisoners who have digestive conditions, how do they find prison food services? Are they able to access the dietary requirements they need?

“This is difficult! We can have some special diet provisions, for example vegan, lactose free, allergen free and gluten free. The kitchens do offer a good variety, 5 different options per meal. Normally there are at least a few options to meet a patient’s needs.

There are limitations unfortunately to this though. For example, if a man comes to me with Irritable Bowel Syndrome (IBS) and requires a low FODMAP diet, this can be a bit of a logistical nightmare if I’m honest. We can do a modified FODMAP diet, for example a few of the men are on lactose free diets. I just try and encourage the men to chose one of the menu choices that best suits their needs.”

We saw on your Instagram page that there is a budget of £2.02 per day per prisoner, how is this achieved for prisoners on specific diets?

“Again, this can be really difficult. When a prisoner does go on a ‘special diet’ even for a digestive condition, they sign a contract. This states that if they break this diet unfortunately, they are immediately taken off this diet. It’s viewed as a special privilege despite it being a medical requirement.

I can intervene in some circumstances when this happens. For example, if a prisoner has coeliac disease, it is vital they are on a gluten free diet. The kitchen staff and I do have a good level of respect for each other. I do understand that for them it’s difficult and they do need to stick to their budgets, but I have to treat these men as patients, not prisoners.”

We also saw on your Instagram page the average education level for a prisoner is that of an 8 – 11 year old. When a prisoner has a digestive condition, how do you best communicate with them about their condition and the management of it?

“It takes time. It’s one of the things I actually enjoy about my job. When I was working in the NHS I had dedicated time slots with patients, whereas in the prison I can take that bit longer with the men. For a lot of them, this is the first time someone has taken the time to chat with them about their condition and the management of it.

I also find photos help, giving them chunks of information at a time and repeating information. It may take a few sessions with them for them to understand. Easy to read documents are great too.

As well I can link in with the Multi-Disciplinary Team, particularly in these circumstances the Speech and Language therapists. They can complete assessments with prisoners to see what they are able to process and understand. This can help me to decide what is the next best steps for that prisoner. For example, I can refer them to a peer mentor. A peer mentor is another prisoner who will help the prisoner to read written information.”

On your Instagram page you talk about having to be careful as some prisoners may manipulate medical services for person gain. How do you deal with these situations?

“Again, this is super difficult. You have to remember that anything can be traded in prison, including medication and special dietary foods.

As a dietitian, I do have a good knowledge around typical digestive conditions symptoms so I can ask questions which can help me decide. For example, if a man is telling me that onions and spicy foods are triggering symptoms, it’s more than likely that this prisoner does have IBS. However, if he’s telling me, it’s cheese and onion crisps causing symptoms, but ready salted crisps are fine, I may have some further questions. As well, I can ask for the men to have medical tests / examinations as any patient would to come to a diagnosis, and then refer them to gastro services for support.

I think the most important thing is to treat everyone equally and just be honest with the men about what we can and cannot do. Never promising something that can’t be achieved.”

Finally, why did you decide to share on social media your experience of working in a prison?

“I used social media throughout my university studies as a way to network and post food photos without constantly annoying my family! Once qualified I’ve tried to make it more of a platform to share what dietitians do and to get our names out there. The NHS needs more dietitians so if I can do anything to help that I will.

I also love highlighting that working in a prison is a great place to work if you want to make a change to people’s lives. I believe there is only 3 dietitians working in prisons, me being one of them! It would be great to have a few more of us.”

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