Prison Health: the forgotten public service opportunities and prospects

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Prison Health the forgotten public service
opportunities and prospects

• Phil Mackie
• Lead Consultant
• Scottish Public Health Network
• NHS Lothian

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Women and Prisons Some Facts

• In Europe women constitute roughly 4 to 5 of the
  total prison population and its increasing.  
• In numbers this equaties to about 100 000 women
  in a European prison every day.  
• Most women are imprisoned for non-violent
  offences, property or drug related ones are
  common.  
• Many women in prison are mothers with an
  estimated 10 000 babies and children in Europe
  affected by their mothers imprisonment.  
• But thats OK as in most European countries
  babies and young children can stay in prison with
  their mothers. Usually until age 3.

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Women and Prisons Some Facts

• Four in five women in prison have an identifiable
  mental illness this is a higher level than for
  male prisoners.
• At least 75 of women entering European prisons
  are problematic drug and alcohol users. Women
  prisoners are more likely to inject drugs than
  male prisoners.  
• The prevalence of HIV and other infectious
  diseases among women prisoners is often higher
  than among male prisoners.  
• Women prisoners are more likely to self-harm and
  commit suicide than male prisoners.  
• Women prisoners are three times more likely than
  male prisoners to report having experienced
  physical or sexual abuse prior to their
  imprisonment. 

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The challenge in Scotland

• Formidable barriers remain overcrowding and
  unhygienic facilities will remain for some time
  as new prison building cannot keep pace with
  rising prison populations prison systems are
  difficult to change because of traditions,
  circumstances, and public and political views
  staff can be reluctant to adopt new ways of
  working, perhaps because they do not get the
  respect for the difficult public service they
  provide nor the training and other support so
  that they can develop the professionalism
  necessary for a modern prison service resource
  restrictions persist because prison services
  seldom rate high priority in governments
  spending public attitudes remain at the best
  ambivalent, and there is a general lack of
  sympathy for a rehabilitative regime in prisons.
• Gatherer et al. Am J Public Health, 200595,
  16961700

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Prison Health A Universal Right

• For over the last decade, the European Region of
  the WHO have sponsored the Health in Prisons
  Project.
• A collaborative venture that has sought to ensure
  that prisoners and those affected by
  imprisonment are not excluded from accessing
  health care or opportunities to improve health

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Prison Health A Universal Right
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Prison Health A Universal Right

• The States recognize the right of everyone to
  the enjoyment of the highest attainable standard
  of physical and mental health.
• The International Covenant on Economic, Social
  and Cultural Rights
• Prisoners shall have access to the health
  services available in the country without
  discrimination on the grounds of their legal
  situation. United Nations Basic
  Principles for the Treatment of Prisoners
• Health personnel have a duty to provide them
  with protection of their physical and mental
  health and treatment of disease of the same
  quality and standard as is afforded to those who
  are no imprisoned or detained.
• UN Principles of Medical Ethics relevant to the
  Role of Health Personnel, particularly
  Physicians, in the Protection of Prisoners and
  Detainees against Torture and
• Other Cruel, Inhuman or Degrading Treatment or
  Punishment
• Regardless of the difficulties faced at any
  given time, the act of depriving a person of his
  liberty always entails a duty of care which calls
  for effective methods of prevention, screening,
  and treatment. Compliance with this duty by
  public authorities is all the more important when
  it is a question of care required to treat
  life-threatening diseases.
• Eleventh General Report on the activities of the
  European Committee for the
• Prevention of Torture and Inhuman or Degrading
  Treatment or Punishment

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Prison Health A Universal Right

• The Moscow Declaration
• penitentiary health must be an integral part of
  the public health system of any country. In this
  connection, it is necessary for both prison
  health and public health to bear equal
  responsibility for health in prisons
• penitentiary populations contain an
  over-representation of members of the most
  marginalized groups in society, people with poor
  health and chronic untreated conditions, drug
  users, the vulnerable and those who engage in
  risky activities such as injecting drugs and
  commercial sex work

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Prison Health A Universal Right

• The Moscow Declaration
• Closer working between health and justice systems
• to ensure high standards of treatment for
  detainees, protection for personnel, joint
  training of professionals in modern standards of
  disease control, high levels of professionalism
  amongst penitentiary medical personnel,
  continuity of treatment between the penitentiary
  and outside society, and unification of
  statistics
• Prison health care should be free
• Harm reduction as principle for prevention of BBV
• Early detection and prompt, adequate treatment of
  TB prevention of onward transmission
• Develop approaches to TB and HIV co-infection
• Improve psychological and psychiatric provision
• Improve prison living conditions in relation to
  light, air, space, water and nutrition

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Health in Prisons - Opportunities

• The prisoner as patient rights and
  responsibilities
• Access to primary health care
• Mental health care
• Communicable disease HIV TB
• Drug methadone services
• Dental health care
• Womens health care
• The health promoting prison
• Workforce health stress

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Health in Prisons - Opportunities

• Complex health needs of women include
• mental health problems
• suicidal behaviour
• substance use problems
• reproductive health
• BBV
• previous experience of violence physical and
  sexual

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Health in Prisons - Opportunities
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Health in Prisons - Opportunities
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Health in Prisons - Opportunities
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Health in Prisons - Opportunities
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Prison Health Public Service