Emerald Group Publishing Limited
Article Type: Editorial From: International Journal of Prisoner Health, Volume 10, Issue 3.
Welcome to Volume 10 Issue 3 of the International Journal of Prisoner Health. In this issue, we are pleased to present a selection of papers that examine key health areas in prison including mental health, HIV/AIDS and palliative care.
In our first paper, Diala Ammar and Alberto Cordova consider strategies to alleviate the problem of HIV/AIDS within the Lebanese prison system. They posit that due to a lack of available data, stigmas associated with the disease and lack of effective assessment and intervention programs, the Lebanese situation is similar to many other countries in the region. Complicating matters further is the apprehensive approach of prison officials towards HIV prevention strategies due to a belief that these may go against prison policies and governing law in the country. Given that current prevention and intervention programs are unavailable or inadequate, the authors propose that a number of guidelines and recommendations, based on successful programmes implemented in developing countries, are introduced to facilitate progress. These include: providing voluntary counselling and testing; protecting prison staff from infectious disease; reducing overcrowding; reducing stigma through education and awareness programs; providing necessary national funding to develop appropriate healthcare resources in each prison; promoting continuity of care of HIV/AIDS prisoners after release to the community and encouraging collaboration between correctional systems and health departments within the community in providing voluntary HIV testing, education and counselling. The authors conclude that, along with the recommendations listed, the World Health Organization guidelines (1993) on HIV/AIDS in prisons need to be fully implemented in penitentiary HIV prevention policies in Lebanon and that future work should focus on implementing, monitoring and assessing HIV/AIDS intervention programs.
Andrew Forrester, Jagmohan Singh, Karen Slade, Tim Exworthy and Piyal Sen consider the functions of a prison mental health in-reach team (MHIT) in a busy, ethnically diverse, male remand prison in London, UK. Data were obtained using a retrospective design involving the collection of basic descriptive information from recorded notes. Information regarding consecutive MHIT referrals was collected over a continuous 18-week period between 2008 and 2009. A range of information was captured including: basic demographics; offending history; clinically assigned diagnoses; psychiatric history; and referral information. The authors report that foreign national prisoners were significantly under-represented amongst referrals, which is consistent with research demonstrating under-use of mental health services following migration. The finding of a proportionate referral level for white and non-white prisoner referrals suggests that under-referral is the consequence of language or communication difficulties, cultural deprivation, misunderstanding or reluctance to engage with services. The prevalence of mental health issues is noted by the authors and a call for improved screening arrangements to facilitate better recognition of those with mental health problems forms one of the concluding recommendations along with greater investment in services for foreign national prisoners and a research comparison of multiple MHIT models, working towards agreed model templates.
Drawing on the published literature Sarah Larney, Curt G. Beckwith, Nickolas D. Zaller, Brian T. Montague and Josiah D. Rich assess the potential benefits and challenges of applying a strategy of “seek, test, treat and retain” (STTR) to hepatitis C virus (HCV) in the USA criminal justice system. The authors note that STTR was developed as a response to the HIV epidemic following evidence that early diagnosis and treatment entry produces individual clinical benefits, is associated with reduced HIV transmission, encompasses identification of at-risk populations, high coverage of testing among those at risk, early initiation of antiretroviral therapy and adherence to and retention in treatment. The paper examines each component of STTR and considers how it could be applied to HCV in the US criminal justice system, noting that several challenges, notably cost, are apparent. A further barrier is a lack of appropriately trained treatment providers with prison health services often lacking specialists experienced in hepatitis C treatment. The authors note, however, that primary care physicians with appropriate support can safely provide treatment. On-going injection drug use is also identified as a barrier to treatment despite evidence that demonstrates good treatment outcomes among people who are actively injecting drugs. While the aforementioned challenges are acknowledged by the authors, they conclude that the application of STTR to HCV in the criminal justice system would result in substantial public health gains.
In our fourth paper Tina Maschi, Suzanne Marmo and Junghee Han review and critically appraise the methods and major findings of the international peer-reviewed literature on palliative and end-of-life care in prison. The purpose of the review is to identify the common elements of promising palliative and end-of-life services in prison, and identify what factors facilitate or create barriers to implementation. Using a sample of 49 studies published between 1991 and 2013, the authors utilised deductive and inductive analysis techniques to generate frequency counts and common themes related to the methods and major findings. The authors report that the majority of studies were conducted in the USA, and were largely non-empirical conceptual articles. In addition, there appears to be a lack of theoretically driven empirical research studies on the aging and serious and terminally ill in prison. While noting the limitations of the study, the authors note that theory has been used in empirical studies that address the older and seriously ill and dying in prison, with several researchers and scholars offering insights on future directions for theory development that centres around core themes related to human development, systems of care, and power structures. The authors conclude that palliative care in prisons is an often over looked right to health, especially among people in prison and that change can only be effected if correctional staff and society at large move beyond a mode of thinking that foregrounds the punishment paradigm, to a more compassionate palliative approach that all humans deserve.
Finally, Elizabeth Walsh, Christine Butt, Dawn Freshwater, Rachael Dobson, Nat Wright, Jane Cahill, Michelle Briggs and David P. Alldred explore the management of pain in adult male prisoners in a large category B prison in England, focusing on the attitudes and perceptions of prison staff towards pain management in prison. Using data gathered from a questionnaire and focus group, the authors report that respondents demonstrated an awareness of prisoner pain, with some staff stating that managing pain in prisoners took a significant amount of their workload. Respondents also felt that whilst prison may not cause pain, the social and affective nature and reality of imprisonment could aggravate existing conditions. Additionally, many issues were thought by respondents to impact on pain in prison including depression, having excessive time to reflect, having restricted access to illegal drugs leading to withdrawal, lack of natural light, and hard beds/pillows/mattresses. The majority of respondents reported that they had witnessed or heard about prisoners trading medications while all felt that prisoners access healthcare services to obtain pain medication that they do not need, with opiate drugs being the most popular for trading. While noting the limitations of the study the authors conclude that further research is required to develop, implement and evaluate pain management programmes in prison that take account of the complexities of the culture and environment. In addition, they note that more work is essential in order to ascertain the extent to which pain management provision in prison is safe and effective whilst simultaneously meeting the security requirements of the prison.
Morag MacDonald, Robert Greifinger and David Kane