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Editorial part 1
Article Type: Editorial part 1 From: International Journal of Prisoner Health, Volume 8, Issue 3/4
Welcome to issue 8 (3/4) of the International Journal of Prisoner Health.
This editorial is in two parts; the first introduces the broad range of papers that comprise the issue while the second part is a contribution from our co-editor Robert Greifinger, inspired by a paper included in this issue, in which he shares his reflections on the difficulties and challenges faced by physicians who are required to provide testimony during legal proceedings.
Nat Wright, Charlotte N.E. Tompkins and Zanib Mohammed open the issue with a paper that considers the effects on physicians who are required to undergo examination and cross-examination in coroners’ inquests following in-custody deaths in the UK. The paper draws upon the wider international literature to focus upon the investigation of prisoner deaths in England and Wales, concentrating on clinician involvement in this process. The authors note that clinicians may have little training or knowledge of what to expect in such situations with the result that giving evidence can be stressful and can, in some circumstances, place an undue burden of investigation upon clinicians. The paper considers the function of the coroner in the UK legal system, the role of medical witnesses and welcomes initiatives to improve the coroner system and address current idiosyncrasies, inconsistencies and inefficiencies, as long as such reform incorporates the experiences of clinicians working within prison environments. The authors conclude that improved training is necessary for clinicians regarding expectations of the coroner’s inquest, coupled with the introduction of a system where questioning in coroner’s courts is directed through the coroner. Such initiatives, they argue, will ensure that coroners’ inquests do not get diverted into issues of blame and culpability and will also assist in minimising the daunting nature of the experience for clinicians without compromising the thorough nature of the investigation.
The remaining papers that comprise this issue span the broad spectrum of health issues affecting prisoners internationally. Päivi Viitanen, Heikki Vartiainen, Jorma Aarnio, Virpi von Gruenewaldt, Sirpa Hakamäki, Tomi Lintonen, Aino K. Mattila, Terhi Wuolijoki and Matti Joukamaa report on the work ability and employment history of Finnish female prisoners and their need for treatment, an issue, the authors note, which has received scant attention. The sample consisted of 101 Finnish female prisoners participating in a comprehensive national prison health survey in 2006 and was compared with 309 male prisoners participating in the same survey. The authors report that from their sample, 78 per cent of women were unemployed, while the proportion of men employed was four times greater compared with the women. Substance abuse disorders were the most common reason for impaired work ability, registering at over 70 per cent in both genders. Among women, other mental disorders were the second most common reason. Basic socio-demographic factors were not associated with impaired work ability among women. Violent crime as the present main offence was significantly more common among prisoners with limited working capacity. A need for treatment was identified in 94 per cent of women and 90 per cent of men. In both genders, the majority of treatment needs were for mental disorders. The authors conclude that Finnish female prisoners have serious problems with substance abuse, including both alcohol and drugs, which impairs their work ability, employability and results in their need for treatment. In addition, female prisoners have other mental disorders that commonly complicate their situation.
Ruth Martin, Debra Hanson, Christine Hemingway, Vivian Ramsden, Jane Buxton, Alison Granger-Brown, Lara-Lisa Condello, Ann Macaulay, Patti Janssen and T. Gregory Hislop report on a participatory research project in which a survey tool was developed by incarcerated women in a minimum/medium security women’s prison in Canada. The aim of the survey was to address major concerns expressed by women regarding housing and homelessness. The results of a subsequent self-administered survey using the developed tool included reports of difficulty finding housing upon release, homelessness contributing to a return to crime and a desire for relocation to another city upon release. The authors contend that the study is unique as there are no published reports of people in prison who have engaged in participatory research regarding their housing needs. Further, the results of the study demonstrate the insight and comprehension of women prisoners relating to their recidivism and housing transience. The authors conclude that the study highlights the reality of the cycle of homelessness, poverty, crime for survival, street-life leading to drug use and barriers to education and employment that incarcerated women face. It is the authors hope that housing policy makers may learn from this study about ways women in prison seek to address their housing needs and their ideas for solutions.
In their paper “The role of sport in promoting prisoner health,” Rosie Meek and Gwen Lewis examine and evaluate the existing evidence base and policy context of sports-based prisoner health promotion. They also present an analysis of current provision and best practice in delivering sport to address physical, mental and substance misuse needs among prisoners across the secure estate in England and Wales, with a focus on the variability of provision across different prison establishments. The authors analysed a number of inspectorate reports published by her Majesty’s Inspectorate of Prisons to determine the extent to which health promotion objectives are being implemented through physical education in prisons across England and Wales. The paper includes examples of innovative sport-based health promoting programmes, which are drawn upon to illustrate principles of best practice. The authors conclude that opportunities to address health inequalities are not being fully exploited in the context of physical education and sport, with practice across prisons in the UK being variable. The authors recognize that although physical activity alone cannot resolve the disproportionate health inequalities evident within the prison population, it can be an effective mechanism to reach those who otherwise might show little inclination to engage with health promotion.
In his paper, Marc Lehmann engages with the main ethical aspects of prison health care, whilst considering the differences among the German states and the varying role of psychiatric care. Noting that, generally, medical practice in European prisons is organised in accordance with the principles of equivalence of care and the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) standards, the author argues that German Federal state rules defining the standards of care and medical confidentiality are similar to, but not equal to standards in the community and thereby fail to meet the standard of equivalence. In conclusion, the author notes that in Germany, the principle of equivalence of care for psychiatric illness in prison has not yet been realised and must be addressed during the on-going legislation process, which has yet to produce improved conditions. In addition, it is argued that resources must be made available to secure highly qualified staff and human rights must be adhered to and upheld. The author contends that these goals can only be achieved when salary and working conditions are improved and an understanding of the problems and the complex circumstances of psychiatric care in prisons is made available to all prison employees.
Journal Co-Editor Robert Greifinger contributes a view on the development of performance measurement of the quality of medical care in prison, with the aim of providing guidance on reducing risk of harm and promoting improved health and health care for prisoners. The author argues that one way of ensuring that prisoners receive timely and appropriate health care is through independent review of health care services, to identify strengths of programmes and opportunities for improvement. The author contends that when done in a systematic way, this has the potential to reduce risk of harm and enhance the personal health of the prisoner and improve public health. Independent external review provides the best opportunity to identify and remedy opportunities for improvement. Greifinger notes that the methodology for assessment of the quality of medical care in the community has recently blossomed, yet there is little guidance on how to adapt this methodology to the prison setting: the paper introduces a prison-oriented method for assessing clinical performance.
In the final paper, Sibusiso Sifunda, Priscilla Reddy, Ronald Braithwaite, Torrance Stephens, Robert A.C. Ruiter and Bart van Den Borne explore the psychosocial and contextual determinants of intention to reduce risky sexual behaviour amongst inmates in South African prisons. An interview questionnaire was administered to a sample of 357 prisoners drawn from four prisons located in two provinces. The analysis indicated that self-efficacy, general life skills efficacy and sexual communication were the strongest predictors of intention to reduce risky behaviour upon release. The authors acknowledge limitations in the study including the low literacy levels amongst prison inmates and that data relied heavily on self-reports of behaviours that may have occurred prior to the participants being incarcerated. They conclude however, that the exploration of subpopulation specific behavioural determinants is a critical step in the development of effective contextually-relevant health education interventions.
Morag MacDonald, Robert Greifinger, David Kane