Search results

In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

Mental illness affects the majority of prisoners. Mental health issues are beginning to take a central position in the development of prison health services, reflecting this burden of disease. This change in focus is not before time. But prison mental health services cannot exist in isolation. Public health systems should lead provision of care for patients with acute and severe illness. A whole prison approach to health and, specifically, mental health will offer the greatest likelihood that offenders will thrive, benefit from imprisonment, and lead law‐abiding lives after release. Public awareness of the scale and commitment of prisons to mental health and illness, and understanding of prisons’ role in society, are necessary developments that would protect and enhance public mental health, as well as creating a healthier and safer society. This article draws on recent reviews, information and statements to set out a public health agenda for mental health in prisons.

The purpose of this paper is to give an overview of the WorldwidE Prison Health Research & Engagement Network (WEPHREN) which aims to improve the evidence base for health and health service delivery within prison settings and so improve the health and wellbeing of people in prison, reduce health inequalities and influence prison health policy.

A viewpoint piece that highlights the need for higher quality health research in the field of prison health globally and the potential for WEPHREN to help support this.

This paper presents an overview of the poor health of many people in prison and the inequalities between countries in terms of research output relating to the health of people in prison. It argues for all those interested in prison health to work together to produce more practitioner and policy relevant health research.

This editorial highlights a unique global network for prison health.

The quality and relevance of what happens in prisons are measurably improved once prisons are seen, and have to act, as an integral part of society and the community. The provision of health care has benefited a great deal from the involvement of national and local agencies whose professional expertise is in health and education. HM Inspectorate of Prisons (HMIP) has developed the World Health Organisation's concept of a ‘healthy prison’ (WHO, 1998) to judge the treatment of prisoners and the conditions in which they are held against four core criteria. Partnership working between the Prison Service and NHS was formalised in April 2000, and the majority of prisons have transferred the commissioning of health care to the NHS. This paper considers the challenges and developments of partnership working in improving health outcomes for prisoners, and identifies future improvements.

The strongest international recognition of the importance of women’s health in prisons and the urgent need for radical change was highlighted of a WHO Conference held recently in Kiev, Ukraine.

Health care practitioners in prison face the challenge of providing high standards of health care within the unique peculiarities and restraints of the prison environment. The strict adherence to principles of medical ethics by the prison health care staff and the knowledge and acceptance of these principles by the whole prison community not only results in ethical conduct but also yields practical professional advantages such as guidance in situations of conflict, promotion of confidence and avoidance of misunderstandings. The internationally consented conventions, declarations and recommendations relevant on medical ethics in prison are presented and their basic principles ‐ the primary task of the prison doctor, access to a doctor, equivalence of care, patient’s consent and confidentiality, preventive health care, humanitarian assistance, professional independence, professional competence ‐ are discussed. In addition, the personal obligation of the prison doctor for ethical reflection and decision making in individual ethical issues not covered by the quoted documents and in ethically controversial issues is emphasized. A training course and published guidelines for ethical conduct in prison health care are recommended.

From first contact with the police to release from prison, people with mental ill health who come into conflict with the law often find that their mental health needs are neglected while they are under the authority of the criminal justice system. In 2008, the Prison Reform Trust surveyed independent monitoring boards in England and Wales, asking them to comment on mental health care. Topics included the adequacy of court diversion schemes, assessments carried out in prison reception units, and preparations to ensure continuity of care upon release. The responses documented some of the consequences of neglect in prisons in England and Wales. Over half of the boards felt that they frequently saw prisoners who were too ill to be in prison. Boards also expressed concerns about assessment processes in prison reception areas, which were by no means adequate to identify mental health problems. A number of boards stated that, too often, people with severe mental illnesses are held in segregation units, where they endure an impoverished regime. The boards observed that many prisons lack any means of identifying people who have learning disabilities, and often their disabilities restrict their capacity to engage fully with the regime.

HIV/AIDS is a serious health threat for prison populations in many countries, and presents significant challenges for prison and public health authorities. This situation is often exacerbated by high rates of hepatitis and/or tuberculosis. The generally accepted principle that prisons and prisoners remain part of the broader community means that the health threat of HIV within prisons, and the health threat outside of prisons, are inextricably linked and demand coordinated action. Yet many countries have not implemented comprehensive HIV prevention programmes in prisons, or achieved a standard of prison healthcare equivalent to the standard outside of prison. In December 2004, the authors were retained by the United Nations Office on Drugs and Crime (UNODC) to prepare an international Framework to address HIV/AIDS prevention, care and treatment in prisons. The Framework is a tool designed to assist governments meet international obligations on human rights, prison conditions, and public health. It outlines a 100‐point action plan for implementing a response to HIV/AIDS in prisons based on international health and human rights standards, and on evaluated models of good practice.

In the context of the transfer of the responsibility for prison health from the Prison Service to the National Health Service, a survey of doctors working in prisons reveals doctors’ own high priorities for training in the distinct patient contexts found in prison as well as in certain clinical conditions. The analysis identifies exclusive competences required only for doctors working in prisons and special interest competences that although applicable to practice in the community are particular strengths of doctors working in prisons because of the prevalence of conditions they are required to address.

In Kyrgyzstan the prevalence of injecting drug behaviour is among the highest found throughout the world. Health promotion training, improved health care and needle/syringe exchange (NSE) programmes have been shown to decrease risk behaviour among injecting drug users. In Kyrgyzstan, an intervention study with training of prison staff and prisoners was performed in one prison. Before and after the training, a random selection of the prisoners answered a questionnaire about drug use, risk behaviour and health care. The survey was carried out in both the intervention prison and in a reference prison. The number of drug users, the use of drugs and risk behaviour were improved significantly within half a year and, especially, the injection and use of drugs decreased in the intervention group. The study clearly shows that increased focus, improved healthcare and training of prisoners and staff on drug use and harm reduction can reduce both use of drugs and risk behaviour.