Mental healthcare in prison • Prisoners with mental health conditions have the right to equal recognition before the law. (CRPD, Article 12) • All prisoners must be protected from discrimination, including on the grounds of their mental health status. (Mandela Rule 2) The role of prison healthcare staff Key international standards As in the community, the primary responsibility of all healthcare professionals in prisons is the care and treatment of their patients, based on individual assessments of their medical needs. Their fundamental ethical obligations are to respect the autonomy and best interests of the patient, to evaluate, promote, protect and improve the physical and mental health of prisoners, and to avoid harm being done to them. At the international level, UN member states recognise that people in prison have complex mental health needs and have adopted standards that outline mental healthcare provision in prison, based on best practice. These include the UN Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) and the UN Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules). The UN Convention on the Rights of Persons with Disabilities (CRPD) also provides key safeguards for people with mental impairments in prison. There are clear responsibilities of prison healthcare staff to prevent and treat mental ill-health, including: • Ensuring that medical assessments include screening for mental health conditions and the risk of suicide and self-harm. Basic principles (Mandela Rule 30) • All prisoners have a human right to the highest attainable standard of physical and mental health. (International Covenant • Ensuring there is continuity of care, including the transmission of files in cases of transfer, and close links with community healthcare services. (Mandela Rules 24(2) and 26(2)) on Economic, Social and Cultural Rights (ICESCR), Article 12) • States have an obligation to provide adequate treatment and care for the mental health of all prisoners, and to mitigate the effects of imprisonment on mental well-being. • Protecting medical confidentiality and ensuring informed consent for any medical treatment. (Mandela Rules 26, 31 and 32(b),(c)) (Mandela Rules 24, 25 and 33) • Referring any cases requiring specialist treatment to relevant professionals. (Mandela Rule 27(1)) • Mental healthcare and support must be provided at the same level of care as in the community. (UN Principles of Medical Ethics, • Reporting to the prison director any adverse effects on mental health from restrictive measures, and advising if the measure should be terminated or altered. (Mandela Rule 46) Principle 1; Mandela Rule 24) • Prisons should retain a sufficient number of specialists on their staff, including psychiatrists and psychologists. (Mandela Rule 25) • Prisoners with mental ill-health must be treated with humanity and respect for their inherent dignity. (Mandela Rule 1) Trencˇín statement on prisons and mental health ‘Promoting mental health and well-being should be central to a prison’s health care policy. This will address such matters as the general prison environment, prison routines and levels of prisoner activity, education and work opportunities, and staff-prisoner relationships.’15 • Gender-specific provision of mental healthcare should be provided to women prisoners. (Bangkok Rule 10) • All prisoners have the right to protection from exploitation and abuse, including torture and ill-treatment. (CRPD, Article 16; Convention against Torture, Article 2; Mandela Rule 1) 14 15