Tool 5: Places of Deprivation of Liberty and Gender Box 14: Promising initiatives in the management of women’s physical and mental health in Australia  Development of a national set of health indicators for prisoners, including specific measures for women, such as the proportion who report being pregnant.  Establishment of a dedicated facility for women with complex psychological issues.  Provision of timely and relevant health screening, e.g. breast checks and cervical screening, and introduction of ultrasound clinics and dedicated drug-free units.  Measures to meet specific nutritional needs of pregnant and lactating women.  Availability of drop-in health services and provision of a broad range of onsite medical services, including general nursing, GPs, psychiatrists, dentists, opticians, podiatrists, mental health nursing and pharmacotherapy.  Health promotion programmes, for example smoking cessation, diabetes prevention and heart health, as well as provision of information on blood-borne diseases.  Provision of pharmacotherapy treatments for prisoners upon release.  Efforts to ensure treatment for existing healthcare needs are transitioned into the community, and liaison with community healthcare networks is promoted.  Measures addressing needs of special groups, e.g. indigenous or older women. Source: Lorana Bartels and Antonette Gaffney (2017) “Good practice in women’s prisons: A literature review”, Technical and Background Paper No. 41, Canberra, CT: Australian Institute of Criminology, p. 50. The PAHO notes that a lack of gender-mainstreamed policy protecting transgender people in prison increases their vulnerability while restricting their access to appropriate care. Specific needs of transgender persons related to gender affirmation are often dismissed as purely “cosmetic” concerns with no relationship to health. Special attention is needed to ensure transgender people receive the healthcare they require: for example, it is important that transgender people who are in the process of receiving hormonal treatment continue to have access to hormones, including supervision by appropriately trained medical staff and medical care to address the potential health effects of hormone therapy. Persons who have undergone surgical modification of their bodies should have access to adequate care. Persons who have not undergone treatment but seek to do so while incarcerated should be able to access such procedures through health services provided by prisons.20 Rehabilitation programmes and vocational training In many locations women and girls do not have the same access to rehabilitation programmes, education or vocational skills training as men and boys. In some cases this means that those with sentence plans are unable to fulfil the criteria that will allow them to be released to the community. It also limits women’s ability to find legal and meaningful ways of sustaining themselves financially upon release, compared to those who have been able to access support. Offending-behaviour and substance-misuse programmes should not just be replicated for women, but fundamentally rethought for what is most appropriate and effective from a women-centred gender perspective. Staff conducting these programmes should be crosstrained in substance abuse, trauma and mental health, and adequate resources must be provided for these services.21 Treatment and rehabilitation should be holistic, and recognize that people are likely to face multiple issues that intersect and will affect their reintegration. 39