SPECIAL FOCUS There are some situations related to mental ill-health that require urgent responses, including if prisoners pose a threat to themselves or others or to the safety and security of the facility.44 People with mental illness can be at greater risk of suicide and/or self-harm. The WHO notes that suicide is ‘often the single most common cause of death in correctional settings’45 and it accounts for about half of all prison deaths.46 There is a particularly high rate of suicide among women prisoners, children and newly released prisoners.47 An international study conducted by the University of Oxford in 24 high-income countries between 2011–201448 found that the risk of suicide was three times higher for male prisoners compared to the general male population, and at least nine times higher for women. Interestingly, the study did not find any correlation between the rates of prisoner suicide and rates of overcrowding. States should take all reasonable steps to prevent deaths in prison, including suicide. The question of ‘reasonable steps’ has been considered by the European Court of Human Rights in its jurisprudence, and as a minimum these should include:49 • The transfer of prisoners to mental healthcare settings if required. • Screening as soon as possible after admission, including an assessment of suicide risk. • All prisons having a suicide prevention strategy. • Where a suicide does occur, an independent investigation should be undertaken.50 Prison healthcare staff also have a critical role to play in suicide prevention, although this is not a matter for them alone.51 Awareness raising on the prevention of suicide should take place across the entire prison.52 8 | Case study from Australia Wandoo is a dedicated alcohol and drug rehabilitation prison for women in Perth, and the first female prison in Western Australia to run an intense rehabilitation programme known as a ‘therapeutic community’. The facility can treat up to 77 selected minimum- and medium-security prisoners, who must demonstrate a desire to treat their addiction. The focus of Wandoo is to offer a supportive environment where women can break the cycle People in prison who use drugs Prisons can provide a range of evidence-based rehabilitation treatment programmes to break the cycle of substance dependence and crime. The IDPC Drug Policy Guide from the International Drug Policy Consortium53 sets out a series of recommendations for prison authorities for delivering treatment to prisoners who use drugs, which are summarised below. Education and information Simple information on the risks of infection and the steps prisoners can take to protect themselves and others should be widely distributed to prisoners in a format that is appropriate to their language skills and education. Some prison administrations have also used educational videos or lectures to deliver the same messages, leading to higher levels of awareness. Vaccination programmes There are effective vaccinations to protect against hepatitis B, and a period of imprisonment is an opportunity to encourage people (many of whom do not use preventive health services in the community) to have the vaccination. of addiction and drug-related offending. It aims to provide a ‘safe, healthy, supportive and respectful space to recover and make positive lasting changes’. Wandoo offers dedicated and intensive trauma-informed treatment within a therapeutic community. Women are supported via multi-disciplinary case-management to reduce addiction, improve mental and physical health and reduce the chances of reoffending. Women at Wandoo are also offered transitional and post-release support for their ongoing rehabilitation. Access to safer sex measures Many prison administrations have allowed the distribution of condoms to prisoners, offering them access to the same protection that is available outside prison. Further measures have included information, education and communication programmes for prisoners, and prison staff on sexually transmitted diseases; these have included voluntary counselling, testing for prisoners, and measures to prevent rape, sexual violence and coercion. Needle and syringe programmes Programmes involving the distribution of clean injecting equipment to people who inject drugs have been effective at preventing HIV and hepatitis infections. However, there has been great reluctance to introduce these public health programmes in prison settings. Preventing drug overdose Prisoners who use drugs are a very high-risk group for accidental overdose, particularly in the period immediately after release. Overdose prevention programmes therefore need to be targeted at prisoners, and should involve information and awareness raising. Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019