HEALTHCARE IN PRISONS such as post-traumatic stress disorder, depression, anxiety, and a tendency to attempt self-harm and suicide,33 much of which is linked to trauma from previous violence they have suffered.34 As a result, many women are believed to be a security risk and are over-classified. Most women who are admitted to prison are mothers, and the separation from their children, as well as from the rest of their family, can have a severely negative impact on their mental well-being.35 Bangkok Rule 12 acknowledges that successful treatment of mental health issues requires an individualised gender-sensitive approach, addressing the root causes and taking into account any trauma that the female prisoner may have experienced. If a female prisoner requests to be examined by a female healthcare professional, then a female physician or nurse should be made available wherever possible. If a female physician or nurse is not available, then a female staff member should be present during any examination by a male healthcare professional. Sufficient female healthcare staff should be appointed to work in prisons housing female prisoners. Although pregnant women and women with young children should not be imprisoned unless absolutely necessary,36 most women in prison are mothers Case study from Thailand In Thailand, yoga and t’ai chi practices were used in two projects that aimed to improve the health of women prisoners. Ten women prisoners from Ratchaburi Central Prison became instructors and travelled to Koh Samui women’s prison to teach yoga. The project also boosted the morale of prison staff and built better relationships between prisoners and between prisoners and staff.43 and are usually the primary or sole caregivers for their children. The Bangkok Rules make specific provision for healthcare and psychological support needs for children living with a parent in prison.37 The specific needs of women are often not met by prison systems, which have been largely designed by and for men. There needs to be ‘explicit recognition that women and men are different, and that equal treatment of men and women does not result in equal outcomes’.38 Prisons should have good mental healthcare in place for prisoners with existing conditions, and all policies, regimes, routines and practices in prisons should be trauma-informed. In addition, the individual needs of vulnerable groups such as women need to be taken into account to ensure that the SDGs are met, primarily in regard to healthcare (Goal 3) and gender equality (Goal 5). Children Placing children in detention can cause long-term psychological and physical harm. The UN Special Rapporteur on torture has noted that ‘regardless of the conditions in which children are held, detention has a profound and negative impact on child health and development. Even very short periods of detention can undermine the child’s psychological and physical well-being and compromise cognitive development.’39 Children held in detention are at risk of developing post-traumatic stress disorder, and may exhibit symptoms such as insomnia, nightmares and bed-wetting. Feelings of hopelessness and frustration can be manifested in acts of violence against themselves or others. Reports on the effect of detention on children have found higher rates of suicide, suicide attempts and self-harm, and mental disorder and developmental problems, including severe attachment disorder.40 Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019 Children in detention may come from difficult family or social backgrounds and may have been subjected to sexual abuse and other violence. Some will have been victims of sexual exploitation. Young prisoners are also at high risk of ill-treatment, including sexual abuse, within prisons. All children in prison should be properly interviewed and physically examined by a medical doctor (preferably a paediatrician), or by a qualified nurse reporting to a doctor, as soon as possible upon admission to a detention facility, preferably on the day of arrival. In the case of girls, access to gynaecologists and education on women’s healthcare should be provided. Rules 38 and 39 of the Bangkok Rules address the specific healthcare needs of juvenile female prisoners, including the need for age- and gender-specific programmes and services, such as counselling for sexual abuse. This is particularly important given that the needs of girls in detention are often overlooked due to their small numbers within many prison systems. People in prison with mental health needs Research has found that approximately one in seven prisoners has a serious mental health condition; these figures have not changed significantly in the past 30 years.41 Protecting mental well-being and addressing mental ill-health are two of the most challenging issues in prisons worldwide, yet many prisons do not have the resources to provide adequate mental healthcare for either prisoners or staff. Prison staff have an important role to play in supporting all people in prison with mental health conditions and staff who communicate positively with prisoners may be well placed to identify warning signs and potential triggers for mental health decline.42 |7