6. HEALTH-CARE PUTTING IT INTO PRACTICE 6 Initial medical screening 148 18 Principle 24 of the UN Body of Principles mirrors the Mandela Rules, stipulating that “[a] proper medical examination shall be offered to a detained or imprisoned person as promptly as possible after his admission to the place of detention or imprisonment”. It may not always be possible to conduct medical screenings for all prisoners immediately upon admission, especially if large groups of prisoners arrive at the same time. The CPT has clarified that “as soon as possible” should be understood to mean within 24 hours of admission.342 19 When identifying any ill‑treatment that may have occurred prior to a detainee’s admission to prison, including previous exposure to sexual and/or domestic violence, any signs of psychological or other stress and the risk of suicide/self‑harm, it is important that the health-care professional has a conversation with the prisoner about her or his current health and health history. Information on the requirements for documenting and reporting signs of torture or other ill‑treatment can be found in Chapter 1, paragraphs 161–162, Chapter 3, paragraphs 77–83 and Chapter 6, paragraphs 76–101 of this guidance document. 20 It is good practice to have a psychologist involved in initial medical assessments, particularly because signs of torture and other ill‑treatment and suicidal/self‑harm tendencies are not always obvious. 21 The assessment of stress or other mental health conditions, as well as the risk of suicide or self‑harm and drug or alcohol dependency, should form part of the overall prisoner needs and risk assessment and should be included in the prisoner’s medical file. 22 Initial medical screening should include systematic screening for Tuberculosis and prisoners should be offered voluntary testing for other communicable diseases (such as HIV or Hepatitis B and C). 23 During the initial screening prison staff should check if any accessibility measures need to be put in place to accommodate a prisoner’s disability. This could include different types of disabilities, such as physical, mental, intellectual or sensory disabilities. 24 It may not always be possible for a qualified doctor to conduct the initial medical screening. In these cases, the screening should instead be carried out by a qualified nurse. However, nurses should always act under the supervision of prison doctors and bring prisoners who have arrived with health problems or injuries to the attention of the doctor. 25 The requirement to have sufficient qualified personnel in each prison, as stipulated in Rule 25(2), must take into account staffing needs for the initial medical screenings. 26 If prisoners are placed back into police custody for further investigation pertaining to the case against them, they should also be provided with a medical screening as soon as possible after their return to prison. This constitutes a key safeguard against torture and other ill‑treatment, in particular due to the common risk of coercion of confessions and statements during interrogations through ill‑treatment or even torture. It is also in the interest of prison staff to identify any such abuse so they are not falsely accused of ill‑treatment themselves. 27 Health-care personnel should open a medical file for every newly arrived prisoner. Medical files are dealt with in more detail in Chapter 6, paragraphs 125–132 of this guidance document. 342. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), 23rd General Report of the CPT – CPT/Inf (2013) 29, Council of Europe, 6 November 2013, para. 73 at www.refworld.org/docid/528490ba4.html. Guidance document on the Nelson Mandela Rules