HEALTHCARE IN PRISONS Every human being has the right to the highest attainable standard of physical and mental health. When a state deprives someone of their liberty, it takes on the duty of care to provide medical treatment and to protect and promote his or her physical and mental health and well-being.3 This duty of care is critical, because prisoners have no alternative but to rely on the authorities to promote and protect their health. The revised UN Standard Minimum Rules for the Treatment of Prisoners (known as the Nelson Mandela Rules) 4 also emphasise state responsibility for healthcare and confirm that people in prison should enjoy the same standards of healthcare that are available in the community. The Rules elaborate further on obligations relating to prisoners’ health: people in prison should have access to necessary healthcare services free of charge and without discrimination on the grounds of their legal status; health staff working in prisons should have clinical independence; continuity in healthcare is important; prisoners need prompt access to healthcare in emergencies; informed consent of the prisoner to treatment should Useful resources on the right to health in prison World Health Organization, Moscow Declaration: Prison health as part of Public Health, 2003. OSCE Office for Democratic Institutions and Human Rights and Penal Reform International, Guidance Document on the Nelson Mandela Rules: Implementing the United Nations Revised Standard Minimum Rules for the Treatment of Prisoners, 2018. World Health Organization and the International Committee for the Red Cross, Information Sheet: Mental Health and Prisons, 2005. Penal Reform International, Mental health in prison: A short guide for prison staff, 2018. UN Office on Drugs and Crime, Handbook on Prisoners with Special Needs, 2009. UN Office on Drugs and Crime, Handbook on Women and Imprisonment, 2nd edition, 2014. be obtained; and up-to-date and confidential medical records should be maintained and should accompany each prisoner on their journey through the prison system. In general, the provision of healthcare in prison settings across the world is underfunded, understaffed and of a lower standard than in the wider community. Looking at the SDGs, Goal 3 on health will not be achieved if the right to World Health Organization, Good governance for prison health in the 21st century. A policy brief on the organization of prison health, 2013. World Health Organization, Prisons and Health, 2014. The Worldwide Prison Health Research and Engagement Network (WEPHREN) provides a forum for all stakeholders interested in prison health across the world to exchange ideas and develop collaborative, multi-centre research. (www.wephren.org). health for people deprived of their liberty continues to be deprioritised. Prison can be an important setting for preventing and addressing physical and mental health inequalities among the prison population. Identifying and responding to ill-health and mental health needs is a vitally important component of a prisoner’s journey towards rehabilitation and reintegration on release, which in turn can reduce reoffending. Provision of healthcare: a ‘whole-of-government’ approach Independence of healthcare staff The World Health Organization (WHO) and the UN Office on Drugs and Crime (UNODC) state that ‘the management and coordination of all relevant agencies and resources contributing to the health and wellbeing of prisoners is a whole-of-government responsibility’.5 A crucial aspect of this ‘whole-of-government’ approach is the requirement for healthcare staff to operate independently of the prison administration, so that any clinical and health assessments of detainees are based solely on medical criteria. This independence is important for prisoners so that they feel they can trust the healthcare provider regarding their health conditions, and can also speak to them openly in order to report torture or other ill-treatment. Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019 If healthcare staff are directly employed by the prison service, or if they appear to be overly friendly with regular prison staff, prisoners are unlikely to trust them – particularly if the prisoners have been ill-treated by prison staff. If they are not independent, healthcare staff may experience a conflict of interest and feel a greater sense of duty towards the prison administration as their employer, than towards the patient. |3