SPECIAL FOCUS They may also operate in fear of negative consequences, including dismissal, if they do not comply with requests from prison staff, and may themselves be subjected to retaliatory actions. To guarantee this independence, direct hierarchical or even contractual relationships with prison management should be avoided. Irrespective of their conditions of employment (whether they are a civil servant, public employee or private contractor), medical staff should always be independent of police or prison authorities. The WHO and the UNODC argue that the best way to safeguard the independence of healthcare staff is to ensure that they are employed by healthcare authorities rather than by correctional authorities.6 Equivalence of care Healthcare professionals have a duty to provide equivalence of care, meaning that they should provide the same standard of healthcare that a prisoner could expect to receive in the outside world.7 To achieve equivalence of care, it is vitally important to adequately resource and fund prison health services and to employ sufficient numbers of suitably trained staff. This will be possible only if salaries and terms and conditions are attractive, in order to recruit and retain prison healthcare staff. Continuity of care Continuity of care is important, not only on admission to prison but also upon release, and is generally easier to manage when prisoners are allocated to a prison close to their usual place of residence. When individuals with specific medical conditions are released from prison, healthcare professionals in the prison should consider whether they need to provide them with medication to account for the time it may take them to arrange further medical consultations and receive a regular supply of medication. The requirement to provide continuity of care also includes a duty to properly manage and transfer a prisoner’s medical files. When a prisoner is transferred, their medical files should be transferred to the healthcare service of the receiving institution and should be subject to medical confidentiality.8 The most effective way of ensuring continuity of care is to assign responsibility for providing healthcare in prisons to the national health authority. If this is not possible, there should be close links between community and prison healthcare providers. Training To adequately respond to healthcare needs in prisons, both staff and healthcare providers may require specific training opportunities and support services. For example, they should receive training on how to report torture or other ill-treatment within the prison system, including in cases where it may have occurred outside prison and is identified upon a prisoner’s arrival. To this end, all healthcare staff should be provided with a copy of the Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (known as the Istanbul Protocol), and should be trained in applying it.9 They should also receive training on human rights and medical ethics. All prison staff should receive training on first aid.10 This is important because they are often the first responders in the event of an emergency health situation. Nelson Mandela Rule 76(d) also requires that all staff receive training on the psychosocial needs of prisoners and on social care and assistance, including early detection of mental health conditions. Reducing the risks to health and promoting well-being Assessment Newly arrived prisoners may have pre-existing, untreated health conditions and/or undiagnosed mental health conditions. Physical and mental health conditions are likely to be exacerbated by imprisonment and should therefore be identified as soon as possible after admission, so that the prisoner can receive appropriate treatment. 4 | Initial medical screening enables health personnel to detect and record any injuries, including potential signs of torture and other ill-treatment. Access to a medical professional as soon as possible upon admission ensures that prisoners with pre-existing health conditions continue to receive the care they need and have access to appropriate medication and other treatment. Newly arrived prisoners are unlikely to have medication with them, or may be too disoriented and stressed to remember to take their medication as required. Prison medical services may also need time to acquire and provide the specific type and quantities of medical supplies needed by individual prisoners. Communicable diseases also need to be identified and treatment provided, with any Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019