Health in prisons

1 Health in prisonsA WHO guide to the essentials in prison healthHealth in prisonsA WHO guide to the essentials in prison healthEdited by: Lars M ller, Heino St ver,Ralf J rgens, Alex Gatherer and Haik NikogosianThe essentialsPromoting Health in prisonsAbstractBased on the experience of many countries in Europe and the advice of experts, this guide outlines some of the steps prison systems should take to reduce the public Health risks from compulsory detention in often unhealthy situations, to care for prisoners in need and to promote the Health of prisoners and staff. This especially requires that everyone working in prisons understand well how imprisonment affects Health and the Health needs of prisoners and that evidence-based prison Health services can be provided for everyone needing treatment, care and prevention in prison .

2 Other essential elements are being aware of and accepting internationally recommended standards for prison Health ; providing professional care with the same adherence to professional ethics as in other Health services; and, while seeing indi-vidual needs as the central feature of the care provided, promoting a whole- prison approach to the care and promoting the Health and well-being of those in PROMOTION organization and administrationHEALTH SERVICES standardsPRIMARY Health CARE standardsPRISONSPRISONERSQUALITY OF Health CAREHEALTH PLANNING GUIDELINESEUROPEEUR/07/5063925 ISBN 978 92 890 78209 Address requests about publications of the WHO Regional Office for Europe to:PublicationsWHO Regional Office for EuropeScherfigsvej 8DK-2100 Copenhagen , DenmarkAlternatively, complete an online request form for documentation, Health informa-tion, or for permission to quote or translate, on the Regional Office web site ( ).

3 World Health Organization 2007 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in designations employed and the presentation of the material in this publication do not imply the expression of any opin-ion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation country or area appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recom-mended by the World Health Organization in preference to others of a similar nature that are not mentioned.

4 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not neces-sarily represent the decisions or the stated policy of the World Health essentialsPromoting Health in prisonsContentsForeword vii Preface viii Contributors x Definitions xvi1. Introduction 1 Who this guide is for 1 How to use this guide 1 The essentials and important first steps 1 Political leadership 2 Management leadership 3 Leadership by each member of the staff 4 The special leadership role of Health personnel 4 Partnerships for Health : (1) the role of prisoners 5 Partnerships for Health : (2) community support 5 References 52.

5 Standards in prison Health : the prisoner as a patient - Andrew Coyle 7 The basic principles 7 The relationship between the prisoner and Health care staff 8 The organization of prison Health care 9 European prison Rules 11 Conclusion 12 References 12 Further reading 13 3. Protecting and promoting Health in prisons : a settings approach - Paul Hayton 15 Introduction 15 Major problems that need to be addressed 15 The whole- prison or settings approach and a vision for a Health -promoting prison 17 References 20 Further reading 20 4. Primary Health care in prisons - Andrew Fraser 21 Introduction 21 The components of primary care 24 The journey of primary care 24 prison Health care resources 25 Common problems encountered in primary care practice in prisons 26 Building blocks for primary care in prison 26 Measuring performance in Health care 27 Conclusion 30 References 31 Further reading 31 5.

6 prison - specific ethical and clinical problems - Jean-Pierre Restellini 33 Introduction 33 Health care staff in prison 34 Disciplinary measures 35 Physical restraint 36 Intimate body searches 36ivThe essentialsPromoting Health in prisons Prisoners who stop eating or go on hunger strikes 37 Torture and inhumane or degrading treatment 40 Conclusions 41 Reference 41 Further reading 41 6. Communicable diseases - Dumitru Laticevschi 43 Introduction 43 Bloodborne diseases 45 Tuberculosis 47 Sexually transmitted infections 50 Skin conditions 56 Infectious diseases of the digestive tract 57 Reference 58 Further reading 59 7. HIV infection and human rights in prisons - Rick Lines 61 Setting the context: HIV-related stigma and discrimination in prisons 61 Confidentiality in prison 62 HIV testing and pretest and post-test counselling 64 Coercive approaches are counterproductive 65 Coercive approaches are counterproductive 65 Addressing concerns about trust and confidentiality: working with nongovernmental organizations, people living with HIV, peers and professionals outside the prison system 68 Compassionate or early release 69 Conclusion 69 References 70 Further reading 70 8.

7 Tuberculosis control in prisons - Jaap Veen 73 Introduction 73 What is tuberculosis? 74 What can be done to reduce the risk of transmission of tuberculosis? 76 How to manage tuberculosis cases 79 Treatment 79 How should tuberculosis services in the penitentiary system be organized? 80 Conclusion 82 References 82 Further reading 83 9. Drug use and drug services in prisons - Heino St ver and Caren Weilandt 85 Drug use and the consequences for prisoners, prisons and prison Health care 85 Definition of a drug user 87 Nature and prevalence of drug use and related risks in prisons 88 Prevention, treatment, harm reduction and aftercare 90 Organization and practice of Health care, treatment and assistance 91 Assessment of drug problems and related infectious diseases 94 Preventing drug use 95 Detoxification 95 Drug-free units 97 Contract treatment units and drug-free units 97 Abstinence-oriented treatment and therapeutic communities in prison 98 Substitution treatment 99 Counselling and peer support 100 Harm reduction programmes 101 Involvement of community services 105 Vocational training 109 References 109 Further reading 111 10.

8 Substitution treatment in prisons - Andrej Kastelic 113 Introduction 113 What is substitution treatment? 114 The main goals of substitution treatment 115 Evidence of the benefits of substitution treatment 116 Effective treatment 120vThe essentialsPromoting Health in prisons Criteria for treatment and treatment plan 121 Risks and limitations 122 Substitution agents 122 Some basic information about treatment 126 The link with treatment for HIV infection 128 Special considerations for women 128 Future perspectives 129 References 129 Further reading 130 11. Mental Health in prisons - Eric Blaauw and Hjalmar van Marle 133 Mental Health and mental illness in prisons 133 Mental harm reduction and mental Health promotion 134 Levels of care 135 Basic circumstances 137 Staff training 139 Conclusion 141 Mental Health promotion in prisons : a checklist 141 References 144 12.

9 Dental Health in prisons - Amit Bose and Tony Jenner 147 Introduction 147 Dental Health needs in prisons 148 Challenges in providing dental care to prisoners 148 Oral Health promotion 149 Organization of prison dental services 150 Models of good practice 151 Conclusion 155 Further reading 155 13. Special Health requirements for female prisoners - Jan Palmer 157 Introduction 157 Mental Health problems 158 Suicidal behaviour in prisons 159 Substance use 161 Pregnancy 164 Children 165 Sexually transmitted infections 166 Bloodborne viruses 166 Violence 166 General Health issues 167 References 169 Further reading 169 14. Promoting Health and managing stress among prison employees - Heiner B gemann 171 Introduction 171 Research on the Health of prison employees 172 Risk factors and stress among prison employees 172 Frequent psychosocial risk factors in prisons 173 Promoting and developing employees with Health in mind 174 Practical approaches to Health promotion.

10 Best practices 174 Comprehensive Health promotion for prison employees 175 Example of a Health in prison project with important milestones 175 Essentials for active Health management in prisons 176 Health promotion self-help networks in prisons 177 Continuing education 178 Results and prospects 178 References 179viviiThe essentialsPromoting Health in prisonsForewordA continuing challenge in public Health is to get services to the people who need them the most, especially those who are hardest to reach. Yet it is a sad reality of life that, at any one time, a high proportion of those with multiple Health problems are incarcerated in the prisons of each country. They are certainly reachable, for a certain period at more than a decade, WHO has had a network of countries of the European region (with more than 30 countries now involved) supported by senior representa-tives approved at the ministerial level that gather to exchange experiences and evidence on how best to make prisons healthier places for staff as well as prison -ers.