OBJECTIVE
The objective of this chapter is to emphasize that prisoners should have access to a full range of health-care facilities and that there should be a strong link between health-care services in prisons and those in the community or nation.
ESSENTIAL PRINCIPLES
Every prison should have proper health facilities and medical staff to provide for a range of health needs, including dental and psychiatric care. Sick prisoners who cannot be treated in the prison, such as prisoners with mental illnesses, should be transferred to a civil hospital or specialist prison hospital.
All prisoners shall have access to a qualified dental practitioner.
Services for psychiatric diagnosis and, if appropriate, treatment shall be available at every prison.
Sick prisoners who require specialist treatment shall be transferred to specialized institutions or to civil hospitals.
Prisoners who are insane shall not be detained in prisons, but transferred as soon as possible to mental institutions.
Prisoners suffering from other mental diseases shall be treated in specialized institu-tions under medical management, or treated and supervised by prison medical services as appropriate.
These principles should be presented visually and remain on display throughout the session.
BASIS IN INTERNATIONAL INSTRUMENTS Exercise:
Using the Compilation of Instruments, the trainees should work in pairs in order to discover the basis for each of these principles.
The information should be reported back after a suitable period has been allowed for research.
IMPLICATIONS
The message is that specialist care facilities are not a privilege but a right for detainees, in the way that they are for any patient.
It must be acknowledged that, although the mentally ill should not be held in prison, the reality is that many are. It falls to the prison staff to take care of these individuals.
This is a considerable strain on them and every effort should be made to prevent this happening.
PRACTICAL RECOMMENDATIONS
It should be pointed out to the trainees that the information they receive on this training programme is intended to be taken back to the workplace and implemented.
The best way of ensuring that this will happen is to make certain that the trainees un-derstand the principles involved and the reasoning behind them. This is particularly true in the case of medical matters.
TOPICS FOR DISCUSSION
A list of topics is provided in the Manual.
Methodology:
The trainees should be divided into small groups for discussion.
These are two interesting topics which affect all prison workers. In order to maximize participation, each group should be given one topic to discuss and be asked to prepare to report back to the full group.
At this session, comments from the floor should be encouraged.
Points to be highlighted/suggested areas for discussion:
39. – Prison staff often have to deal with people everyone else has given up on; they are also often criticized if they appear to fail;
39. – A purely rational approach is not always appropriate because the prisoner may be impaired by persistent addictive substance abuse;
39. – Prison staff might wonder if prison is the right place for such people; they are likely to feel particularly frustrated if they see the same people coming back to prison again and again;
39. – What agencies exist in the community to deal with addicts? Could they be involved as part of a programme after release?;
39. – How much training do non-specialist prison staff need on the nature of the HIV virus, how it is transmitted and what precautions need to be taken? Why do they need this training?;
39. – If the training is comprehensive, the remaining questions are easy to answer;
39. – The HIV virus cannot be transmitted through ordinary day-to-day contact, so HIV-positive prisoners who are not actually ill can be located normally;
39. – The important point is that prison staff will not be aware of the health status of all prisoners;
39. – These matters are confidential between the prisoner and the doctor. The only safe way to proceed is to assume that everyone may have the infection and to apply the highest possible standards of hygiene in all aspects of prison life;
39. – This advice is just as valid outside prison.
CASE STUDIES Methodology:
The two case studies can best be discussed by a panel which would include recognized experts in the medical and psychiatric fields.
The trainees should be encouraged to ask questions when appropriate in order to en-sure that their understanding of the medical and psychiatric conditions is as complete as possible for a lay person, and that the requirements of the instruments, in this area, are sufficiently clear for them to take the knowledge back to their workplace with con-fidence.
Points to be highlighted/suggested areas for discussion:
CASE STUDY 1
39. – The panel will expand on the need for the medical officer to take charge of arrangements for the mentally disordered prisoner until he can be removed to a specialist hospital.
CASE STUDY 2
39. – The panel will concentrate on explaining that the major concern is fear;
39. – HIV is a very frightening illness because the one thing everyone knows about it is that it has no cure;
39. – This is sometimes the only thing people know about it;
39. – It is very important that everyone be better informed for their peace of mind as well as their own personal safety;
39. – For prison staff, this knowledge is an essential element of their training;
39. – The medical officer must embark on a training programme for all staff immediately;
39. – The real risks must be managed by strict adherence to protocols;
39. – The imaginary risks must be discredited;
39. – Prison staff must realize that they may come into contact with HIV-positive people every day without ever knowing it;
39. – The only safe way to proceed is to apply strict hygiene measures at all times and in all circumstances.