International law recognises the right of everyone, including people deprived of their liberty, to the enjoyment of the highest attainable standard of physical and mental health. However, in practice, many prisoners receive healthcare of a far inferior standard to that available outside in the community, if they receive treatment at all.
Prisoners with existing healthcare conditions may have their health needs ignored or neglected, and others may develop health problems whilst in prison thanks to unhealthy and unhygienic prison conditions and poor control of infectious diseases.
Health protection in prisons is a serious public health issue, which states ignore at their peril, as the vast majority of people in prison will return to the community at the end of their sentence.
Prisons can be a breeding ground for HIV/AIDS, tuberculosis (TB) and other infectious diseases. The incidence of TB, which thrives in cramped, overcrowded conditions, in European prisons for example can be up to 81 times higher in prisons than among the general population (WHO). Studies have shown that in most countries in Europe and in Central Asia, rates of HIV infection are much higher in prisons than outside, because of, for example, high rates of drug dependency and dangerous practices such as needle sharing.
Drug dependency in prisons is widespread. In the European Union, regular drug use or dependence prior to imprisonment ranges between 16% and 79%. Addressing the needs of prisoners with drug problems is a critical challenge for successful rehabilitation, in terms of both public health and preventing reoffending. Treatment should be preferred over incarceration where possible, but prison can be an opportunity to help inmates address dependency. However, returning to drug use on release is a common problem and success depends on continuing treatment and support in the community.
Prison populations have a disproportionately high rate of people suffering with mental health or behavioural problems, many pre-dating prison and others developing or worsening when inside due to poor conditions and lack of mental healthcare. In many countries, people with mental health problems who have not committed a crime, or who have committed a minor offence, are sent to prison rather than given appropriate care.
The revised UN Standard Minimum Rules for the Treatment of Prisoners (2015) state that people with severe mental health issues should not be imprisoned, but receive treatment. Where people with mental health problems are detained, prison management should focus on their treatment. Responding to mental health problems in prison not only improves the quality of life of the individual prisoner and prison population in general, but also relieves the strain on prison staff who must otherwise deal with untreated mental health issues unsupported.
- International standards, such as the revised Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) and the UN Bangkok Rules, require the provision of adequate healthcare, which includes mental healthcare and transfer to specialised institutions or to civil hospitals where specialist treatment is required.
- The importance of the principle of equivalence – that prisoners are entitled to the same standard of healthcare as the general public without discrimination – is widely recognised including in the revised Standard Minimum Rules. Healthcare for prisoners should be delivered by the country’s national health service rather than by prison authorities or judicial institutions.
- Overcrowding is an obvious cause of and contributing factor in many of the health issues in prisons, most notably infectious diseases and mental health issues. The latest data shows that 22 national prison systems hold more than double their capacity, with a further 27 countries operating at 150% – 200%.
- Due to overcrowding and poor nutrition, tuberculosis rates – and rates of multi drug-resistant TB – in many prisons are 10 to 100 times higher than in the community. TB in prisons is also commonly associated with HIV co-infection.
- Rates of HIV/AIDS are much higher in prisons than in the general population. Infection spreads through needle-sharing among injecting drug users, tattooing and piercing, unprotected sex (whether consensual or rape), and poor standards of medical hygiene.
- At least 10-15% of prisoners in Europe have a significant mental illness, according to the World Health Organisation, and many more have common mental health problems such as depression or anxiety. As well as poor prison conditions, bullying, marginalisation, stigma and discrimination all harm mental health.
- Women prisoners have particular health needs, which go far beyond their need for reproductive healthcare and pre- and post-natal healthcare. Women in prison are disproportionately likely to be victims of domestic or sexual abuse, to experience poor mental health, and to have alcohol and drug dependency problems. The World Health Organisation estimates that at least 75% of women entering European prisons are estimated to have problems with drug and alcohol use, for example. Women are also more likely to develop mental health problems while in prison and are more likely to self-harm or attempt suicide than male prisoners. Women prisoners surveyed by PRI in Central Asia and the South Caucasus (2014) said that what they needed most to help them build a new life on release was health treatment.
- Research shows that children and young people are far more likely to have poor mental health and to attempt suicide than their peers outside prison. Children in prison in particular may struggle to follow staff instructions and suffer disciplinary measures as a result.