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Workshop IV: Provision of Health Care The Impact of International Standards and Guidelines on prisoner health in Eastern and Central Europe Antalya, Turkey 17-18 March2011 Prof. Morag MacDonald Overview This presentation focuses on • Research on prisoner health in police detention & in prison in some European member states The presentation will • Outline key issues • Provide examples of change and emerging good practice • Discuss what is required to maintain & improve health & drug services for detainees Structural Factors Overcrowding • Impacts on delivery of Health care, harm reduction and drug treatment services • leads to staff shortages • reduces opportunity for staff to attend training provide services and activities for PD & Aus High levels of staff and patient turnover • Staff retention Buildings fit for purpose • Poor conditions Key issues identified: Access to Health Care • Police detention & arrest houses • Harm-reduction measures • HIV and Hepatitis C • Confidentiality • Mental Health Key issues identified: Lack of a joined up approach across CJS Lack of continuity of care between police custody and prisons and arrest houses and prisons & community Need for staff training – Communicable diseases – Partnership working Examples of change and emerging good practice Provision of health care • • • • Medicines provided by prison to take to arrest houses HIV pre –post test counselling more available Arrest Houses under control of prison system Provision of health care moving to NHS Improved harm-reduction • • • • • Withdrawal prior to prison Methadone maintenance in police custody Substitution treatment for prisoners increasing Needle and syringe programmes increasing Increase in throughcare provision what is required to improve health and drug services for detainees? • The police are behind prisons in the provision of health care and drug services • Need to develop monitoring and evaluation • Improve sustainability of initiatives • Increase provision in rural areas • Better dissemination and translation of Key documents available produced by for example, UNODC, WHO • Implementation guides with methodologies i.e. how to set up a drug free section Barriers to implementation • Overcrowded prisons and lack of alternatives to prison • Lack of continuous programme of training • Autonomy of individual prison managers • Impact of the concept of abstinence • Lack of sustainable funding for projects • Key documents not reaching grass roots staff/ not translated into required language • Lack of coherent approach or guidelines across criminal Justice agencies Future Assistance • Opportunities for criminal justice agencies to participate in training and projects together • Partnership between prison system, NGOs, and experts from other countries with related problems • Funding for pilot projects • Assistance to development monitoring and evaluation framework