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A health-informed approach to penal reform

New Institute for Criminal Policy Research report warns of public health risks from prison overcrowding and lack of adequate healthcare

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A new report, Towards a health-informed approach to penal reform? Evidence from ten countries, is published today by the Institute for Criminal Policy Research (ICPR), at Birkbeck, University of London. The report, by Catherine Heard (Director of ICPR’s World Prison Research Programme), examines the effects of failed penal policies through the lens of health.

Drawing on ICPR’s unique World Prison Brief database and research in ten countries across all five continents, the report highlights the serious public health risks caused by today’s unprecedented levels of prison overcrowding worldwide.

Recent surges in prisoner numbers across much of the world have produced a global prison population of well over 11 million; and chronically overcrowded, under-resourced prisons. These are prisons, the report argues, in which health problems proliferate – particularly as regards communicable diseases, mental illness, substance misuse and increased risk of violence, self-harm and suicide. Severe risks to health are posed not only to prisoners but also to staff, the families of prisoners and staff, and wider communities.

The report features personal accounts from people who have experienced incarceration in overcrowded prisons in England, Thailand, Kenya, South Africa and Brazil. Their harrowing descriptions attest to the damage that prison so often causes to inmates’ physical and mental health – damage that can last years beyond their actual sentence. 

© Andy Aitchison

Prisoners describe:

  • being unable to access medication and treatment, even for serious conditions like diabetes, tuberculosis and HIV
  • continual hunger, weight loss, sickness, self-harm and deaths in custody
  • babies and children, imprisoned with their mothers, regularly falling ill with diarrhoea, cholera and skin diseases
  • lack of opportunity for exercise, causing frustration and violence
  • endemic drug use, with more prisoners picking up habits than becoming clean while inside
  • sleeplessness, anxiety, confusion and fear, persisting long after release.

Two themes are central to the report, each amply illustrated by evidence from this widely diverse group of countries.

First, prison populations bear a far greater burden of mental and physical health problems than general populations. People who enter custody are largely drawn from the poorest and most marginalised sections of society – communities that often have disproportionate levels of health problems, due to socio-economic and health inequalities. And it is all too easy for people with mental health conditions, drug or alcohol dependency, or other vulnerabilities to be propelled into the criminal justice system and custody, when their needs would be better addressed through health-led interventions.

Secondly, prison environments tend to exacerbate existing health problems and often give rise to new ones. This happens as a result of poor material conditions, a lack of healthcare, the availability of illicit drugs, social and psychological stresses, violence and mistreatment.

The report concludes by calling for a reduction in prisoner numbers overall, as an essential first step to improving conditions and increasing access to healthcare and treatment. A key part of this is reducing the numbers of people with mental health conditions who enter custody. For the reduced prison populations that remain, there must be proper access to healthcare, screening and treatment; health and wellbeing should be promoted; and harm reduction measures put in place to minimise risks to the health of prisoners, staff and the wider public.

Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here.

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