News Release

Tackling the mental and physical illnesses of prisoners will improve public health

Peer-Reviewed Publication

The Lancet_DELETED

A Review examining the health of prisoners (with most data from high-income countries*) reports that greater health-care resources need to be targeted at prisons as they provide a rare public health opportunity to treat millions of young, marginalised, and diseased individuals who are often beyond the reach of community health services. The numerous health problems experienced by prisoners inevitably become public health concerns when prisoners return to their communities. As such, reforming prison medical services could make a substantial contribution to improving public health, concludes the Review published Online First in The Lancet.

Seena Fazel from the University of Oxford, UK, and Jacques Baillargeon from the University of Texas Medical Branch, USA, argue that the importance of prison health care to public health needs to be recognised: "Prisoners act as reservoirs of infection and chronic disease, increasing the public health burden of poor communities."

They add: "For these individuals, prison provides an opportunity for diagnosis, disease management education, counselling, and treatment that they would not receive in the general community."

The authors reviewed the evidence on the prevalence and risk factors for some of the major physical and mental illnesses in prisoners. They discuss the challenges to providing health-care services to this population, and make recommendations for action.

More than 10 million people are imprisoned worldwide and this number has increased by more than a million in the last decade. Prisoners are often from the poorest sectors of society and as a result already suffer from greater health inequalities. The studies reviewed showed that mental disorders and infectious diseases are much more common in prisoners than in the general population.

The studies reviewed reported that high rates of injecting drug use, risky sexual practices, and overcrowding exacerbate the spread of infectious diseases within prisons. Following release, high rates of suicide and increased death from all causes have been recorded in many countries. Furthermore, the Review notes that these existing health problems are often aggravated by poor treatment in prison and aftercare provision.

The evidence confirms that current approaches to prisoner health are not working and that prison medical services need urgent improvement.

The authors recommend that the responsibility for health care in prisons comes under the remit of public health systems because the main focus of the criminal justice system is on security and not health. They also propose universal screening of prisoners for physical and mental illness by trained individuals along with community-based aftercare for released prisoners.

Additionally, they call for national prison-specific policies and guidelines incorporating minimum standards and goals for improvement in the health care of women, older adult prisoners, and juveniles (groups that have higher rates of many disorders compared with other prisoners). Finally, they state that transparency is vital and that annual statistics on numbers of suicides and undetermined deaths and infectious disease rates should be made publicly available.

The authors point out that current strategies to address health issues in prisons are based on evidence from high income nations and that there is a lack of research from non-Western countries. Furthermore, they say that prisoners have been systematically excluded from important clinical studies and urge prisons to become more research-friendly environments.

They conclude by calling for further research into measures to improve the health of prisoners by "reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoffending."

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Dr Seena Fazel, University of Oxford, Oxford, UK. T) +44 (0) 77 852 658 43 E) seena.fazel@psych.ox.ac.uk

For Dr Jacques Baillargeon, University of Texas Medical Branch, Galveston, TX, USA, please contact Maureen Bayless Balleza, Media Relations. T) +1 409 772 8785 / +1 713 240 0402 E) maballez@UTMB.EDU

For full Review see: http://press.thelancet.com/prisoner.pdf

Note to editors: *There is information on HIV, Hepatitis and TB (ie, infectious diseases) from both low and high income countries. For the other health problems (mental disorders, chronic physical problems, suicide), almost all the information is from high income countries

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