A QUALITATIVE ANALYSIS OF

1. A QUALITATIVE ANALYSIS OF IN PRISONS FOR WELLBEING AND HEALTH LAWS Dr. K.S. Rekh Raj Jain Assistant Professor, ICFAI Law School Hyderabad INDIA

2. OBJECTIVES • Effect of prison environment on wellbeing • Healthy prison and prison healthcare • Therapeutic and medical services provided to prisoners and prison staff • Practical challenges of prison healthcare • Legal basis for healthcare and health laws • Restorative practices within institutional contexts

3. INTRODUCTION • society without crimes criminals unimaginable • society confronted problem criminality - State to grapple with crimes - CJS Nation operates accordance with specific criminal statutes

4. INTRODUCTION • Retort criminality-punishment -imprisonment • Sentencing ultimate object criminal trial • tail-end criminal justice is prison • Prison - house under trials and prisoners • Prison environment vary widely around world and the wide range of prison conditions reflect how each country treats its criminals

5. INTRODUCTION • country’s prison administration depends upon several variable and practical considerations • prison’s administration - deprivation of liberty – holistic approach development, skills and to include comprehensive medical psychological treatment - successful reintegration and wellbeing upon release

6. INTRODUCTION • Evolution prison reforms and prisoners’ rights- corrective philosophy-restoration, restorative practices • Proper restorative practices and approach in prisons-pertinent to healthcare, overall wellbeing matter of concern- prisoners suffer a disproportionate burden of health problems

7. RESTORATIVE JURISPRUDENCE • prison environment have profound, negative impact physical, mental, emotional wellbeing inmates-emergence restorative jurisprudence holistic solution addresses healthcare system • Restorative jurisprudence • asserts to promote positive effects on wellbeing • renders humanistic approach strategies that allow treatments for wellbeing in incarceration

8. RESTORATIVE JURISPRUDENCE • assist in treating prison population with identified diseases, mental illness and substance abuse • to ensure that the supervision and treatment of prisoners is in line with the rule of law, with respect to individuals’ human rights • period imprisonment used prepare individuals for life outside prison following release

9. DETERMINANTS OF HEALTH IN PRISONS • determinants which influence health are multiple and interactive-include institutional, environmental, political, economic, physical and mental constitutions of persons themselves • inmates enter prisons with infections and prison also places prisoners at a disproportionate risk of acquiring infectious diseases

10. DETERMINANTS OF HEALTH IN PRISONS • prevalence of communicable diseases among prisoners-major risk-prisoner, prison staff, general population-pubic health • Incarceration is an acute stressor-risk for both mental and physical health problems • “Sense of place”-potential impact on health • prison environment is grey and visually impoverished

11. DETERMINANTS OF HEALTH IN PRISONS • physical & social environments play important role determining health wellbeing prisoners • factors that have negative effects on mental health includes overcrowding, violence, enforced solitude, lack of privacy, lack of meaningful activity, isolation from social networks and insecurity about future prospects

12. DETERMINANTS OF HEALTH IN PRISONS • Prisons in general and prison health in particular are rarely high on political agenda • Incarceration has greater impact on the economics of individual, family, society and prison • prison populations have higher rates of physical and mental health problems

13. DETERMINANTS OF HEALTH IN PRISONS • prisoner enters in new world of environment which is very different from their own culture • Conducive atmosphere, encouraged and assisted utilize time prison rather than whiling away time and being slumber, Active participation • Mental illness among today's inmates is pervasive-treated inhumanely in most nations

14. DETERMINANTS OF HEALTH IN PRISONS • mental illnesses-schizophrenia, bipolar disorder and autism disorders • older population prison experience a high burden physical and mental health problems • Longer incarceration little mental stimulation • inmates mental illness intensive treatment • Rates of physical victimization - vary

15. NOTION OF A HEALTHY PRISON • Prison is complex social world comprising of heterogeneous population that is highly vulnerable or susceptible to poor health which possibly reduces the chances of returning to society in a fit state to rebuild their lives • social world of prison, its regime, architecture and time spent influence the health and wellbeing

16. NOTION OF A HEALTHY PRISON • concept healthy prison first set out by WHO • concept of the ‘‘healthy prison’’ is the product of an environment that, within the confines of the law and the penal system, promotes and maintains health • emphasis on a healthy prison arises from the recognition that ‘‘prison service is a public service’’

17. NOTION OF A HEALTHY PRISON • Theoretically, healthy prison concept is not all about prisoners’ health who are incarcerated but also seeks to consider health of the staff • Healthy prison connotes just not space-occupying body, but a body with medical and mental health care needs, proper treatment and maintenance of health and a potentially healthy body rather than just a correctional entity

18. NOTION OF A HEALTHY PRISON • healthy prison must be perceived as an integral part of the concept of restorative jurisprudence focusing on health in prisons and public health • An effective, efficient and healthy prison requires adequate levels of staffing, with proper training, a mix of disciplines and specific expertise in key important areas

19. NOTION OF A HEALTHY PRISON • Healthy Prisons Agenda proposed by the World Health Organization- • The Health Promoting Prisons project began in 1995 in the WHO EURO region, in view of the recognition of inequality between public health and prison health • First international conference on Healthy Prisons was held in 1996-

20. NOTION OF A HEALTHY PRISON • In 2007, the World Health Organization published ‘‘Health in Prison” a document that summarizes the philosophy and practice of a ‘‘whole prison approach toward achieving health in prisons

21. PRISON HEALTHCARE • Concept healthcare in prisons evolved due to commitment of individual countries and WHO • Prison healthcare medical specialty in which healthcare practitioners provide treatment and care for prisoners • process providing comprehensive healthcare services in prison

22. PRISON HEALTHCARE • Prisoners often come from communities which are not free from health related issues • no proper access to healthcare community before being incarcerated • Even the impoverished environments of prisons are breeding grounds- • Healthcare must be based on an assessment of needs of the prison population

23. PRISON HEALTHCARE • neither strategic vision nor practical guidance on healthcare promotion in prison and there is little direct evidence of the effectiveness of healthcare in a prison setting • Major health concern-HIV/AIDS • range and frequency of health problems experienced by prisoners appears to be similar to that of people in the community

24. PRISON HEALTHCARE • principle of equivalence of care-implies access same standards of quality of healthcare as general population • Aging prison population escalated-“ageing crisis” -Geriatric prison population experience multiple chronic physical and/or mental health conditions, physical disabilities

25. PRISON STAFF HEALTHCARE AND WELLBEING • Incarcerated individuals are a piece of prison world, but they are not the entire group – Prison staff-share similar environment that of prisoners and face same physical hazards of prison environment which impacts overall health • healthy workplace should be a realistic goal for all prison employers-comply with health and safety laws, regulations and conventions

26. SOLITARY CONFINEMENT AND WELL BEING OF PRISON INMATES • Excessive use solitary confinement in prisons around world becoming an increasing concern • effect solitary confinement depends on duration and circumstances • cause serve mental and psychiatric effects-exacerbate symptoms of mental illness including anxiety, panic, insomnia, paranoia, aggression and depression

27. SOLITARY CONFINEMENT AND WELL BEING OF PRISON INMATES • engage in self-mutilation, leads to suicide • 80,000 prisoners are currently in solitary confinement in “supermax” prisons across the United States • Canadian inmates-one in six for 120 days or more • France-subject to judicial review • negative impacts of the practice

28. PRISON VICTIMIZATION AND WELL BEING OF PRISON INMATES • Victimization widespread and common phenomenon within prisons and rates are notoriously high • varied forms of victimization occur in prison-most common physical • possession of certain characteristics make prisoners vulnerable and susceptible to victimization-rate of victimization difficult ascertain

29. PRISON VICTIMIZATION AND WELL BEING OF PRISON INMATES: • dynamics victimization present new challenges on aspects of health • Overall, prisons with poorer climates had higher rates of inmate‐on‐inmate and staff‐on‐inmate victimization • Prison victimization has number of psychological effect -

30. PRISON VICTIMIZATION AND WELL BEING OF PRISON INMATES • Sexual victimization prisons controversial issue -vary across nations-range of behaviors from sexually abusive conduct to nonconsensual sexual assaults and has a variety of severe health consequences • Victimization has influence on both body and mind and the forms of prison victimization definitely effect the post-release adjustment

31. PRACTICAL CHALLENGES OF PRISON HEALTHCARE • primary aim of the prisons is confinement and to serve a sentence and maintaining safety and security through administrative control • Each of these purposes can pose a challenge to the provision of high quality healthcare • Prisoners themselves are a challenging population to treat effectively

32. PRACTICAL CHALLENGES OF PRISON HEALTHCARE • physical and social environments of a prison presents special challenge promotion of healthcare prisoners • Promoting and maintaining a healthy lifestyle in this vulnerable population is therefore a key challenge for prison staff, prison healthcare staff and visiting healthcare professionals • Incarceration complicates ethical provision of healthcare

33. PRACTICAL CHALLENGES OF PRISON HEALTHCARE • health professionals in prisons have a conflict between primary healthcare, wellbeing and duty to follow rules of prison management • Prisoners have no choice for selection of their healthcare professionals and services as available to the general population • Among the various challenges the one which pertains is emergencies

34. PRACTICAL CHALLENGES OF PRISON HEALTHCARE • Prison populations-Overcrowding • Substance abuse among incarcerated populations • burgeoning geriatric prisoner population • Lack of resources and staffing in the prisons • prison environment is not totally closed to the outside world • Prisoner reentry – recidivism

35. PRACTICAL CHALLENGES OF PRISON HEALTHCARE • Poor health and poor health coverage have been major challenges for former prisoners trying to reintegrate into the community • Translating the health promoting prisons concept into practice is a real challenge

36. PRACTICAL CHALLENGES OF PRISON HEALTHCARE # Women prisoners • health needs women prisoners are complex -widespread and persistent inequities • Women prisoner specific health problems-pertain to reproductive health such as menstruation, menopause, pregnancy and breastfeeding • specific needs are often unmet

37. LEGAL BASIS FOR HEALTHCARE FOR PRISONERS AND HEALTH LAWS • The Standard Minimum Rules for the Treatment of Prisoners 1955 • 2015-GA adopted revised rules - “United Nations Standard Minimum Rules for the Treatment of Prisoners”-"the Nelson Mandela Rules” • Article 12 of the International Covenant on Economic, Social and Cultural Rights

38. LEGAL BASIS FOR HEALTHCARE FOR PRISONERS AND HEALTH LAWS • The United Nations (1990) Basic Principles for the Treatment of Prisoners • The European Court of Human Rights • American Bar Association Criminal Justice Standards on the Treatment of Prisoners, 2010 part VI • Prisons and Health book, 2014

39. LEGAL BASIS FOR HEALTHCARE FOR PRISONERS AND HEALTH LAWS • Human rights and prisons, manual on human rights training for prison officials, 2005 of section IV • United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment • nation’s prison manual

40. RESTORATIVE PRACTICES WITHIN INSTITUTIONAL CONTEXTS • A dilemma prevails pertinent in providing healthcare within environments that may in many ways undermine inmate health- • The pains of institutionalization affect all prisoners in different ways as they are exposed to a new environment, which is very different from their own culture-

41. RESTORATIVE PRACTICES WITHIN INSTITUTIONAL CONTEXTS • Prisoners are reliant on prison staff for almost every aspect of their existence due to their limited ability- • Prison conditions should not be an additional punishment- • Prison is a place where prisoners live and staff work-

42. RESTORATIVE PRACTICES WITHIN INSTITUTIONAL CONTEXTS • Leading a busy life in prison would facilitate a better physical and mental health- • Geriatric prisoners’ health needs- • restoration covers activities including medical and psychological treatment, counselling and cognitive-behavioural programmes • responsibility of the State to take care of the prisoners’ health and the treatment-

43. RESTORATIVE PRACTICES WITHIN INSTITUTIONAL CONTEXTS Prison administrations obligation to establish conditions promote wellbeing of prisoners • Best practices for preventing suicides in prison settings- • core aim of prisons must be restorativeness • Reentry is the transition from incarceration • enjoyment of the highest attainable standard of physical and mental health

44. RESTORATIVE PRACTICES WITHIN INSTITUTIONAL CONTEXTS • Prisons should adopt more of a public health model-focuses on wellness, disease treatment and management, prevention and creating a continuum of care during after incarceration • Integrated approach to prison healthcare that is consistent with the best interests of prisoners and sound public policy can improve prison health and preserve public resources

45. ECONOMICAL IMPACT • Prisoners are expensive to maintain-impact of growing prison populations places enormous financial burden on governments at a great cost to the social cohesion of society • average cost of incarceration-United States is between $20,000 and $40,000 per year, United Kingdom, it costs £65,000, Australian it costs $110,000 per-prisoner per year, India the annual average about Rs. 29,538

46. ECONOMICAL IMPACT • Restorative jurisprudence invariably reduce price of prisons and save taxpayer money • Medical spending incarcerated individuals is therefore a key for healthcare governance in prisons • Prisoners with better health would render cost saving not to prison expenditure but would also benefit economically and socially after their release

47. CONTINUITY OF CARE • Continuity of care during incarceration highlights a positive attitude of prison officials which ensures better standard of care • specific guidance while prison, exiting prison along with provision of treatment and support • Partnerships with community-based medical, public health practitioners’ and voluntary agencies coordination

48. CONTINUITY OF CARE • Screening and diagnosis of infectious and other diseases is necessary to ensure that care begun during incarceration is continued following release for wellbeing of the prisoner and the community

49. INDIAN SCENARIO • prison environment epitomizes unhealthy atmosphere, lack of basic amenities, unhygienic food, limited space, overcrowding of inmates, lack of healthy lifestyle and poor medical facilities • prisoners in India have an increased risk of physical, mental disorders including self-harm and are highly susceptible to various communicable diseases

50. INDIAN SCENARIO • Indian prisons lack of training, personnel and infrastructure to deal the exigencies of health problems • Medical staff is grossly inadequate to address the primary medical needs • No special branch to suit the particular health requirement of prisoners