Prisoners in the European Union (EU) are facing severe physical and mental health threats exposing them to a range of diseases and in extreme cases driving them to commit suicide, said a study released by the World Health Organization (WHO) on Friday.
Due to insufficient mental health screening, 13.5 percent of deaths in European prisons are from suicide.
In a survey of 39 European countries between 2016 and 2017, the WHO found that 14 percent of member states do not screen for severe mental health disorders either in prison, or close to a future inmate's arrival, and recommended prisons test for mental health problems and addictions.
"The deprivation of liberty is itself the punishment for crime; respect for human dignity and fundamental human rights must be observed at all times during imprisonment," said Dr Piroska Östlin of the WHO.
In a region where about six million people are incarcerated every year, prison health — both mentally and physically — could have a big impact on society-at-large, since the majority of those in detention will eventually return to society.
Many return to prison due to reoffending, and this cycle between prison and community can lead to disjointed and ineffective health-care. "This has significant public health implications and can constrain a country's capacity to address health inequalities systematically," said Östlin.
Mental health support for prisons
The report called for authorities to provide adequate mental health support for the incarcerated, and to screen for risk factors prior to imprisonment.
While most member states reported access to mental health support, just over half stated that national guidelines exist for the treatment of severe mental health disorders in prisons.
Besides severe mental health issues, it also highlighted inappropriate treatment for those suffering from addiction.
Fewer than half of the countries reported that national guidelines exist for the prevention of drug-related deaths in prison, and 19 percent of EU countries do not currently offer opioid substitution therapy in prison.
Forty-one percent reported that they do not screen for the harmful use of alcohol on or close to reception. And of those that do screen, only 47 percent use a validated screening tool.
It said member states should develop and implement national guidelines for the prevention of post-release drug-related deaths, including appropriate medication on release from prison and arrangements for continuity of care with community health services.
Lack of data on EU prisons
The report, while groundbreaking, was limited across many indicators, said the UN agency. It especially noted indicators on the prevalence of health risk factors and substance use on admission to prison, for which up to 97 percent of countries reported they had no national data for.
"Most countries were not able to provide valid responses for many of the database indicators. Without this information, policy-makers will not be able to develop evidence-based policies that effectively target the needs of the prison population," said Bente Mikkelsen, Director of the Division of Non-communicable Diseases and Promoting Health through the Life-course at WHO.
There was also a lack of professional oversight regarding the health of prisoners.
"The Ministry of Justice was the authority most frequently holding responsibility for health-care service authority, administration of the health-care service budget and health-care service funding," said the report, adding that fewer than half reported government health authorities as being responsible for the assessment of prison health-care systems.
Meanwhile, overcrowding remains a problem in European countries. Eleven countries including France, Italy and Portugal are operating beyond maximum capacity, according to a 2018 study by the Council of Europe.
The WHO said that of the 30 countries that provided sufficient data to calculate overcrowding in 2016, nine reported capacity levels over 100 percent, with an average of 90 percent.
"To achieve universal health coverage and better health and well-being for all, as in WHO's vision, it is vital that prisons are seen as a window of opportunity to change lifestyles and ensure that no one is left behind," said Mikkelsen.
(Cover: A photo taken on August 4, 2015, shows the gangway at Clairvaux Prison in Ville-sous-la-Ferte, northwestern France. /VCG photo)