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BHB Psychiatrist Helps Develop Prison Standard

With nearly 11 million people in prisons worldwide, how should countries treat and manage prisoners with health problems?

Bermuda Hospitals Board’s Consultant Forensic Psychiatrist Dr Seb Henagulph was called on to help the World Psychiatric Association develop a standard, which was published in February.

The Prison Public Health Position Statement is useful not only for healthcare providers working in prisons but also governments and those who have responsibility for managing prisons around the world.

Dr Henagulph was one of 11 psychiatrists who contributed to the landmark document. It was issued on the 27th anniversary of Nelson Mandela’s release from Victor Verster Prison, South Africa, where he was held for 27 years.

Dr Henagulph was asked by a colleague in the UK, Dr Andrew Forrester, to join a task force on prison health. Dr Forrester, joint chair of the task force and clinical director of the Offender Health Research Network at the University of Manchester, knew of Dr Henagulph’s experience with prisons both in Bermuda and the UK and wanted him on the team.

“It was a virtual group over the last two years, with Dr Forrester and Dr Mary Piper the joint chairs,” said Dr Henagulph. “They approached various psychiatrists with experience in working in prisons, trying to be as international as possible.”

The consultation group included psychiatrists from India, Egypt, Australia, Canada, the UK and Bermuda. The comments, discussions and the various international perspectives were collated and the position paper ratified at a consensus meeting of the World Psychiatric Association in Cape Town, South Africa, in November 2016.

The Statement begins with a quote from Mr Mandela: “Only free men can negotiate. A prisoner cannot enter into contracts.”

While the paper clearly sets out a standard which countries can adopt, Dr Henagulph pointed out that it is not mandatory.

“It’s not legally binding like a UN convention or anything similar,” he said. “It’s more a position statement which the World Psychiatric Association will use to negotiate with governments who are not meeting the standards and encourage them to improve conditions. Psychiatrists in countries with poor prison conditions can also use it to inform their governments of needed changes.

“Prisoners as a whole tend to have chaotic lives with multiple physical, mental and social health issues and can be difficult to engage in treatment in the community. It makes sense from a public health perspective to provide the highest level of care possible while they are incarcerated,” he added.

Dr Henagulph said Bermuda meets most of the standards set out in the paper but noted there is room for improvement.

“More effective rehabilitation services for prisoners and the provision of a fully independent prison healthcare service are two recommendations we could work on in Bermuda,” he said. “The World Health Organisation recommends that providers of prison healthcare should be fully independent from the justice system.”

To further assist jurisdictions that want to improve prison standards, the group also provided the Prisoner Mental & Public Health Care Curriculum.

The WPA prison public health position statement follows below [PDF here]:

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