9.1 Health care in prison
It is a fundamental human right of everyone, including prisoners
to the enjoyment of the highest attainable standard of physical and mental health.
The state has a particular responsibility towards prisoners, as their loss of liberty means that the primary responsibility for their health then falls on the prison administration. Imprisonment itself can have a damaging effect on the physical and mental well-being of a prisoner. Not only do prison authorities have a responsibility to provide medical care, they must also:
establish conditions which promote the well-being of prisoners and staff. Prisoners should not leave prison in a worse condition than when they entered.
Prisoners retain the right to medical care, which is at least the equivalent of that provided in the wider community. The Queensland Women Prisoners' Health Survey found that women in prisons are a high need group for health services relative to women in the community. It stated:
there is a need for general health services to match community standards, and the need for additional services pertaining to issues more prevalent amongst female prisoners. Overall, the prison population requires over servicing in terms of community norms for health services.
The survey identified that the three major issues pertaining to the health of women in prisons are drug abuse, mental health and childhood sexual abuse.
Although health care delivered to women prisoners generally matches community standards, some areas identified by the Queensland Women Prisoners' Health Survey are still not receiving appropriate servicing based on the very high health needs of a large proportion of female inmates. In particular, a much greater level of resourcing needs to focus on the three major issues identified by the survey, namely drug abuse, mental health, and childhood sexual abuse.
For many women these three health issues do not stand alone, but are related to and coincide with each other. To assist inmates to deal with these issues requires a multi-disciplinary approach involving psychiatrists, psychologists, mental health workers, social workers and counsellors. The multi-disciplinary approach should also include expertise from other non-prison based or community-based organisations with skills and expertise in these areas. This would provide a level of ongoing support during and after a woman leaves prison. In particular, groups with expertise in assisting and supporting women who have experienced sexual assault need to be a part of the team.
The ADCQ understands that this type of approach is already adopted to a limited extent by health services' teams at the prisons. It is used for prisoners assessed as being at risk of suicide, but only at a level to serve these patients/prisoners with high level acute issues. Longer term ongoing support at a level of any significant assistance is not provided to prisoners who pose no risk of suicide.
The ADCQ appreciates that providing quality long term assistance to help women with a complex mix of problems may be a relatively expensive service, especially compared to services traditionally available to them. However the costs of providing such services do need to be weighed against the possible long term benefits. These include community safety issues such as reducing rates of re-offending, and the flow-on benefits for women who have primary caring responsibilities for children. Women who are in a better position to cope in their lives, generally have a greater ability to provide more secure and consistent parenting to their children. This results in long term benefits not only to their children but ultimately to the greater community.
154. International Covenant on Economic, Social and Cultural Rights, GA Res 2200A (16 December 1966) article 12.
155. Andrew Coyle, 'A human rights approach to prison management-handbook for prison staff' (2002) 49.
156. Basic Principles for the Treatment of Prisoners, See note 145, principle 4.
157. B A Hockings et al, See note 46, iii.