International standards, such as the Nelson Mandela Rules and the UN Bangkok Rules, lay out the requirements for the provision of adequate healthcare – both for physical and mental health – in line with the right to health.
The importance of the principle of equivalence – that people in prison are entitled to the same standard of healthcare as the general public without discrimination – is a principle enshrined in the Nelson Mandela Rules. Prison health should be public health: it should delivered by the country’s national health service rather than by prison authorities or judicial institutions.
The global COVID-19 pandemic has exposed poor sanitary conditions, insufficient healthcare, overcrowding and general lack of prioritisation of the health and well-being of people in prison globally. Many countries have responded quickly and implemented a series of public health measures to prevent mass outbreaks in places of detention, but some emergency measures have compromised the human rights of people in detention. Many other criminal justice systems have detained people in unsafe environments with inadequate protection against infection from COVID-19, despite the higher proportion of existing health conditions among people in prison. Read more.
Overcrowding is an obvious cause of and contributing factor in many of the health issues in prisons, most notably infectious diseases, such as COVID-19, and mental health issues. The World Prison Brief, updated regularly, finds that 23 national prison systems hold more than double their capacity, with a further 29 countries operating at 150% – 200%.
Due to overcrowding and poor nutrition, tuberculosis rates – and rates of multi drug-resistant TB – in many prisons are 10 to 100 times higher than in the community. TB in prisons is also commonly associated with HIV co-infection.
Rates of HIV/AIDS are much higher in prisons than in the general population. Infection spreads through needle-sharing among injecting drug users, tattooing and piercing, unprotected sex (whether consensual or rape), and poor standards of medical hygiene.
People in prison have a disproportionately high rate of poor mental health, and these rates are even higher for women in prison (as many as one in seven persons detained has a serious mental health condition). Poor mental health can be exacerbated or brought about by poor prison conditions, overcrowding, bullying, marginalisation, stigma and discrimination. There is widespread discrimination towards people with mental ill-health and mental health conditions are often misunderstood.
Many prisons also do not have the resources to provide adequate mental healthcare for both people in prison and staff. Suicide is often the single most common cause of death in custody, especially in Europe and Oceania.
Women in prison have particular health needs, which go far beyond their need for reproductive healthcare and pre- and post-natal healthcare. They are also disproportionately likely to be victims of domestic or sexual abuse, to have alcohol and drug dependency problems and mental health conditions.
Children and young people are far more likely to have poor mental health and to attempt suicide than their peers outside prison. Children in prison in particular may struggle to follow staff instructions and suffer disciplinary measures as a result.