Contents
Acknowledgments
ii
Foreword
iii
Summary
v
1. Introduction
1
1.1 Background
1
1.2
3
2.
Health problems with which people enter custody
4
2.1
Health problems in populations most affected by imprisonment
4
2.2
Mental health conditions and their criminalisation
4
3.
Damage to health caused by imprisonment
7
3.1
7
Structure of the report
Conditions of custody
3.1.1
Equal rights to health and healthcare
7
3.1.2
Communicable diseases
8
3.1.3
Non-communicable diseases
9
3.1.4
Substance misuse in prison
9
3.1.5
Effect of incarceration on mental health
10
3.1.6
Suicide and self-harm
10
3.1.7
Vulnerable sub-groups of prisoners
11
3.2 Overcrowding
14
3.2.1
What is ‘overcrowding’?
14
The extent of prison overcrowding in the ten countries and worldwide
17
3.2.2
4.
Developing a health-informed approach to penal reform
19
4.1
Imprisonment and the associated health risks: the implications
19
4.2
Reducing numbers in custody
20
4.2.1
Reducing overall numbers in custody
20
4.2.2
Reducing numbers of people with mental health conditions in custody
22
Improving conditions and health provision in custody
24
4.3.1
Mental health
24
4.3.2
Physical health
27
4.3.3
Continuity of care
28
4.3
4.4 Conclusion
29
References
30
33
Appendix: Standards and further reading
i