From equivalence of standards to equivalence of objectives: The entitlement of prisoners to health care standards higher than those outside prisons

Abstract

It is generally accepted that people in prison have a right to a standard of health care equivalent to that available outside of prisons. This ''principle of equivalence'' is one that enjoys broad consensus among international health and human rights instruments and organisations. However, given the extreme health problems evident in prisons worldwide, the legal obligations of the State to safeguard the lives and well-being of people it holds in custody and the implications of poor prison health on overall public health, this article suggests that Á even if achieved Á standards of prison health care only equivalent to that in the community would in some cases fall short of human rights obligations and public health needs. The article argues it is time to move beyond the concept of equivalent standards of health care, and instead promote standards that achieve equivalent objectives. In some circumstances, meeting this new standard will require that the scope and accessibility of prison health services are higher than that outside of prisons.

The development of equivalence as a mechanism to improve prison healthcare

“…7 In a comprehensive cross-sectional study, Singleton et al 13 documented the full extent of psychiatric morbidity in remand and sentenced prisoners detained within the United Kingdom. Mental disorder was found to be the single most significant cause of morbidity among prisoners, with nine out of 10 meeting the criteria for at least one mental disorder and no more than two out of 10 suffering from only one disorder.…”

“…7,11 This tension between mental disorder and imprisonment can be aggravated further if specialist mental health services are inflexible in their approach. Although substantially improved over the past 10-15 years, there is still considerable variation in the range and scope of services provided nationally: services are often limited in volume, range and quality, raising questions regarding their effectiveness in meeting the needs of this population.…”

Substance use and problem awareness among drug-involved prisoners in Norway

“…However, even less intensive prison-based addiction interventions such as drug counselling are typically regarded as secondary to the functioning of prisons as punitive institutions (McIntosh & Saville, 2006). The possibility to engage in treatment while in prison is still limited, and there are fewer options in prisons as compared to the community (Lines, 2006;O'Brien, 2008;Dolan, 2009). In line with findings from several other countries, nearly half of the about 3500 Norwegian prisoners have used hard drugs regularly before imprisonment (Ødegård, 2008).…”

Viewpoint: Will I stay or can I go? Assisted suicide in prison

“…This would adhere to the principle of equivalenceof-care. 17 Enhancing public safety by multiplying life-long detentions must include reflections on possible alternatives. Policy makers should acknowledge that life-long incarceration can cause mental suffering to a point where AS needs to be a viable option for prisoners, as it is for people living in the community.…”