The health of prisoners: summary of NICE guidance

In the ‘health of prisoners’ guideline: summary of NICE guidance’ (1) we find a well-designed focus on a first stage health assessment during the person’s initial imprisonment as well as a clear post-release plan, but scarce or no recommendations during the most important period, namely the long stay of incarceration. Probably as result, and also mentioned by the authors of the guideline, nearly all recommendations are based on low quality evidence.

And indeed, in fact we lack a lot more recommendations e.g. on the consultation-time: must it be comparable to general practice? Recommendations on an effective operating triage system to visiting the prison doctor. On the possibility to see the patient alone or always together with a nurse in prison? Items on available interpreter/translator options are not visible. We lack recommendations on access to psychiatric (psychological) care and on privacy rules. In some prisons the psychologist is a member of the staff; in others it is neither present nor affordable. We need more information on acceptable waiting lists (time) for referral.

We need more studies and recommendations also for the prison doctor to know if there is a need for an adequate basic education to work in this setting. Possibilities for in-service training on relevant subjects; each prison needs assessment on the value of multidisciplinary contacts organized between the different medical disciplines (doctor, nurse, psychiatrist, psychologist ...). Is the current electronic medical record user friendly for all parties? Very little is known about the use of standards (prevention delirium e.g. by entrance of new detainees / benzodiazepines /isolation/ fixation/; and targets for the specific groups of women, juveniles, the elderly, psychosis ...)? All this might be important for the prisoner.

All aforementioned items are often recommended, sometimes present but sometimes not, even in the prisons of one country (2). As a matter of fact, all the aforementioned items are not mentioned in the new guideline (1)

With a 28% reduction in prison staff between 2010 and 2014, poor officer retention, worsening overcrowding, restricted daily regimes, and mostly unsuccessful attempts to improve the prison estate and introduce work schemes we agree with the editorial of Frater and Bartlett (3): health professionals must now be heard—speaking up for evidence based recommendations at a time when prisoners’ health and humanity are at risk.

As Winston Churchill once said: “the mood and temper of the public in regard to the treatment of crime and criminals is one of the most unfailing tests of the civilisation of any country”.

Dr. Jan Matthys, GP and part-time prison doctor. Ghent, Belgium

1. Bradshaw R, Pordes BA, at al. The health of prisoners: summary of NICE guidance. BMJ. 2017 Mar 27;356:j1378. doi: 10.1136/bmj.j1378
2. Primary care in Flemish prisons: an explorative and descriptive interviewstudy. 2016. Manama thesis. Doctor A. Miclotte; co-promotor J. Matthys; In Dutch.
http://www.icho-info.be/masterproefpdf/thesis/%7B4fc7fe50-2587-a02a-4224...
3. Frater A, Bartlett A. Human cost of delivering healthcare in unhealthy prisons. BMJ. 2017 Mar 28;356:j1374. doi: 10.1136/bmj.j1374.