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Inside Story - Prison Health |
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(Source: British Medical Journal, 22 January 2007)
bmj.bmjjournals.com/cgi/reprint/326/7379/56.pdf
I can speak from first hand experience about the lack of health care within the prison service, albeit from the perspective of the much over populated female estate.
The job of being a prison doctor is hard. Many inmates are drug users or self harmers. They pull fast ones to get legal prescriptions to alleviate the gnawing need for heroin or crack cocaine. They try to get sick notes so they do not have to work. However, not all prisoners are addicts or skivers, yet we are treated as if we are.
On the out, as it is colloquially known in prison, a general
practitioner doesnt have to ascertain physically that someone has been
up all night vomitinghis or her word is accepted as the truth.
Unfortunately, someone residing at Her Majestys pleasure is and always
will be an inmate first and foremost.
From my experience there is a complete lack of health care for
everyone. At HMP Drake Hall there is no night cover, and only three
officers on for a population of 315 women, which is shocking. This led
to one pregnant inmate being taken down to the segregation unit to
miscarrythe segregation unit is the only place where there are
officers constantly in attendance. We had no panic buttons in our cells
to call for help in an emergency. Losing a baby is bad enough without
being subjected to this type of dehumanising treatment.
Other inmates are the main carers for those who are sick and mentally
ill. I personally telephoned Stafford Hospitals maternity unit, using
my own valuable telephone units, in an attempt to get some help for the
woman, only to be told that unless a directive came from the prison
itself the hospital could do nothing. This inmate was finally
transferred to HMP Foston Hall, which has a hospital wing. It was some
days before the medical staff arranged a scan, only to discover that
the inmate had been carrying twins and had lost only one. It is
inconceivable that this could happen anywhere other than in prison.
So vast is the scale of mental health problems that accompany the
physical needs of women in prison that it would take a team of highly
trained and dedicated professionals to begin to come to grips with
them. Most women in prison have been sexually abused either during
childhood or in adolescence. These problems are greatly magnified
simply because women come into prison with all their emotional baggage
(unlike men, who get their heads down and do their time while their
wives or girlfriends keep their lives intact for them.) Women have
often left their children behind and are typically the sole or primary
carers. Not knowing where the children are and not seeing them on a
regular basis, if at all given the distances some mothers are placed
away from their families, only makes matters worse. There are only 13
womens prisons in England and none in Wales.
Without doubt the most horrific thing that I have come across while in
prison is decrutching. This is the term used when a prisoner comes in
with drugs secreted in her vagina and other inmates pin her down and
remove those drugs with any available tool. This has led to serious
injuries, which are all kept quiet because if the victim reports them,
she will be charged with supplying. Female rape with implementsdoes it
get any worse than this?
Finally a warninghepatitis and HIV are rife in the female estate and
most women conduct sexual relationships with other prisoners for all
sorts of reasons. Many are also prostitutes when not in prison. These
relationships go on without any protection or education at all. How
long before the ticking bomb explodes into the wider population and
everyone pays the price?
Penny A Mellor advocate, Coven, Staffordshire
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Competing interests: PM is a former inmate of three prisons and is
currently involved in an investigation into the health care for
pregnant prisoners that is being conducted by HMP Womens Estate. If
you would like to submit a personal view please send no more than 850
words to the Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR
or email
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Health in Prisons 
