Expert Group on Prison Health (PH EG)

Eighth Meeting

Helsinki, Finland

16-17 June, 2009

Title / Minutes from the 8th meeting of the NDPHS PH EG
Submitted by / PH EG ITA in coordination with the PH EG Chair
Summary / Note / This document recalls the most important information and statements presented, as well as, where available, the conclusions and decisions made during the meeting.
Requested action / For information and adoption

1. Opening of the meeting and welcome

The meeting was opened by Ms.Ingrid Lycke Ellingsen, Chair of the PH EG, who chaired the meeting.

She welcomed all the participants, especially the newly appointed Russian member, Ms. Alla Kuznetsova. Special thanks went to the host of the Meeting Mr. Jukka Kärkkäinen., who managed, despite a very short note to organize a meeting in Helsinki. Unfortunately, due to problems related to the current financial crisis, representatives of the 3 Baltic countries, were unable to participate in the meeting.

Ms. Alla Kuznetsova introduced herself. She is the Vice-deputy of Health department of the Russian Federal Services of Correction and Punishment.

Mr. Jukka Kärkkäinen, Director of Medical office of the Prison and Probation services of the Ministry of Justice of Finland, welcomed the participants in his status as the host of the Meeting.

2. Adoption of the Agenda

The ITA in coordination with the PH EG Chair had beforehand distributed the Draft Agenda to all members of the group and NDPHS Secretariat with a request for comments and additions together with annotations they might wish to propose. It was proposed to add one more agenda item, related to the finalization of Mid-Term Goals, preparation of the progress report, and the action plan for 2010. The Meeting adopted the Provisional agenda with the proposed changes (submitted as document PH 8/3/1).

3. News from recent meetings

The Chair informed about her participation in the working meeting of the SILWHA EG, which took place in Östersund, Sweden. During this meeting she briefed the SILWHA group members on the activities of the PH EG, and also informed them on the side event on Prison Health, which will take place in Oslo, November, 2009. Invitation to participate in this meeting, and she proposed to nominate the presenter and the topic of the presentation. The possibilities to further explore how to increase collaboration between the respective EGs were also discussed.

The Chair together with the ITA participated in the CSR meeting wich took place in Gdansk, April 23-24, 2009. The aim of the meeting was to exchange information on current activities implemented by NDPHS partner countries, and to discuss the preparation for the upcoming PAC meeting. The day before the CSR meeting, they also participated in the ad hoc Strategy Working Group (SWG) meeting. This was the third meeting of the SWG, and the main issues discussed were: Mid-term vision and goals; social well-being issues; strategies and policies; success indicators and criteria; projects; funding of Partnership activities; NDPHS Membership/Partner status; Expert Group related matters; publication guidelines; as well as other recommendations. It was decided that one of the main issues for the upcoming months for the SWG would be to identify mid-term goals, which could support the finding of attractive and important topics that were needed for the region. All EGs were requested to draft their Mid-term Goals and submit them to the Head of the SWG.

The ITA was invited to participate in the working meeting of HIV/AIDS EG, which took place in Ottawa, Canada. The discussions during the meeting were around the TB/HIV confection, and a big part of it was related to the prison settings. The representative for the Canadian Corectional services made a special presentation of the issue. The representative for Portugal concentrated his presentation of the activities which had been introduced in the prisons of Portugal by the Ministry of Health and the Ministry of Justice. It was decided that the ITA would follow up on these issues, and he was invited to Portugal to discuss it further.

During Mr. Tsereteli’s visit to Portugal, meetings with the representatives for European Monitoring Centre on Drug Demands (EMCDDA) and Portugal’s Ministry of Health were held. Agreement was reached that both of these organizations will participate and make presentations in the side event on Prison Health in Oslo. In addition, it was agreed that Portugal will send its representative to the PH EG meeting in order to share information on their ongoing activities and reforms of the Penitentiary system of Portugal.

ITA had also visited Belarus. Meetings with the Deputy Minister of Interior affairs, and the Head of Medical Services of the Penitentiary system were held. The Prison Central Hospital was visited, and ongoing activities and projects were discussed. Belarus expressed its willingness to deepen its contact with the NDPHS, and proposed some interesting topics for collaboration in the field of Prison Health. During the visit meetings with SIDA representative in Belarus, UNDP and local NGOs, working in the prison settings, were organized. The meeting with SIDA was related to the overview of activities supported by the Government of Sweden in Belarus prison settings, and the possible future collaboration with NDPHS. The same topic was touched in the meeting with UNDP, and it was agreed that in possible future activities by NDPHS in Belarus, those two organizations would closely cooperate, and establish the mechanism of exchange of information.

Ms. Ursula Scheben, Germany, informed about the 4th European meeting of German speaking countries on AIDS help (Gesundheitsförderung in Haft), which took place in Vienna, Austria. The representatives of Germany, Austria and Switzerland had exchanged information related to the good practices of HIV and AIDS treatment, and also issues related to Drug addiction treatment. Several NGOs, and representatives of groups of the family members of drug addicts had participated in this meeting. She also informed that it was currently published an interesting book on Prison Health (orientation of working in Prisons) in Germany, which could be of interest for NDPHS partner countries. It was agreed that more info, and the link to this book will be shared with the group members.

Ms. Rauni Ruohonen, Finland, informed about her participation in the Nordic Pulmonary conference, which took place in Denmark. She also participated, by invitation of WHO, in the assessment of TB control Programme in the Donetsk (Ukraine) Prisons

The Chair briefed about a so-called “Environmental scan” which was developed in Canada in the fall of 2008 in order to support and provide information for a renewed public health strategy for the Correctional Services Canada. The Canadian member of PH EG has distributed this scan, in preparation of which the NDPSH member countries were also taken some part. The Chair underlined the importance of this document and the interesting information it contains. It was agreed that EG members would send their possible comments to this document directly to the Canadian EG member.

It was mentioned with regret that, despite a close contact with the WHO HIPP and involvement in the preparation of the draft of the Kyiv Declaration ”Women’s health in Prison”, NDPHS was not mentioned in the final version of this document.

The Meeting took note of the presented information.

4. Country reviews

Mr. Andreas Skulberg, Norway, informed on ongoing revision of prison quidliens, which had first been done in 1997, followed by a revision in 2004. The purpose of the revision is to update info on Pretrial detention, the status of health care during this period, and the role of the medical doctor in doctor-inmate interactions. The main issue to be revised is related to the isolation of inmates during the pre-trail period, and the role of the medical doctor in the process. The isolation of inmates sometimes leads to worsening of their personal situation, as they feel insecure, which then unfortunately can lead to suicidal or self-destructive actions. All this will be thoroughly discussed, and possibly necessary changes of the guidelines will be made.

Ms. Ursula Scheben-Winkelhog, Germany, mentioned in this respect that in Germany they are operating with different laws for different types of prisons (remand, high security, etc), taking into account the different conditions in those institutions. The medical doctors are independent in making decision on referring patients for treatment, when it is necessary. In the meantime, based on the health status assessment, they can also send a request to the court to revise the decision, if it can lead to worsening of the psychological conditions of the inmate.

Ms. Alla Kuznetsova, Russia, informed that they also are operating in a similar manner, and approximately more than 1000 inmates had been freed by court decisions, after medical requests had been filed to the court.

Due to the budgetary situation the Penitentiary system must cut their expenses with in total 32,5% (e.g. 32,1% for the salaries). That means, that the capacity of the Prison hospital will be reduced substantially (but keeping TB treatment). Concrete measures are not known yet, but as soon as they are known, she will let us know.

As for the situation on some diseases, the situation is probably the same as in year 2007, and 2008.

Only the situation of TB, and cases of AIDS had changed:

- Death cases from AIDS in the first 3 months have reached 60% from relevant indicator during the year 2007 and 2008.

- There is an increase of diagnosed TB cases inside the prisons in the first 4 months of the year 2009 – 85% from all diagnosed in the year 2008. 50% of the diagnosed cases had received their disease during the imprisonment. The resent prognoses was said to be bad – during the year 2009 there will be 2,5-3 times higher rates than in 2008. This situation is entailed with the closing of X-ray rooms in most of the prisons in 2006 due to the unconformity with the modern standards. That is why most of the detected TB cases are already lingering, and the risk of infection of others is very high.

The Meeting took note of the presented information.

5. The Prison system in Finland

Mr. Jukka Kärkkäinen, Finland, presented the structure of the Finnish Prison system, and objectives and activities of the health care within the system.

The Prison Service is part of the administrative branch of the Ministry of Justice. It consists of the following branches:

Criminal Policy Department of the Ministry of Justice, which provide strategic guidance of the administrative branch

Criminal Sanctions Agency: guidance and direction of activities.

Prison Service: consists of five district units and a national health care unit

The Criminal Sanctions Agency is also in charge of the direction of the Probation Service, and the joint enforcement and administrative duties of the field

Training Institute of Prison and Probation Services is in charge of the basic and further education of the field

The goals of the Prison Service are: to contribute to the security of the society by maintaining a lawful and safe system of enforcement of sentences, and to assist in reducing recidivism, and to prevent the development of social exclusion which maintains criminality . There are in total 5 Prison districts in Finland, which will, next year, be reduced to 3. Totally there are 26 prisons, with the biggest in Turku (350 inmates). All together is currently 3500 inmates, registered, and a main average sentence is 7-8 months, which leads to approximately 7-8000 prisoners per year.

There are the following types of institutions: Closed institutions: Remand prisoners, sentenced prisoners, and those serving conversion sentences for unpaid fines;

Open institutions; Independent open prisons; Open units subject to closed institutions; Open work colonies: for prisoners who participate in activities, pose no risk to escape, and has given commitment to abstinence .Prisoners get paid for work, and they pay taxes.

On the first day of arrival to the prison the inmate is undergoing a risk and needs assessment, and based on this assessment the prisoner receives a detailed plan of the sentence term. Germany asked if these assessments are repeated, and if so, how often. Finland clarified that those kinds of assessments are repeated but the frequency is not well defined.

Norway asked if there are special standard tools and guidelines for the assessment. Finland confirmed that these things are available and standardised.

Finland allocates in total 15 Mln € for the health care budget of the penitentiary system, from which 1,7 mln is allocated for medications. That means approximately 4000 Euro per inmate. From this budget 2 mln euro can be used by the Health care department to buy services from outside the Prison health care system. The total budget of the Prison Service in Finland is € 181 million/year, which means that the cost of a prison day per person is approximately 141 €.

Prisoners are obliged to work, participate in education, or in other activities. The prisoner’s working and functioning capacity is assessed.. The aim is to develop the prisoners’ vocational skills and life management, and to promote their possibilities to cope in society at large. About 34% of the average daily prison population are working daily.