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Prison Health Doctor Patient and Society 410 6 th Feb, 2013 Ruth Elwood Martin L arry Howett

Prison Health Doctor Patient and Society 410 6 th Feb, 2013 Ruth Elwood Martin L arry Howett. Acknowledgements and Disclaimers. Public Health Agency of Canada. What are the goals for today’s DPAS410 readings, discussions and presentations?.

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Prison Health Doctor Patient and Society 410 6 th Feb, 2013 Ruth Elwood Martin L arry Howett

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  1. Prison Health Doctor Patient and Society 410 6th Feb, 2013 Ruth Elwood Martin Larry Howett

  2. Acknowledgements and Disclaimers Public Health Agency of Canada

  3. What are the goals for today’s DPAS410 readings, discussions and presentations? • To understand the health disparities of incarcerated populations; • To discuss the public health implications of lack of ‘through care’; • To listen to narratives of prison health experiences in Canada; • To appreciate ways that social exclusion impacts the health of an individual over their lifespan.

  4. Outline of today’s learning activities • My presentation • International context • My own story • Numbers of Canadian prisoners and their demographics • Health care of Canadian prisoners • Prevalence of disease burden among incarcerated people • How do we respond? • Larry Howett’sstory • Announcements • How do we respond to ‘Determinants of Health’? • Plenary Quest RFP results • Volunteer guests will share their stories with you in in your discussion group

  5. ‘One can measure the quality of a society by the quality of its prisons’ …..attributed to Dostoevsky

  6. Nelson Mandela2 RobbenIsland and Pollsmoor Prison 1962-1990 ‘The Long Road to Freedom’

  7. The Lancet, 2011. The health of prisoners.3 • American Journal of Public Health, 2005. Public health implications of substandard correctional health care.4 • American Journal of Public Health, 2005. The World Health Organization European Health in Prisons Project after 10 years: Persistent barriers and achievements.5 • Annals of Internal Medicine, 1993. Correctional Health Care: A public health opportunity.6 • Canadian Medical Association Journal, 2000. Health care problems in prisons.7

  8. World Health Organization (Europe)Health in Prisons Programme(HIPP)8 • Initiated in 1995 – academics – mental health • 44 member European countries • WHO International Policy Declarations: • Prisons, drugs and society (2001) • Prison health as part of public health (2003) • Prisons, drugs and harm reduction (2005) • Prisons and mental health (2007) • Women’s health in prison (2009) • Drug overdose in prisons (2010)

  9. WHO Health in Prisons Programme (HIPP) • Countries should provide prison health care that demonstrates: • Community equivalence • Integration with a country’s public and primary health care services • Prison health care transferred from Ministry of Justice to Ministry of Health: England, France, Norway, Australia9 and Italy; and, Nova Scotia!

  10. Back in 1994.....

  11. Incarceration provides a public health opportunity to access and to servea high-risk population otherwise inaccessible to health care providers10

  12. “the value of having prison health as part of medical school is that it exposes you to more or less every population (determinant of health) you could imagine. It’s immigrants, it’s women, it’s homelessness, it’s aboriginal, it’s drug dependency ….” —medical student11

  13. Numbers of Canadian prisoners and demographics • Federal offenders: sentenced>2 years • Provincial inmates: sentenced<2 years • Remanded to custody: awaiting sentencing…may be overnight or many months • Canadian custodial admissions 262,067(2010)12

  14. Correctional Service Canada • 53 federal penitentiaries • 8,323 federal custodial admissions (2010)12 • 11% female • 27% Aboriginal • 15,055 ‘count’-> institution Webpages (2011) • 8,016 federal community admissions (2010)

  15. Provincial Correctional System • 8 adult correctional centres • 23,837 BC custodial admissions (2008)12 • 11% women • 25% Aboriginal (4% gen popn) • 2100 ‘count’->institution Webpages (2011) • Mean sentence length 45 days • Recidivism 34% returned within 2 yrs of release (2008/9)13  effectiveness

  16. Health Care of Canadian Prisoners Health care of federal prisoners • The Correction Service Canada shall provide every inmate with • essential health care; and • reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful integration into the community14 • The provision of health care shall conform to professionally accepted standards

  17. Health care of provincial prisoners • Nova Scotia – Ministry of Health • BC - Ministry of Justice -> private health contractor • Health Care Services Manual15, Corrections Branch, BC • First aid • Emergency care • Primary care • Provisions for 24-hour nursing care if required • Isolation care capability

  18. What is the prevalence of ill health among the Canadian prison population? Sexually transmitted infection: • Chlamydia: • 0.15% in general population • 5.5% on admission testing to CSC • Gonorrhea: - 0.02% in general population - 0.9% on admission testing to CSC16

  19. Cervical Dysplasia and other neoplasia • Prevalence of all types of cancer higher among incarcerated populations17, 18 • BC provincial female prisoners: • High grade abnormalities 11x > • 47% Pap in the previous 3 years, Vs87% age-matched population (p<0.001)19 • Designed a Pap screening intervention20

  20. Psychiatric illness, death & suicide • 267 new intakes in BC federal penitentiaries • 31.7% current diagnosis mental disorder • 12% serious mood/psychotic disorder.21 • Review of deaths all causes of incarcerated men, CMAJ (2002)22 • OD deaths- fed 50 x: prov 10 x • Strangulation- fed 10 x: prov 4.5 x • Rate of death all causes/100,000- 420 fed: 211 prov: 187 gen. male popn.

  21. Yvonne Johnson Stolen LifeThe Journey of a Cree Woman231990’sAshley SmithInquest24CBC Fifth Estate25

  22. Substance Use, HIV and HCV • 10 Quebec penitentiaries, survey (N=317), (1999)26 16 % alcohol, 29% drugs, 17% heroin • 9 women’s federal facilities, qualitative interviews, (2000/1)27 20/105 (19%) of participants engaging in IDU • BC Corrections, women surveyed (N=104, 83% response rate) (2001)28 21% women reported IDU while incarcerated

  23. Substance Use, HIV and HCV, cont’d • CSC, self reported, 200729 31% HCV men; 37% HCV women 5% HIV men; 8% HIV women 22% men IDU; 29% women IDU • CSC, 200530 2.84% HIV women 1.63% HIV men (0.2% prevalence in general Canadian popn) • Ontario correctional centres, 199831 2% HIV men • BC provincial corrections,199432 1% HIV men 3.3% HIV women

  24. ....from a poem….Grey Cocoon

  25. Substance Use 74% of BC female prisoners surveyed33 “My current prison sentence is because of crime directly related to my drug use”

  26. Leanne’s letter to the Parole Board

  27. Methadone • CSC • 1998, Phase l: maintain methadone if accessing methadone prior to incarceration • 2002, Phase 2, ‘expanded access to MMT’ • BC Correctional Centres • 1996, continued on the program • Initiation if person meets requirements of College of Physicians and Surgeons and if a MD available in the community for continuity of care

  28. Action on HIV/AIDS in Prisons34Too Little, Too Late- A Report Card (2002) -

  29. Scoring System

  30. Harm reduction report card

  31. Prison Needle Exchange Programs • Review of Prison Syringe-exchange programs, 200335 - feasible, no negative events - drug use reduced or stable - syringe sharing reduced dramatically - no new cases of HIV, HCV, HBV • Ontario Medical Association, position paper, 200336 • Why is Canada lagging behind in establishing needle exchange programs in prisons? • CSC, Ottawa, October 1999 • Study Group on Needle Exchange Programs; Final Report remains internal

  32. Paradox…… Providing health care for my patient (the prisoner) within a correctional system

  33. How should prison health care clinicians respond? • Witnesses and observers of our patients’ lives • Conscientious and compassionate medical care • Prison-based clinical quality improvement activities • Advocacy role……..

  34. Collaborating Centre For Prison Health and Education (CCPHE)

  35. Thank you for listening! Collaborating Centre for Prison Health and Education 300 - 5950 University BoulevardVancouver, BC V6T 1Z3 Tel: (604) 827-4976 Fax: (604) 827-4184Email: prison.health@familymed.ubc.ca CCPHE banners paintings: Artist Mo Korchinski lives in Maple Ridge, BC, and is a mother and grandmother. Mo paints with acrylics on canvas to portray images that inspired her during her incarceration and during her (re)integration into the community. Mo is also community-based researcher with Women in2 Healing and is passionate about working to improve the health and education of women inside and outside of prison.

  36. References 1Dostoevsky, Fyodor. The House of the Dead(1862) 2Mandela, Nelson. Long Walk to Freedom: The Autobiography of Nelson Mandela 3Fazel S, Baillargeon J. The health of prisoners. The Lancet 2011; 377(9769):956-965. 4Restum ZG. Public health implications of substandard correctional health care. Am J Public Health 2005; 95(10):1689-1691. 5Gatherer A, Moller L, Hayton P. The World Health Organization European Health in Prisons Project after 10 years: Persistent barriers and achievements. Am J Public Health 2005; 95(10):1696. 6Glaser JB, Greifinger RB. Correctional Health Care: A public health opportunity. Ann Intern Med. 1993; 118:139-145 7Ford PM, Wobeser, WL. Health care problems in prisons. CMAJ 2000; 162(5):664-665 8 World Health Organization (Europe), Health in Prisons Programme (HIPP)http://www.euro.who.int/en/what-we-do/health-topics/health-determinants/prisons-and-health/who-health-in-prisons-programme-hipp 9Prison Health and Public Health: the integration of prison health services (report from a conference). International Centre for Prison Studies. April 2004. http://www.prisonstudies.org/info/downloads/health_service_integration.pdf 10Glaser JB, Greifinger RB. Correctional Health Care: A public health opportunity. Ann Intern Med. 1993; 118:139-145 11Filek H, Buxton J, Harris J, Pang H, Sharif, N. Martin RE. Medical Students and Residents go to Prison. American Public Health Association, 140th Annual Meeting and Exposition, San Francisco, USA, Oct 2012 12Canada Statistics. Correctional Services. Adult correctional services, admissions to provincial, territorial and federal programs . [Internet]. Available from: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/legal30b-eng.htm 13Ministry of Public Safety and Solicitor General, 2010/11 – 2012/13 SERVICE PLAN , March 2010 14Health Care, Corrections and Conditional Release Act (S.C. 1992, c. 20). Available from: http://laws-lois.justice.gc.ca/eng/acts/C-44.6/page-24.html#h-33 15Health Care Services Manual, Corrections Branch, Ministry of Justice, BC 16Zakaria D, Thompson JM, Jarvis A, Borgatta F. Research Reports [Internet]. Summary of Emerging Findings from the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey. 2007 [cited 2012 Mar 13]. Available from: http://www.csc-scc.gc.ca/text/rsrch/reports/r211/r211-eng.shtml

  37. References, continued 17Davies EA, Sehgal A, Linklater KM, Heaps K, Moren C, Walford C, Cook R, Møller H. Cancer in the London prison population, 1986–2005. 2010. Journal of Public Health. pp. 1–6. doi:10.1093/pubmed/fdq009 18Harzke AJ, Baillargeon JG, Kelley MF, Pruitt SL, Pulvino JS, Paar DP. Leading medical causes of mortality among male prisoners in Texas, 1992--2003. J Correct Health Care. 2011 Jul;17(3):241-53. doi: 10.1177/1078345811401362. 19Martin RE. A review of a prison cervical cancer screening program in British Columbia. Can J Public Health. 1998; 89.6: 382 - 386. 20Martin RE, Hislop GT, Grams GD, Calam B, Jones E, Moravan V. Evaluation of a cervical cancer screening intervention for prison inmates. Can J Public Health. 2003; 95.4: 285 - 289. 21Brink, J.H., Doherty, D., & Boer, A. (2001). Mental disorder in federal offenders: A Canadian prevalence study. International Journal of Law and Psychiatry 2, 330- 356. doi:10.1016/S0160-2527(01)00071-1. 22Wobeser WL, Datema J, Bechard B, Ford P. Causes of death among people in custody in Ontario, 1990-1999. CMAJ. 2002 Nov 12;167(10):1109-13. 23Wiebe R, Johnson Y. Stolen Life: The Journey of a Cree Woman. Vintage Canada. ISBN-10: 0676971962. 24See daily postmedia news reports written byChristie Blatchford. For example, Guard cries at Ashley Smith inquest over ‘what we were reduced to’, Feb 6, 2013. http://www.canada.com/Guard+cries+Ashley+Smith+inquest+over+what+were+reduced/7928857/story.html 25CBC Fifth Estate documentaries, Behind the Wall http://www.cbc.ca/fifth/2010-2011/behindthewall/and Out of Control http://www.cbc.ca/fifth/2009-2010/out_of_control/ 26 Poulin C, Michel A, Gilles L, Gaston G, et al. Prevalence of HIV and hepatitis C virus infections among inmates of Quebec provincial prisons. CMAJ .2007;177(3): 252-256.DOI: 10.1503/cmaj.060760 27DiCenso AM, Dias G, Gahagan J. Unlocking our Futures: A National Study on Women, Prisons, HIV, and Hepatitis C. 2003. Prisoners' HIV/AIDS Support Action Network (PASAN). http://www.pasan.org/Publications/Unlocking_Our_Futures.pdf 28Martin RE, Gold F, Murphy W, Remple V, Berkowitz J, Money D. Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia. Can J Public Health. 2005; 96.2: 97 – 101. 29 Calzavara L, Ramuscak N, Burchell AN, et al.Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities. CMAJ.2007; 177.3: 257 30Correction Service Canada Infectious Disease Surveillance System (2005). Available at http://www.csc-scc.gc.ca/text/pblct/infdscfp-2005-06/p6-eng.shtml#l31

  38. References, continued 31 Ford, P. et al. HIV and Hep C Seroprevalence and Associated Risk Behaviours in a Canadian Prison.Canadian HIV/AIDS Policy and Law Newsletter (Volume 4, Number 2/3, Spring 1999). 32Rothon D, Mathias R, Schechter M. Prevalence of HIV infection in provincial prisons in British Columbia. CMAJ. 1994; 151.6: 781-786. 33 Martin RE, Gold F, Murphy W, Remple V, Berkowitz J, Money D. Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia. Can J Public Health. 2005; 96.2: 97 – 101. 34Lines, Rick. Action on HIV/AIDS in Prisons, Too Little, Too Late - A Report Card. http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=179 35Dolan K, Rutter S, WodakAD.Prison-based syringe exchange programmes: a review of international research and development. Addiction. 2003 Feb;98(2):153-8. 36Improving our health. Why is Canada lagging behind in establishing needle exchange programs? Position paper, Ontario Medical Association. 2004. http://www.iprt.ie/files/oma_pnep_doc.pdf 37Study Group on Needle Exchange Programs (October 1999). Final Report of the Study Group on Needle Exchange Programs. Correctional Service of Canada: Ottawa.

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