Prison medicine: Ethics and equivalence
Senior Lecturer in Forensic Psychiatry, University of Southampton, Ravenswood House, Knowle, Fareham, Hampshire PO17 5NA, UK.The British Journal of Psychiatry (Impact Factor: 7.99). 02/2006; 188:4-6. DOI: 10.1192/bjp.bp.105.010488
Guidelines for good medical practice do not reflect the complex reality of the ethical problems that arise in prison. Perhaps the best a doctor working in prison can do is realise that there are ethical dilemmas everywhere, try to recognise them and feel the tension.
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- [Show abstract] [Hide abstract] ABSTRACT: Developing and implementing community standards of care in correctional mental health and psychiatric practice will facilitate progress toward attaining equivalency in care in prisons and jails. Specialized therapeutic procedures such as application of restraints and seclusion when properly implemented are valuable tools in the treatment of the chronically mentally ill in prisons. The authors share some useful points for working in maximum-security prisons.
- [Show abstract] [Hide abstract] ABSTRACT: The principle of "equivalence of care" in prison medicine is a principle by which prison health services are obliged to provide prisoners with care of a quality equivalent to that provided for the general public in the same country. It is cited in numerous national and international directives and recommendations. The principle of equivalence is extremely relevant from the point of view of normative ethics but requires adaptation from the point of view of applied ethics. From a clinical point of view, the principle of equivalence is often insufficient to take account of the adaptations necessary for the organization of care in a correctional setting. The principle of equivalence is cost-effective in general, but has to be overstepped to ensure the humane management of certain special cases.
- [Show abstract] [Hide abstract] ABSTRACT: Prisoners are at greater risk of developing mental health problems compared with people of a similar age and gender in the community. They are less likely to have their mental health needs recognised, are less likely to receive psychiatric help or treatment, and are at an increased risk of suicide. Prison mental health in-reach services have been developed in the UK to address these problems. An organisational case study method was used to generate theory about the links between the aims, processes and impacts of the introduction of mental health in-reach teams to prison contexts. Case studies were undertaken on six sites and included interviews and focus groups with in-reach team staff, prison healthcare staff, and discipline staff. The aims of prison mental health in-reach were related to providing an equivalent service to a Community Mental Health Team, with a primary focus on serious mental illness, but a widening role. Achievement of these aims was mediated by the organisational context, active relationship development and leadership. Overall effects were positively reported by all stakeholders. Successful development was not just a function of time in post, but also a function of the effectiveness of leadership within the in-reach teams. The more effective teams were having a wide impact on the response to mental health problems in the prison setting.