Building a sustainable, comprehensive response to COVID-19 in prisons
Claire Keen and Lindsay Pearce, Justice Health Unit, Melbourne School of Population and Global Health
Tackling COVID-19 must include building a sustainable response in prison systems and other detention settings.
Image credit: Calvin Ma @mkwcalvin via Unsplash
In the first of a series of six webinars on building a whole-of-government, long-term response to COVID-19 in places of detention, we asked four international experts, “What is happening in prisons globally and what else needs to be done?”
Detention settings create a perfect storm for infectious diseases. On any given day, over 11 million people are incarcerated globally . Given the quick “churn” of people through prison, the number of people who experience incarceration each year is estimated to be approximately three times higher .
People in prison often have poorer physical and mental health that the general population, with high rates of complex, co-occurring mental illness and chronic physical conditions. Living in often unclean and overcrowded conditions, with reduced access to health care services, a single infection in a detention setting can spread rapidly. Diseases can migrate quickly between prisons and the broader community, as many people move in and out of prisons daily.
COVID-19 has exploited these vulnerabilities. The infection has swiftly spread through prisons, overwhelming already precarious and underfunded health care services. It has exposed the reality that prisons were already in a state of crisis prior to the pandemic. It has called into question the ability of our prison systems to uphold human rights in a public health crisis.
We heard from our expert panel that there have been struggles to integrate public health policies, such as physical distancing, ensuring adequate personal protective equipment, providing adequate spaces for quarantine and adopting basic sanitation measures. National prison systems in over 124 countries already exceed their maximum occupancy rate, with 22 countries reporting that their prisons contain over twice as many people as they were designed to hold. This makes physical distancing nearly impossible.
The public health response has been stymied by the separation of prison health, often under the control of departments of justice, from the broader public health system. Some policies that have been introduced, such as mass isolation in solitary confinement, delaying or reducing time spent outside of prison cells, and banning visitation, have compromised human rights.
However, as COVID-19 brings the prison health crisis into the spotlight, it may create an opportunity to address the ongoing systemic issues that make the criminal justice system so vulnerable. COVID-19 has forced prison systems to innovate, bringing in technological advancements such as telehealth, electronic visitation, and remote e-hearings. These have substantially changed the way prisons operate and have the potential to improve the health and wellbeing of people who are incarcerated.
Image credit: Martha Dominguez de Gouveia @mdominguezfoto via Unsplash
Decarceration and alternatives to incarceration are being widely discussed, and trialled, globally. Prison and public health systems have been forced to communicate and form new partnerships. All these changes have been introduced in a matter of months – an unprecedented timeline for these types of developments in prison systems.
So, as we move past the half-year mark in the COVID-19 response, what is required for a long-term, sustainable response in detention settings? Here’s what we learned from our expert panel:
1. We must recognise that the COVID-19 response has moved past “temporary measures”.
Measures implemented in the early stages of the pandemic are no longer temporary given the ongoing threat of COVID-19. We need to monitor, evaluate, and adapt policies to support a long-term response and ensure that human rights and minimum standards are not compromised in the name of public health.
2. We must rapidly reduce the number of people in prison.
Prison overcrowding undermines public health measures for COVID-19. Reducing the number of people held on remand or jailed for non-violent offences is one mechanism to lower the number of people in prison without compromising public safety. This includes over 400,000 children detained globally each year. However, government responsibility for people’s wellbeing cannot stop at the prison gate. Ensuring that appropriate community supervisory measures and health and social supports are in place after release are essential to address the risk of COVID-19 in the community.
3. We must break down the silos between health, social policy, and prison sectors.
COVID-19 has revealed the weaknesses that arise when prison systems operate in isolation. We must build partnerships that support prison health and ensure continuity of healthcare as people move in and out of prisons and other detention settings. People in this field often say that “prison health is public health”, and COVID-19 throws this into sharp relief. This notion must be wholeheartedly embraced.
4. We must listen to and learn from those on the ground.
People who are incarcerated and staff working in detention settings have often found creative and innovative ways to adapt their settings to COVID-19 in a way that works in their specific context. We must listen, learn, and support local solutions to this global problem. One size will not fit all.
More information about the upcoming webinars in this series, and a recording of the first webinar, are available from the Justice Health Unit website.
All views expressed in this article are those of the authors, and may not reflect the individual views of the panel members of the webinars or their organisations.
Content moderator: Kathryn Snow