You definitely agree that access to health services is a human right for everyone, without exception. This means including prisoners who are imprisoned. However, it must be remembered that the health needs of men and women are different, so this should also be of particular concern.
As discussed in the previous article, the health of female prisoners tends to be secondary even though there are already standard rules regarding health services for detainees. Whereas on the other hand, the number of female prisoners is also increasing from time to time, they come from various backgrounds. With these existing problems, another question arises: what kind of health services should be prioritized for female prisoners?
According to research, women in prison have far more mental health issues than both the general community and male convicts (Bastick & Townhead, 2008; Mardiati & Anindyajati 2013). Women’s mental health is more likely to suffer as a result of domestic violence, physical abuse, and sexual assault (Atabay, 2008). This population’s high rates of unresolved trauma and socioeconomic hardship predispose it to higher rates of mental health difficulties. For example, more than half of all women were subjected to traumatic incidents, which resulted in major mental health problems (Wolff, Shi & Seigel, 2009).
Women who are addicted to alcohol or drugs are more prone to suffer from depression, detachment, post-traumatic stress disorder, other anxiety disorders, eating disorders, and personality disorders (Covington & Bloom, 2007). Substance addiction and alcohol misuse are the most common mental health disorders among Indonesia’s female inmate population (Tyler et al., 2019). Many women require psychotherapy that particularly tackles previous trauma in addition to substance abuse treatments.
To ensure that incarcerated women have greater access to mental health services, gender-sensitive and appropriate mental health treatment and care must be implemented. People with mental disorders should have access to assessment, treatment, and, if necessary, referral as part of the health services available to prisoners. Health care should be equal to those available in the community, according to the UN Standard Minimum Rules for the Treatment of Prisoners.
This can be established by the following:
- Establishing regular visits or mobile health services, or enabling prisoners to access health services outside of the prison setting, including telehealth.
- Ensuring the availability of psychosocial support and psychotropic medication.
- Providing training to staff to enhance staff understanding, raise awareness on human rights, and challenging stigmatising attitudes.
Drug offences are among the most prevalent types of crimes in Indonesia. Prisoners with a history of drug use frequently have comorbid disorders, such as mental health issues (Enggist et al., 2014). The main issue is that women usually do not have access to drug treatment programmes, and these are are not designed for women specifically. This is critical to target since drug-related convictions do not reduce drug usage or drug-related crimes, but instead increase prison populations.
Access to harm reduction services is a critical step towards reducing the harms associated with drug use. However, it is now so restricted that infectious illnesses are two to ten times more prevalent than in the population. In 2018, just ten countries have needle and syringe programmes in at least one prison, according to Harm Reduction International (2021). According to the same study, only 54 countries provide opioid substitution therapy in prisons, and female prisoners generally do not have access to such services (Harm Reduction International, 2021).
Ensuring better access to health and drug-specific services to women incarcerated requires the following:
- Provision of drug dependence treatment services for women who use drugs, including opioids and methamphetamine.
- Training for police and prison staff about health interventions needed for people who use drugs.
- Access to easy and confidential access to harm reduction services, including sterile drug and injective equipment.
Illicit substances should be acknowledged in the presence of drug-specific health services in prison. According to reports, 56% of offenders continue to use drugs while incarcerated (Wicaksana, 2020). As a result, convenient and discreet access to sterile drug and injective equipment is required. To discourage women from sharing needles and syringes and so reduce the spread of HIV and other infectious illnesses, clean needles and syringes should be given. This is significant since the HIV/AIDS prevalence among injecting drug users (IDUs) in Indonesia was estimated to be between 60 and 98 percent in 2005 (Aceijas & Rhodes, 2007). Evidence suggests that providing necessities and syringes decreases HIV transmission in jail (Gatherer, 2007). Without a single reported case, these jails have also contributed to occupational safety.
There is also overwhelming evidence supporting the use of drug substitution treatment. For example, Naxalone, an opioid antagonist, has been used in take-home packs to prevent overdose deaths in the community for the past 20 years (Lintzeris & Wilson, 2020). Substantial evidence shows improved physical and social health outcomes in relation to opioid substitution therapy (OST) including reduced crime and reduced blood-borne viral spread (Avert, 2019). It has also been associated with a 54 per cent reduction in HIV among people who inject drugs (UNAIDS, 2014).
Improvement of Women’s Health Services
Women’s special health care requirements are frequently neglected in jail because the prison environment does not always take women’s specific needs into consideration. Female prisoners have different health and well-being needs than male prisoners, and they are known to have higher rates of physical and sexual abuse, mental health problems, and drug and alcohol dependence than men.
This may be the first time these women have had access to health care, social assistance, and counselling. As a result, awareness and preventive programmes for women in jail are critical, and special attention should be paid to various groups of women and their unique needs (Zoia, 2005). The challenge lies in providing comprehensive health care within correctional settings, where there is limited access to health clinics and priority access give to emergency care.
Different institutions in the criminal justice system can help mitigate the lack of gender-specific health care by:
- Delivering women’s health services comparable to that available in the community, personalised in a holistic and humane manner.
- Investment in staff training and addressing skill gaps to meet service needs.
Inclusion of the views, opinions, and feedback of female prisoners for future review.
This article was written by an Internship Student from UNSW University in the Internship Program of the Anak Bangsa Merajut Harapan Foundation (Angsamerah Foundation) and The Australian Consortium for ‘In-Country’ Indonesian Studies (ACICIS), Hannah Mendoza