Systematic review of healthcare use and needs of prisoners

125 Pages·2017·1.09 MB·English

KCE REPORT 293
SYSTEMATIC REVIEW OF HEALTHCARE USE AND NEEDS OF
PRISONERS
2017 www.kce.fgov.be

KCE REPORT 293
HEALTH SERVICES RESEARCH
SYSTEMATIC REVIEW OF HEALTHCARE USE AND NEEDS OF
PRISONERS

MICHAL WITKOWSKI, POLLYANNA HUDSON, SARAH BATSON, BRIGITTE MOORE, STEPHEN MITCHELL

2017 www.kce.fgov.be

COLOPHON
Title: Systematic review of healthcare use and needs of prisoners
Authors: Michal Witkowski (DRG Abacus), Pollyanna Hudson (DRG Abacus), Sarah Batson (DRG Abacus), Brigitte Moore
(DRG Abacus), Stephen Mitchell (DRG Abacus)
Project coordinator: Marijke Eyssen (KCE)
Reviewers: Wendy Christiaens (KCE), Chris De Laet (KCE), Raf Mertens (KCE)
Belgian experts / stakeholders See chapter 11: List of contributing experts and stakeholders
International experts See chapter 11: List of contributing experts
External validators: Kristel Beyens (VUB), Eamonn O’Moore (PHE), Hans Wolff (HCUGE) Kristel Beyens (Vrije Universiteit Brussel,
Department of Criminology, Belgium), Eamonn O’Moore (National Lead for Health & Justice, Public Health England
& Director of the UK Collaborating Centre for WHO Health in Prisons (European Region). Hans Wolff (Médecin-
chef du service de médecine pénitentiaire, Hôpitaux Universitaires de Genève, Suisse)
Acknowledgements: We thank the FPS Justice to have provided the authors with an anonymised Epicure dataset, and in particular Mr.
José Derlet for his constant availability.
We thank the ‘Dienst Gezondheidszorg van de Gevangenissen – Service des Soins de Santé en Prison’ (DGZG
– SSSP), and in particular Mr. Werner van Hout, Mr. Francis De Smet and Mr. José Derlet, for their continuous
willingness to share data and answer questions.
We thank all persons in the prisons that welcomed us for a visit and to share their insights.
We thank the members of the steering committee penitentiary health, for their useful comments on the research
protocol and intermediate results.
We thank the members of the Penitentiary Health Council for their useful comments on the intermediate results
We thank our KCE-colleagues Carl Devos, Stephan Devriese, Nicolas Fairon, Roos Leroy and Leen Verleye for
their support and advices in this research.
Other reported interests: ‘All experts and stakeholders consulted within this report were selected because of their involvement in the topic
of Health care in Belgian prisons. Therefore, by definition, each of them might have a certain degree of conflict of
interest to the main topic of this report’
Layout: Ine Verhulst
Disclaimer:  The external experts were consulted about a (preliminary) version of the scientific report. Their
comments were discussed during meetings. They did not co-author the scientific report and did not
necessarily agree with its content.
 Subsequently, a (final) version was submitted to the validators. The validation of the report results
from a consensus or a voting process between the validators. The validators did not co-author the
scientific report and did not necessarily all three agree with its content.
 Finally, this report has been approved by common assent by the Executive Board.
 Only the KCE is responsible for errors or omissions that could persist. The policy recommendations
are also under the full responsibility of the KCE.

Publication date: 18 October 2017
Domain: Health Services Research (HSR)
MeSH: Prisons, Prisoners, Criminals, Health Services Research, Healthcare Financing, Insurance, Health, Legislation as
Topic
NLM Classification: WA 300 (Health issues of special population groups)
Language: English
Format: Adobe® PDF™ (A4)
Legal depot: D/2017/10.273/68
ISSN: 2466-6459
Copyright: KCE reports are published under a “by/nc/nd” Creative Commons Licence
http://kce.fgov.be/content/about-copyrights-for-kce-reports.

How to refer to this document? Witkowski M, Hudson P, Batson S, Moore B, Mitchell S. Systematic review of healthcare use and needs of
prisoners. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2017. KCE
Reports 293. D/2017/10.273/68.
This document is available on the website of the Belgian Health Care Knowledge Centre.

KCE Report 293 Systematic review of healthcare use and needs of prisoners 1
 TABLE OF CONTENTS
LIST OF FIGURES ...............................................................................................................................................3
LIST OF TABLES .................................................................................................................................................3
LIST OF ABBREVIATIONS .................................................................................................................................5
 SCIENTIFIC REPORT ............................................................................................................................8
1 INTRODUCTION ....................................................................................................................................8
1.1 BACKGROUND INFORMATION ...........................................................................................................8
1.2 OBJECTIVE ............................................................................................................................................8
2 METHODS ..............................................................................................................................................9
2.1 PROTOCOL REGISTRATION ...............................................................................................................9
2.2 ELIGIBILITY CRITERIA..........................................................................................................................9
2.3 INFORMATION SOURCES .................................................................................................................10
2.3.1 Electronic database search ....................................................................................................10
2.3.2 Search strategies ...................................................................................................................10
2.3.3 Supplementary data sources .................................................................................................10
3 STUDY SELECTION ............................................................................................................................11
3.1 BELGIUM-SPECIFIC SEARCH ...........................................................................................................11
3.2 SYSTEMATIC REVIEW SEARCH .......................................................................................................11
4 RESULTS .............................................................................................................................................13
4.1 BACKGROUND ....................................................................................................................................13
4.2 GENERAL HEALTH AND HEALTHCARE-SEEKING BEHAVIOUR ...................................................15
4.2.1 Belgian studies .......................................................................................................................15
4.2.2 Systematic reviews ................................................................................................................18
4.3 TUBERCULOSIS ..................................................................................................................................18
2 Systematic review of healthcare use and needs of prisoners KCE Report 293
4.3.1 Belgian studies .......................................................................................................................18
4.3.2 Systematic reviews ................................................................................................................19
4.4 HIV, VIRAL HEPATITIS, AND BACTERIAL STI ..................................................................................19
4.4.1 Belgian studies .......................................................................................................................19
4.4.2 Systematic reviews ................................................................................................................21
4.5 MENTAL HEALTH ................................................................................................................................21
4.5.1 Belgian studies .......................................................................................................................21
4.5.2 Systematic reviews ................................................................................................................26
4.6 DRUGS AND DRUG ADDICTION IN PRISON ....................................................................................30
4.6.1 Belgian studies .......................................................................................................................30
4.6.2 Systematic reviews ................................................................................................................32
4.7 AGEING IN PRISON ............................................................................................................................34
4.7.1 Belgian studies .......................................................................................................................34
4.7.2 Systematic reviews ................................................................................................................35
4.8 EUTHANASIA (BELGIAN PUBLICATIONS) ........................................................................................35
4.9 MEDICATION USE IN PRISON (BELGIAN PUBLICATIONS) ............................................................35
4.10 ISSUES SPECIFIC TO FEMALE PRISONERS ...................................................................................36
4.10.1 Belgian studies .......................................................................................................................36
4.10.2 Systematic reviews ................................................................................................................36
5 LIMITATIONS .......................................................................................................................................38
6 DISCUSSION .......................................................................................................................................38
 APPENDICES ......................................................................................................................................41
APPENDIX 1. SEARCH STRATEGIES ........................................................................................................41
APPENDIX 2. CHARACTERISTIC OF INCLUDED STUDIES.....................................................................49
APPENDIX 3. EXCLUDED STUDIES ...........................................................................................................86
KCE Report 293 Systematic review of healthcare use and needs of prisoners 3
 REFERENCES .................................................................................................................................. 108

LIST OF FIGURES Figure 1 – PRISMA flow diagram for the Belgian search ...................................................................................12
Figure 2 – PRISMA flow diagram for the systematic review search ...................................................................12
Figure 3 – Belgian prison population and capacity from 2000-2016 ..................................................................13
Figure 4 – Density of Belgian prisoners per 100 prison spaces .........................................................................14
Figure 5 – Rates of male prison suicide compared with general population male suicide rates ........................26

LIST OF TABLES Table 1 – Eligibility criteria for prisoner review .....................................................................................................9
Table 2 – Key healthcare recommendations by the European Committee for the prevention of torture
and inhuman or degrading punishments or treatments8 .....................................................................................15
Table 3 – General health state of Belgian prisoners ..........................................................................................16
Table 4 – Evolution of TB detection rate in prisoners and incidence in the general population
(per 100,000) ......................................................................................................................................................19
Table 5 – E4 analysis – proportion of adherence to the different WHO/UNODC guidelines among all
participating prisons (n=109) ..............................................................................................................................20
Table 6 – Prison staff per 100 prisoners .............................................................................................................20
Table 7 – Availability of HIV, HCV/HBV and psychiatric consultations to prisoners ..........................................21
Table 8 – Diagnoses among prisoners referred to the CGG ..............................................................................22
Table 9 – Diagnosis data of mentally ill offenders in Flemish prisons ................................................................23
Table 10 – Prevalence of mental health issues among female mentally ill offenders ........................................23
Table 11 – Prevalence of major mental problems among mentally disordered offenders .................................24
Table 12 – Prevalence of traumata in Belgian male long-term prisoners ...........................................................25
Table 13 – Mental health disorders prevalence in general and prison populations ...........................................27
Table 14 – Average number of substitution therapy clients in prisons in January 2011 ....................................31