March 2. 2024. 2:17

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Health brief: Prisoner of your own mind


Mental disorders are the most prevalent condition in prisons all over the world, affecting one-third of inmates, according to the World Health Organisation (WHO), which is calling on member states to invest more in prison health services.

It is estimated that about 11.5 million people were held in prison globally in 2020, including about 13% in Europe – or 613,497 people.

The most prevalent condition among those incarcerated is mental health disorders, which affect 32.8% of the prison population, according to figures from the latest WHO report on healthcare in prisons released on 15 February.

Worse still, this figure is underestimated because “most non-communicable diseases are poorly recorded and less than half of the countries surveyed provided data,” the report said.

Among these mental disorders, WHO identifies depression, bipolar affective disorder, schizophrenia and other psychoses, dementia and developmental disorders, including autism.

However, 86.1% of WHO member states reported having a protocol for treating mental disorders in prisons.

The report shows that, when you are in jail, access to healthcare is a path full of pitfalls, of which the inmates are the first victims.

The WHO calls for greater investment to ensure equity in standards of care, for example, by increasing the ratio of psychiatrists to people in prison.

Prison overcrowding: a common pattern

Several factors can explain the mental health disorders prisoners suffer, starting with prison overcrowding. In Europe, 1 in 5 countries reported overcrowding in their prisons, according to the WHO report, which considers this figure worrying.

In Romania, prison overcrowding reaches 119%, in Belgium and Turkey, 108%, and in France, 104%. In contrast, Spain (74%), Finland (80%) and Germany (82%) perform better, according to data from the Committee for the Prevention of Torture (CPT), a Council of Europe body.

Prison overcrowding has negative consequences for the health of prisoners, the WHO report says. It can lead to violence, mental health problems, the transmission of disease, and lack of access to health care.

In April 2022, the Council of Europe called on member states to end prison overcrowding because it “puts all prisoners at risk, as well as prison staff, and undermines efforts to rehabilitate them,” said Alan Mitchell, president of the CPT.

During the COVID-19 pandemic, there was a decrease in prison overcrowding, in part due to various health restrictions and decreased judicial activity.

This has led to a decrease in prison density: 91 inmates per 100 beds in 2020, down from 85 in 2021, according to CPT.

Suicide leading cause of death in prison

Suicide is the leading cause of death in prison, and its rate is much higher than in the general population.

“Suicide in prison is an expression of distress. Suicide prevention needs to be undertaken differently than the way the prison administration currently undertakes it,” Christophe Michon, a member of the International Prison Observatory (IOP) for France, told EURACTIV.

Nevertheless, almost 90% of WHO member states say they have protocols in place to identify and support people at risk of suicide.

“This suggests that these protocols may be insufficient and that more effective practices to prevent suicide are needed in prisons,” the WHO report states.

Indeed, in prisons, there is a lack of healthcare personnel, and access cannot be guaranteed to all incarcerated persons.

“This is particularly true for psychiatrists, given the high demand for mental health services among the prison population,” says the WHO.

Invest more, incarcerate less

Addiction to drugs, alcohol and tobacco is another problem faced by prisoners and prison staff.

For example, in France, drug addiction is estimated to affect 18.4% of inmates and alcohol addiction 27.9%, according to figures published in 2019 by the French Observatory of Drugs and Addictive Trends (OFDT).

This is why investments must be made in preventing and treating the most common disorders affecting the prison population, including drug addiction, WHO stresses.

To fight prison overcrowding, the CPT suggests “setting an absolute upper limit” on the number of inmates in all prisons, respecting a “minimum living space” of four square meters in collective cells and six square meters in individual cells.

“Incarceration should never become a sentence for poor health. All citizens have the right to good quality health care, regardless of their legal status,” Hans Kluge, director of the WHO Office for Europe, said in the report.

But prison overcrowding and the prevalence of mental disorders raise the question: should people with drug addiction and psychiatric disorders be cared for in specialised facilities instead of in prison?

“It is recommended that alternative incarceration measures be considered for offences that do not pose a high risk to society, and for which more effective measures […] exist”, the report concludes.

Pfizer, EU commission and New York Times. The New York Times is suing the European Commission for failing to make public the text messages exchanged between Commission President Ursula von der Leyen and the CEO of pharmaceutical giant Pfizer during the COVID-19 pandemic.

Pharmaceutical strategy delays. The long-waited pharmaceutical strategy package was planned for Commission’s College meeting in mid-March. This Tuesday (14 February), the updated planning showed that it has been delayed again, now pinned for 28 March. Asked during the press briefing on Wednesday (15 February) for the reasoning behind the change, Commission’s spokesperson Eric Mamer said that when it comes to future college agendas, “there are no specific reasons why any point is shifted from one day to the next. It all depends on the state of preparations on logistical issues.” According to the initial plans, the overarching Pharmaceutical legislation revision should have been presented in December 2022.

Stakeholders start rattling… The ongoing delays on the new EU pharma rules concern stakeholders. On Tuesday (14 February), the European Consumer Organisation (BEUC) has written to European Commissioner Stella Kyriakides to urge the European Commission to publish the much-awaited proposal for a revised EU pharmaceutical legislation no later than March 2023. “While we understand that there might be controversial elements in the text, it is essential that the file is now officially referred to the co-legislators and that a democratic discussion is initiated to make significant progress during this legislature,” their press release said.

European health data space. On 8 February, at the plenary session of the European Committee of the Regions, an opinion on “Regulation on the European Health Data Space” was adopted. It showed that while EU regional and local leaders support the European Commission’s proposals for a European Health Data Space, multiple aspects must be addressed, from patients’ privacy and data rights to financing and infrastructure.

A new health (sub)committee at the European Parliament. As anticipated by EURACTIV, European lawmakers agreed to create a new permanent subcommittee for public health in the European Parliament. The new health sub-committee will still be linked to Parliament’s environment committee (ENVI), which will be considered as the ‘parent committee’ according to the Parliament’s rules of procedures. This means that the 30 members of the subcommittee will be chosen from among the members of ENVI.

Earthquake in Türkiye, Syria. As of Tuesday (14 February), more than 31,000 people have lost their lives to the earthquakes in Türkiye. The number of injured – almost 100,000 people. Across the border in northwest Syria, the death toll is nearly 5,000. All of these figures will likely rise, WHO Europe said in their press release. Urging for support WHO Europe said in their press release: “The needs are huge, increasing by the hour. Some 26 million people across both countries need humanitarian assistance”.

Emergency assistance for Syria and Türkiye. The EU is channelling emergency assistance to both Syria and Türkiye, which were hit by the earthquake. For Syria, the European Humanitarian Response Capacity will distribute winterised tents, heaters, blankets, water, sanitation and hygiene kits and kitchen sets through organisations working on the ground. Furthermore, via the EU Civil Protection Mechanism (UCPM), as of Monday (13 February), 10 European countries have offered thousands of tents, blankets, sleeping bags, mattresses, beds, generators, heaters, medicines, food items, winter clothing, masks, and more, to the Syrian people. Two Liaison Officers of the Emergency Response Coordination Centre (ERCC) will be deployed to Beirut to support the coordination of incoming EU assistance for Syria. This comes on top of an additional initial amount of €3.5 million of humanitarian assistance to cover the most urgent needs, such as cash for the shelter and non-food items, water and sanitation, health, and search and rescue.

In the meantime, for Türkiye the Commission will mobilise additional support and respond to Türkiye’s request for assistance. Already 21 EU Member States and three UCPM Participating States have offered a total of 38 teams – Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Estonia, France, Germany, Greece, Hungary, Italy, Lithuania, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia and Spain, together with Albania, Montenegro and Serbia. In total, 1,652 rescuers and 105 search dogs have been offered by European countries. The Commission is also channelling assistance from 12 EU Member States for emergency shelter items and is providing Relief Housing Units from the rescEU reserve hosted by Sweden, as well as thousands of tents beds hosted by Romania to be deployed to Türkiye.

Air and noise pollution. On 9th February, a new Horizon Europe research project, BEST-COST, aimed to address a gap in policy initiatives that would address the socioeconomic impact of environmental stressors. Air pollution leads to an estimated 400,000 premature deaths in Europe alone, and noise pollution leads to approximately another 12,000 premature deaths. “While there is increasing concern around the implication of environmental stressors on human health, the incomplete methodology for concrete evidence of the socioeconomic cost is limiting policymakers’ ability to act. BEST-COST will help us to identify and understand the impact, leading to stronger policy initiatives to better protect our health,” said Brecht Devleesschauwer, BEST-COST Project Coordinator and Head of Health Information at Sciensano. The results will be made available as open-access tools and trialled in five European countries: Belgium, Estonia, France, Norway and Portugal, before becoming transferable on a larger scale across Europe. Following this, research into their adaptability to other environmental stressors will be explored in a hackathon with key stakeholders.

Vaccination against measles. As measles cases in the WHO European region have been rising since early 2022, the WHO called on 10 February for urgent action in all countries to identify vaccination gaps and devise targeted strategies relevant to local settings to catch up with missed vaccinations. Following large outbreaks of measles in 2018 and 2019, with nearly 200 000 reported cases, the number of reported measles cases in the Region fell in 2020 to just over 12 000. For 2021, only 159 measles cases were reported in 22 countries; however, this increased in 2022, with 904 cases reported to date in 27 countries.

Psychedelic therapies. On 13 February, Psychedelic Access And Research European Alliance (PAREA) welcomed a “much-needed publication which is an opportunity to open up an institutional debate about moving towards safe, effective and accessible adoption of psychedelic-assisted therapies in Europe,” the alliance’s press release said. On 10 February, representatives from the European Medicines Agency (EMA), national experts from the European medicines regulatory network, and the European College of Neuropsychopharmacology co-authored a joint commentary in the Lancet: “The Therapeutic Potential of Psychedelics: The European Regulatory Perspective”.

Global cholera situation. As of 1 February 2023, at least 18 countries continue to report cholera cases, WHO announced on 11 February. Since the first disease outbreak news on the global cholera situation was published on 16 December 2022, the global situation has further deteriorated, with additional countries reporting cases and outbreaks.

MADRID

Madrid protestors stand up against privatisation of public health. About 250,000 people took to the streets of Madrid on Sunday to defend the public health system, protesting against the ‘dismantling’ of the primary care network in the Spanish capital carried out by the right-wing regional president, Isabel Díaz Ayuso, organisers said. By Fernando Heller | EuroEFE.EURACTIV.es

Spain’s Constitutional Court upholds abortion law. Spain’s abortion law, in force since 2010, was deemed constitutional by the Constitutional Law Thursday, rejecting an appeal filed by the centre-right Popular Party twelve years ago. By Fernando Heller | EuroEFE.EURACTIV.es

ROME

Italian government pours €125 billion into healthcare. Staff shortages and long waiting lists for treatment have prompted the Italian government to allocate €125 billion to the national health system, announced Health Minister Orazio Schillaci on Wednesday. By Federica Pascale | EURACTIV.it

BERLIN

Rumours of pharma giant Bayer facing break-up swirl. Rumours that Bayer could be split up following the early replacement of its CEO triggered by the takeover of US corporation Monsanto are swirling in Germany, leading to an outcry from unions but a rise in share prices. By Julia Dahm | EURACTIV.de

PARIS

French health body recommends EU make joint purchases to plug drug shortages. Brussels could make joint purchases of drugs to prevent future shortages in France and the rest of the EU, the national health authority said during a hearing in the Senate on Thursday. By Clara Bauer-Babef | EURACTIV.fr

BELGRADE

Serbia considers banning indoor smoking. Indoor smoking could soon be banned in Serbia as the Health Ministry is already looking for the public to support a bill on the prohibition of smoking in closed spaces. By Milena Antonijević | EURACTIV.rs

16-17 February – EU Council’s working party on public health

17 February – WHO webinar on trust and pandemic preparedness

20 February – EU Council’s working party on pharmaceutical and medical devices

22 Februar – Launch of EURACTIV’s Health Podcast