Lockdowns and restricted visits: COVID-19 and the prison population

The World Health Organization (WHO) has warned of potential widespread infection in closed settings such as prisons, and released its interim guidelines on preparedness, prevention and control of COVID-19 in prisons and other places of detention.
 
Efforts to control the virus in the wider community will prove unsuccessful unless strict measures such as adequate testing and increased hygiene procedures are taken in all places of detention, particularly in overcrowded prisons, according to the WHO.
 
All Australian states and territories have banned face-to-face prison visits to help reduce the spread of COVID-19. Despite allowing inmates virtual visits in a bid to ease their frustration, these disruptions to routines have resulted in tense situations.
 
Mental health impacts are of particular concern, according to Dr Penny Abbott, Chair of the RACGP Specific Interests Custodial Health network and a GP providing care to people in prison. She has experienced firsthand the healthcare challenges faced by this population.
 
‘It is hard to be isolated at such a vulnerable period,’ Dr Abbott told newsGP.
 
‘In my experience, people in prison clearly want to be protected [from the virus] and accept the measures which are being taken, but the lockdown strategies are very difficult for them.
 
‘Additionally, people are having their medical care interrupted unless they have an urgent condition, though telehealth is helping in that regard.
 
‘The prison population has a higher prevalence of chronic disease and other health issues which put them more at risk during the current pandemic. [Therefore] it is very important to have good mental health services in place.’
 
Professor Mark Stoové, Head of Public Health at Burnet Institute and Monash University, agrees that monitoring the mental health of people in prison is important.
 
‘Lockdowns and restricted visitation rights in prisons in response to COVID-19 has the potential to significantly impact the wellbeing of prisoners,’ he told newsGP.
 
‘This is particularly the case for people with mental illness, who are substantially over-represented in prisons.
 
‘Visits from family and friends increase hopefulness, social connectedness and optimism among many prisoners, and there is good evidence to suggest they can also influence how well prisoners reintegrate into the community following release.
 
‘So maintaining opportunities to connect with loved ones, such as increasing access to phone calls and other means of communication, is important.’

A recent MJA paper examined the pros and cons of early release from prison during the COVID-19 pandemic.
 
The paper identified that prisons are susceptible to COVID-19 outbreaks given the confined conditions and potential for overcrowding. However, societal lockdown measures mean regular community support services may not be accessible if people are released early.


‘The prison population has a higher prevalence of chronic disease and other health issues which put them more at risk during the current pandemic,’ Dr Penny Abbott said.

Dr Abbott supports any measures that decrease incarceration rates in Australia, but says now is a good opportunity to undertake a health assessment of people in prison and ensure the right support services are available upon release.
 
‘A risky time like this pandemic is a good time to assess whether people need to be in prison or not,’ she told newsGP.
 
‘It seems many people are in prison because they have had under-treated mental health or substance use disorders, and many have high social support needs.
 
‘Being [in] prison instead of receiving treatment and support in the community destabilises them further and contributes to the cycle we see of ongoing short sentences, social marginalisation and fragmented healthcare.
 
‘That said, it is important [to ensure] the supports are in place for people who are leaving prison and [that] they are not being released into homelessness or dangerous, unsupported environments.
 
‘So, while advocating for release of people in prison who would be better off in the community, we must also advocate for more transitional programs which make re-entry more successful, and good community programs and care from GPs when people are released.’
 
The Australasian Society for HIV, Viral Hepatitis and Sexual Health (ASHM) recently updated its national taskforce on blood-borne viruses (BBVs), sexual health and COVID-19 with recommendations on the care for people in prison with a BBV.
 
A key recommendation is the early release of people in prison living with HIV, hepatitis B or hepatitis C who are at higher risk from COVID-19 because of comorbidities or immunosuppression. The taskforce is also calling for a strengthening of prison-to-community reintegration services.
 
The recommendations were outlined in an open letter to the Federal Government, penned by ASHM’s CEO, academics and lawyers, calling for ‘immediate action to reduce the risk of transmission of COVID-19 in the Australian criminal justice system, especially prisons and youth detention centres’.
 
Taskforce member Professor Stoové stressed that as Australia’s lockdown practices are expected to ease further over coming months, policies and actions need to be put in place across the community.
 
‘These [policies and actions] should limit the extent and impact of cluster outbreaks, which are almost inevitable,’ he said.
 
‘The early release of all prisoners assessed as low risk to the community and at increased risk of poor health outcomes associated with COVID-19 – including those living with BBVs ­– is certainly warranted in this context.
 
‘Given that COVID-19 has significantly disrupted court capacity and delayed many remand hearings, rapid review of cases and potential early release of remandees would benefit them, and also reduce prisoner numbers and reduce the potential future impact of COVID-19 outbreaks in prisons.’
 
Professor Stoové believes measures to ensure the optimal health of people in prison, particularly those living with BBVs, are mirrored with those in the outside community.
 
‘Confined prison environments and restrictions on freedom of movement means prisons are very high-risk environments for the transmission of diseases. This makes hand hygiene, physical distancing and testing all the more important in custodial settings,’ he said.
 
‘The biggest concern is an outbreak fuelled by delayed identification of cases. As in the community, it is important that anyone with even mild symptoms presents as early as possible for testing.
 
‘But given people are most infectious [with COVID-19] in the days prior to symptoms and in the early symptomatic period, it is also crucial that prisons ensure soap and hand sanitiser is widely available and that the prisoners and staff are able to practice social distancing.’
 
Professor Stoové also notes that while it is unknown whether living with a BBV is directly associated with an increased risk of acquiring COVID-19, having these chronic infections can leave people immunocompromised. A high prevalence of hepatitis C among the prison population is ‘a concern’ in the context of any coronavirus outbreaks in prisons, he said.
 
For doctors providing care to people in prison and post-release, ongoing health assessments remain a priority, according to Dr Abbott.
 
‘We certainly have a duty to protect the health of people in prison, particularly during this pandemic time, and prisons and other custodial settings are an integral part of the public health response to COVID-19,’ she said.
 
The RACGP’s Standards for health services in Australian prisons, address infection prevention and control and isolation processes. An update of the Standards is due for release in late 2020.
 
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