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A Study of the Health Care Provision, Existing Drug Services and Strategies Operating in Prisons in Ten Countries from Central and Eastern Europe

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A Study of the Health Care Provision, Existing Drug Services and Strategies Operating in Prisons in Ten Countries from Central and Eastern Europe European Institute for Crime Prevention and Control, affiliated with the United Nations (HEUNI) P.O.Box 444 FIN-00531 Helsinki Finland Publication Series No. 45 A Study of the Health Care Provision, Existing Drug Services and Strategies Operating in Prisons in Ten Countries from Central and Eastern Europe Morag MacDonald (University of Central England) Helsinki 2005 Copies can be purchased from: Academic Bookstore Criminal Justice Press P.O.Box 128 P.O.Box 249 FIN-00101 Helsinki Monsey, NY 10952 Finland USA Website: http://www.akateeminen.fi Website: http://www.criminaljusticepress.com ISBN 952-5333-23-X ISSN 1237-4741 Page layout: DTPage Oy, Helsinki, Finland Printed by Hakapaino Oy, Helsinki, Finland Acknowledgements The completion of this study would have been impossible without the support and assistance of a wide range of individuals. I would like to thank the members of the Scientific Advisory Group:MrRoy Walmsley, the International Centre for Prison Studies in London (England), Dr Heino Stöver, the University of Bremen (Germany), Professor Joris Casselman, the Catholic University of Leuven (Belgium), Ms Laetitia Hennebel, Cranstoun Drug Services (UK). Mrs. Terhi Viljanen, the European Institute for Crime Prevention and Control affiliated with the United Nations (HEUNI) for her encouragement and support throughout the research. I would like to thank the Directors General of the Prison Service in the ten central and eastern European countries for having authorised the research & for having provided logistic support: Mr Peter Vassilev (Bulgaria); Mrs Kamila Meclová (Czech Republic); Mr Peter Näks (Estonia); Mr. István Bökönyi (Hun- gary); Mr Dailis Luks (Latvia); Mr Rymvidas Kugis (Lithuania); Mr Jan Pyrcak (Poland); Mr Emilian Stănișor (Romania); Mr Oto Lobodáš (Slovakia) and Mr Dušan Valentinčič (Slovenia). I would also like to thank all the prison staff in the sample prisons who agreed to be interviewed and who provided such a depth of information and to all the prisoners who participated in the focus groups. The national co-ordinators for having provided support in the organisation of the visit and for providing key background information: Bulgaria: Mr Emil Madzharov (PS) and Mr Ivan Popov, Better Mental Health NGO Czech Republic: Dr Jan Sochùrek (PS) and Jiŕi Richter, SANANIM NGO Estonia: Mr Kert Valdaru (PS) Hungary: Dr László Huszár (PS) Latvia: Ms Regina Fedosejeva (PS) Lithuania: Ms Birute Semenaite (PS) Poland: Dr Marzena Ksel & Marek Bujak (PS) and Ms Masha Salivonenko, MONAR Romania: Mr Emanuel Parausanu (PS), Ms Catalina Iliuta & Mr Marius Tokaci, ARAS Slovakia: Mr Werner Scholz (PS) and Ms Katarína Jirešová, Odyseus NGO Slovenia: Mr Jo¾e Hren (PS) and Mr Borut Bah (NGO) III I would like to thank the interpreters who accompanied me to the sample prisons and translated for me during the interviews, for their professionalism, flexibility and patience: Ms. Marina Togorova (Bulgaria); Mr Indrek Pallo (Estonia); Mr Vladan Sir (Czech Republic); Ms Judit Saád (Hungary); Mrs Liga Gaisa (Lat- via); Dr. Gintaras Urbonas (Lithuania); Poland: Mr Jan Ruszkowski (Poland); Ms Roxana Dude (Romania); Ms Lubica Fedorova (Slovakia) and Mrs Ziva Hren (Slovenia). Particular thanks to Mrs Magdalena Ruszkowska-Cieślak and Mr Grzegorz Król for their excellent co-ordination of all the visits and background reports and their endless patience and helpfulness. Thanks also to Mr Edoardo Spacca and Mrs Vikky Bullock from Cranstoun Drug Services European Team for their help and support. I would also like to thank Dr James Williams, Dr Gill Cappuccini, Mr David Kane and Mrs Susie Atherton from UCE for their help in proof reading and re- searching background information for the report. IV Contents Page Acknowledgements . III Summary . 1 Chapter 1. Introduction. 11 Methodology . 12 Ethics . 15 Description of the prisons and NGOs involved in the research . 16 Chapter 2. Overview . 24 Drugs use in central and eastern Europe . 25 Prevalence, patterns and trends. 25 Strategies to deal with drugs use and trafficking . 26 Risk factors. 26 Drugs use in prisons . 26 Patterns of drugs use in prison . 27 Sexual activity in prisons . 28 Spread of infectious diseases . 28 Treatment for problematic drug users in prisons . 29 Prevention and treatment for HIV/AIDS and other infectious diseases. 30 Education . 30 HIV counselling and testing . 31 Sexual activity . 31 Harm reduction. 31 Methadone maintenance programmes . 32 Chapter 3. Health care, drug use and communicable diseases in the community in the sample countries . 33 Health care and communicable diseases in the community . 33 Drug use . 38 Communicable diseases . 41 Chapter 4. The prison systems of the ten countries . 50 Bulgarian Department for Punishment Execution . 50 Czech Republic Prison Service . 53 Estonian Department of Prisons . 54 Hungarian Prison Department . 56 Latvian Prison Administration . 57 Lithuanian Correctional Affairs Department . 60 Polish Prison Department. 62 Romanian General Directorate of Penitentiaries . 63 Slovakian General Directorate of the Corps of Prison and Court Guard . 64 Slovenian Prison Administration . 66 V Chapter 5. Key issues for the prison administrations of the ten countries . 68 Overcrowding . 68 Budget constraints . 70 Problematic drug users in prison . 73 Drugs in prison . 74 Communicable diseases . 76 Activities and availability to work . 79 Sex, prisoner hierarchy and bullying . 86 Suicide and self-harm . 92 Summary of common problems . 97 Chapter 6. Health care provision in prison . 99 Structure of prison health care . 99 Access to health care . 102 Confidentiality . 105 Equivalence. 109 Cleanliness, hygiene and food . 112 Summary of health care . 118 Chapter 7. Prevention and harm reduction . 119 Harm-reduction information about drugs and communicable diseases . 119 Condoms. 128 Bleach. 130 Needle exchange. 131 Substitution treatment. 132 Summary. 137 Chapter 8. Drug treatment in prison . 139 Drug strategy . 139 Drug treatment . 142 Summary. 160 Chapter 9. Prison staff. 161 Multi-disciplinary working. 161 Training . 166 Staff welfare . 169 Summary. 171 Chapter 10. Conclusion and suggestions . 172 Conclusion . 172 Suggestions for further consideration. 178 References . ..
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