Adding further problems to the already downgraded

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adding further problems to the already downgraded health care for inmates as the prison administration has to wait twenty days for the approval of the proposed transfer and more until the actual approved transfer. So it frequently happens that the visits in external hospitals are effectuated with great delays. In Italy and France this is justified by saying that there are not enough police staff for the transfers. Sometimes the delays cause bigger health problems for the patients and even death. Unfortunately it is commonly not easy to define if the denial/delay of treatment, medical care or HEALTH CARE OUTSIDE PRISON
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European Prison Observatory Prison in Europe: overview and trends 23 diagnosis is caused by gross incompetence or intentional wrongdoing because the line between the two is often indistinct (Vaughn, 1999). In some cases the most serious consequences affect in particular prisoners suffering from mental illness. In the UK the high prevalence of mental health issues and self-harm among prisoners make it difficult for services to effectively reach those in need. In England and Wales prisoners with more complex mental health problems have been found to have good access to mental health staff (although sometimes they should be diverted to more appropriate facilities, e.g. admitted to National Health Service hospitals and are not), but services for patients with common mental health problems are less developed. In some prisons daytime therapeutic support services and access to counselling are limited. The European Prison Rules request that: “specialised prisons or sections under medical control shall be available for the observation and treatment of prisoners suffering from mental disorder or abnormality” (47.1). Moreover, European Prison Rules prescri be that: “the prison medical service shall provide for the psychiatric treatment of all prisoners who are in need of such treatment and pay special attention to suicide prevention” (47.2). Everywhere we can find separate facilities (or branches inside prisons) where mentally ill prisoners can be addressed. In some cases (Spain and UK), the main issue is whether they function well and if there are enough to address the number of prisoners with mental health problems. Such units are often geared towards prisoners thought to be at risk of self-harm or suicide. Even when inmates are hospitalised in public hospitals, the conditions are very harsh: in France, for example, for security reasons, prisoners are frequently placed in isolation wards, in locked rooms where there is no other furniture than a mattress. And this is the case even when such measures are not medically justified. In some instances there are no toilet facilities. A bucket is made available for the patient’s needs. Therefore, the risks related t o segregation are accentuated, as in the above- mentioned case of infectious diseases. Moreover, those conditions raise at least two main ethical
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