Annual Report of the Chief Medical Officer 2013 - Medical Leadership in Scotland

The Scottish Prison Service and NHS face a daily challenge ensuring those detained in prison receive all necessary forms of care. Given the extremely high levels of incarceration in Scotland, this is no small task. That is why the recent Annual Report of the Chief Medical Officer provides illuminating, and also troubling insight into care and need in Scottish custody in 2013.

Nationally, health inequalities remain a ‘major problem in Scotland’, operating in criminal justice spheres ‘offers an opportunity for people in the community who find services hardest to reach, to benefit from support even of the briefest nature’. The report makes clear how problematic it can be to craft the policy and practice of healthcare in criminal justice and not consider those inseparable broader social inequities; stating that it ‘remains the case that key determinants of health are poverty, housing and access to welfare or employment opportunities, along with social aspects of rehabilitation. Without addressing them, risk factor and health improvement intervention will have limited impact and this applies equally to police custody and prisons’.

The disproportionately high medical and healthcare need among the Scottish prison population as compared to the general population was illustrated by a number of key statistics:

• 54% of 200,000 people who had been in police custody in Scotland had problems with alcohol and drugs.
• 68% of the same group had difficulties with substance misuse, and problems with both medical and mental health.
• 73% of prisoners are believed to have an alcohol problem.
• 36% are believed to be alcohol dependent.
• At the time of the offence, 45% of prisoner reported being under the influence of alcohol, and;
• 39% reported that at the time of their offence they were under the influence of drugs.
•  Upon reception to prison, 77% of prisoners tested as positive for illegal drugs (33% for opiates)
• It is believed that 19% of the prison population are Hepatitis C positive.
• About 10% of men in the general population in Scotland suffer from dental decay, compared to 29% of men in Scottish prisons.
• For women in prison in Scotland, 42% suffer from dental decay, compared to 3% of women in the general population.
• Both men and women who have been in prison have higher risk of death than the general Scottish populace. The risk of mortality is particularly high in the immediate post release period ‘as prisoners return to the poor circumstances, poverty of opportunity and hope that they left’.

Read the report, particularly the Health & Justice section here