Bridging the gap between the health services in prison and the civilian world - what could be the role of primary health care? Simo Kokko 22/06/2016 Conference Good prison health – better public health – safer society 1

Seeking help amidst numerous vertical programs Substance abuse services Hyper- tension TB HIV/AIDS clinic Mental health services

Coordination through primary care Special services through referral Consultation of infectious disease specialist Mental health and substance abuse help locally One point of entry to coordinated care

Components of primary health services 22/06/2016 Conference Good prison health – better public health – safer society 4 Prevention; key role in broader health promotion Care of chronic illnesses Demand based help to health problems

Key strategies of primary health care; the three C’s Comprehensiveness Continuity Coordination 22/06/2016 Conference Good prison health – better public health – safer society 5

From the ideal(istic) picture to realities Persons released from prisons have a high prevalence rate of health problems, especially in mental health, substance abuse and chronic infectious diseases Persons released from prisons are less prone to have or develop roots in communities and permanent relations with community-based services Use of services and commitment to care and follow- up would need special arrangements and effort, tailored care management by a care manager These arrangements are usually not in place 22/06/2016 Conference Good prison health – better public health – safer society 6

What to think of the dilemma? Health services and primary health care in particular need to reflect their core values: equitable services, according to need The specialists argue that PHC staff do not have the skills nor the will It is not sustainable to think of PHC (with the ethos of comprehensiveness of services) where psycho- social problems and problems of life with chronic infections would be excluded Therefore, if PHC is not ready, taking steps to become ready should be rapidly started 22/06/2016 Conference Good prison health – better public health – safer society 7

Recent vision in Finland of a group that was addressing the bridge questions Passage of information in both ways Identification of linkage and care coordination persons in PHC Training of core skills Networks with specialized services, mainly to give support, advice and consultation and not just shift of responsibilities here and there In spite of belonging under separate ministerial regimes, prison health services should be developed in close connection with the general health services 22/06/2016 Conference Good prison health – better public health – safer society 8