Estonian Prison System Kristel Ojala Ministry of Justice/ Medical adviser

Specialization of prisons Tallinn Prison – unit for women, special unit separately for inmates with tuberculosis; Tartu Prison – sexual offenders, drug rehabilitation unit, stationary psychiatric unit for 18 inmates; Viru Prison – juveniles unit for 14-21 year old inmates, „super-max“ unit with higher security measures.

Prison healthcare system Healthcare system in prisons as part of Estonian healthcare; Financed from the Ministry of Justice budget (yearly budget around 3 million EUR, incl personnel costs); General medical care in prisons: Medical care is given by general practitioners and nurses (24 h), on average 1 healthcare worker for 29 prisoners; Intensive care is not provided in prisons, but in civil hospital; Initial medical check up for every prisoner on their arrival (incl HIV test, x-ray of lungs etc); Specialist care in prisons: Neurologist, surgeon, ophthalmologist, infectionist, dermatologist, psychiatrist, radiologist, gynecologist, gastroenterologist and dentist.

Inpatient services: All prisons have special after-care wards for inpatient services (24- hour health care provision); Central tuberculosis ward; Central psychiatric ward. Central prison pharmacy – all medications available 24 h.

Main reasons for hospitalization Emergency situations with addiction disorders (alcoholic delirium, acute alcohol or drug detox); Severe mood disorders (depression, problems with adjustment inside prison setting, anxiety disordes); Schizophrenia and delusional disorders (clarification of diagnosis and assessment of need for coercive or involuntary treatment); Mental retardation assessment and behavioural disorder treatment.

Infectious diseases HIV – approx 15% of all inmates are HIV+; Hep-C – almost 1000 prisoners (1/3 of prison population) are diagnosed with Hep-C (outside prisons it is estimated overall 20 000 people are HepC+) Tuberculosis – few cases a year;

Drug dependents in prison system 878 prisoners (32%) have been diagnosed with mental and behavioural disorders due to psychoactive substance use: Approx. half of them have been diagnosed with mental and behavioural disorders due to use of opioids (F11); Quite common are mental and behavioural disorders due to multiple drug use and use of other psychoactive substances (F19). Drug rehabilitation is an important part in prison healthcare – specialized unit with holistic approach for acute dependants in Tartu, other prisons small units plus councelling and medical aid.

Thank you for your attention! Kristel Ojala kristel.ojala@just.ee