1. HEALTH SERVICE IN POLISH PRISON SERVICE- CHALANGES MD, PhD Leszek Markuszewski Director of Health Service Office Central Board of Prison Service 1

2. Prison Service (SW- Polish abbreviation) is a uniformed, military and non-political formation which is subject to the Minister of Justice and has its organizational structure. Prison Service fulfills its assignments in terms of execution of imprisonment and temporary arrest on the basis of the rules specified in the Executive Penal Code. Central Board of Prison Service

3. ORGANIZATIONAL STRUCTURE OF PRISON SERVICE Central Board of Prison Service THE MINISTER OF JUSTICE CENTRAL BOARD OF PRISON SERVICE DISTRICT INSPECTORATES OF PRISON SERVICE (15) PENAL INSTITUTIONS (86) REMAND PRISONS (170) VOCATIONAL TRAINING CENTRES (11) VOCATIONAL TRAINING CENTRE OF SW in Popów VOCATIONAL TRAINING CENTRE OF SW in Kalisz VOCATIONAL TRAINING CENTRE OF SW in Kule

4. STRUCTURE OF PRISON HEALTH SERVICE Doctor general of Prison Service Team of Experts (BSZ CZSW - Polish abbreviation for Health Service Office at Central Board of Prison Service ) 15 x Doctor General at OISW- Polish abbreviation for District Inspectorate of Prison Service ) 155 x Health Care Unit 13 hospitals Central Board of Prison Service

5. Medical personnel Personnel – regular positions: 1817 doctors - 630 nurses- 935 Additional medical personnel (pharmacists, rehabilitation professionals, laboratorians, technicians) – 252

6. On August 31st, 2009 Prison Service capacity for accomodation was 83 537 places (according to the standard of 3m2) On August 31st, 2009 there were 85 319 inmates in penitentiary units. Population 102,9% Central Board of Prison Service

7. THE NUMBER OF THE IMPRISONED DURING THE YEARS 2005-2009 The USA (738) and Russia (611) have the highest ratio. The opposite result belongs to Iceland - 40. Countries- neighbours of Poland: Germany -95,Chech Republic – 185, Slovakia-158, Lithuania – 240, Belorussia- 426, Ukraine – 356. Data received on December 31 st of a given year Overall number of the imprisoned Ratio -the number of the imprisoned for every 100 tousands inhabitants in a given country (international ratio) 200582 955217 2006 88 647 232 200787 776230 200882 882217 Data received on August 31st, 2009. 85 319223

8. THE SCOPE OF ACTIVITY IN 2008 Prison population: 177 785 Movement dynamics: approx 90 tousands receptions and releases Prison hospitals: - the number of the hospitalized by prison health service: 8 086 persons (276 656 person-days); - the number of the hospitalized by hospitals outside prison service: 1 091 persons (3 155 person-days). Frequency of health service assistance: - in a penitentiary unit: 1 698 098 - in health care units outside prison service: 29 776 Central Board of Prison Service

9. THE SCOPE OF ACTIVITY RELATED TO THE NATIONAL HEALTH PROGRAMME Health and educational programmes:  Reduction of health side-effects due to smoking in Poland,  Prevention and Problems Solution related to Alcohol Abuse,  Prevention of Drugs Abuse,  Prevention of HIV Infections and Provision of Assistance for Persons living with HIV and for AIDS Victims,  The Policy of the Ministry of Health „Antiretroviral Treatment for persons living with HIV virus in Poland” Central Board of Prison Service

10. The health and educational programme Prevention and Problems Solution of Alcohol Abuse We have 26 therapeutic units for convicts with alcohol abuse problems (858 places) At the end of the year 2008, 4185 addicted convicts underwent the therapy There is AA club We conduct therapies individually and in groups We conduct programme of basic psychotherapy

11. Health and educational programme Drug abuse prevention On September 3rd, 2009- in penitentiary units there are 3253 inmates (the convicted or the temporarily arrested) who are sentenced or arrested on the basis of the Act regarding drug abuse prevention) There are 15 programmes for methadone substitution in penitentiary units. On August 31st, 2009 – 63 persons undergo the methadone programme There are therapeutic units for addicts to intoxicants and psychotropic drugs There are drug abuse trainings, Specialistic training programmes for reduction of health demage Drafts for extension of methadone programmes for more other 30 units

12. Health and educational programme Prevention of HIV Infections and Assistance for persons infected with HIV and for AIDS victims.  Instruction trainings  Preparation, publishing and distribution of different instructional materials  Educational Trainings on HIV/AIDS  Trainings on post-exposure proceedings  Specilistic monitoring diagnostics  Antiretroviral treatment

13. Health and educational programme „ Antiretroviral treatment for persons living with HIV infection in Poland” EPIDEMIOLOGICAL STATISTICS (until December 31st, 2008) - laboratory tests aimed at HIV virus identification – 3965; - positive results - 281; - newly discovered cases - 88; - confirmed cases reported by patients until August 31st, 2008 – 347, AIDS – 82; Antiretroviral treatment 188 inmates (until August 31st, 2008)

14. Health and educational programme Reduction of health side-effects due to smoking in Poland Preventive check-up tests Educational activities for personnel and inmates Medical advice, assistance during detoxification period Instruction materials distribution Health promotion

15. RESEARCH AIM: EVALUATION OF NICOTINISM SCALE IN POLISH PRISONS  Acknowledgement of the nicotinism scale among correctional officers and inmates  Evaluation of knowledge of correctional officers and inmates regarding nicotinism  Analysis of the necessity to educate correctional offiders and inmates Central Board of Prison Service

16. RESEARCH RESULTS:  81% of the questioned inmates smoke  53% of the questioned correctional officers smoke  70% of the inmates who smoke, declare addiction to nicotine, the result concerning correctional officres is 44 %  89% of the questioned have not participated in trainings regarding smoking side-effects  54% of inmates and 69% of correctional officers are willing to patricipate in trainings regarding smoking side-effects. Central Board of Prison Service

17. CONCLUSIONS:  75% of inmates have tried to stop smoking;  72% of inmates and 74% of prison officers wish to stop smoking  The most frequent reason for smoking among -inmates is lack of motivation to give up the addiction and an excessive amount of free time - prison officers – stressful job Central Board of Prison Service

18. CONCLUSIONS Nicotinism is a serious health problem in penitentiary units. The main reasons: work in a stressful environment, conditions of constant threat, work with a difficult type of a patient- an inmate Central Board of Prison Service

19. THE AIMS WE WANT TO ACHIEVE  Change in attitude of correctional officers- smokers, whose attitude inluences adequate and healthy behaviour among imates;  Protection against tobacco smoke in a workplace as well as in a place of execution of punishment  Creation of atmosphere to help a marginal treatment of tobacco smoking;  Encouraging the addicted to give up the addiction. Central Board of Prison Service

20. Provision of educational programme for inmates and correctional officers „Leaving addiction behind You leave it sooner You become healthier”

21. OPERATIONAL METHODS Preventive check-up tests Educational acitvities Therapies implementation Creation of health and educational programmes Activating of NFZ' s and other institutions' means to enhance health protection such as: - Assistane during detoxication period trainings for doctors and psychotherapists - At least partial financing of nicotine treatment Central Board of Prison Service

22. Suggested directions of change in prison health care

23. Central Board of Prison Service Employment of medical personnel on the basis of contracts and well-paid civil/non-uniformed positions „Detention” of professional and experienced health care personnel Employment of additional management staff at health care units and specilists in the field of family treatment or internal diseases Unifying the education level of management staff by postgraduate studies in organization and management as well as with adequate courses in health protection and promotion.

24. Central Board of Prison Service Founding of the Central Prison Hospital as a strategic investment of the Ministry of Justice and Prison Service Founding within the Central Prison Hospital Vocational Training Centre as postgraduate studies for medical personnel

25. Implementation of new chalanges is sometimes a very tough and curly road, which must be overcome, but we have already decided to take it. Central Board of Prison Service