1. Healthcare Services for Prisoners– Transfer of Responsibility in Finland
MULTILATERAL MEETING
ORGANISATION AND MANAGEMENT OF PRISON HEALTH CARE
Strasbourg, October 2017
Jaana Leipälä, MD, PhD, Adjunct Professor
Deputy Director, Health Care Services for Prisoners
National Institute for Health and Welfare (THL)

2. Presentation outline
Government Institutions involved in the transfer of Prison Health Services in Finland
Transfer Project
Current State

3. Relevant government institutions before and after the transfer
2016 onwards:
Previously:
PHS
PHS

4. National Institute for Health and Welfare (THL)
research&development institute operating under the Ministry of Social Affairs and Health
official functions based in law focusing social care and public health

5. ORGANISATION .

6. Transfer project

7. PHS Transfer Project Timeline
Preparation project for transfer
Ministerial WG #1
New PHS director appointed
Transfer project TEAM
Parliament financing decision
PHS transfer finalized
PHS Board
Transfer discussions Initial preparations
2006
2010
2013
June 2014
Feb 2015
May
June
Dec
Feb 2016
Apr 2016
Individual Prison health units grouped under CSA
CSA re- arrangements
Ministerial WG #2
General PHS staff info
New PHS law approved by Parliament
Development work
Report on prison health care

8. Report on prison health care/
Report on prison health care
(commissioned by the Ministry of Socials Affairs and Health)
(available only in Finnish, sorry…)
Sosiaali- ja terveysministeriön raportteja ja muistioita 2014:12
Matti Suistomaa
Selvitys
VANKITERVEYDENHUOLLOSTA
SOSIAALI- JA TERVEYSMINISTERIÖ
Helsinki 2014

9. Key Principles of the Transfer
Health services for prisoners provided by the existing staff in the existing locations. No changes made for the terms of labour of the staff.
Prison health services (PHS) organised as an independent legal entity performance managed by the National Institute for Health and Welfare (THL), the Department for Government Services.
Administrative services for PHS provided by THL.
Esityksen nimi / Tekijä

10. Legal Framework
Legal work led and managed by the Min. of Social Affairs and Health
The law of organising prison health services approved by the Parliament Dec 31, 2015
Act on the Unit for Prison Health Services approved by the Parliament Dec 31, 2015
Act on Prison Health Services’ charges, approved by the Parliament Dec 31, 2015

11. Coordination of the transfer
Coordination and Cooperation Group led by the Min. of S&H
Operational Group led by the National Institute for Health and Welfare
The THL Coordination Group
The THL Transfer Team 6/2015 ─3/2016
Over THL 30 staff members took part in the transfer
The transfer had its own budget
The transfer project had its extranet & ”intranet” pages

12. Organisation of Prison Health Services
Ministry of
Social Affairs and Health
Ministry of Justice
National Institute for Health and Welfare
Criminal Sanctions Agency
Performance management
Admin. services
Academia & Research
Prison Health Services
Unit
Board
Prison Health Services
Social Services
Public Hospitals
PHS Staff
NGO sector

13. Co-operation agreement
Criminal Sanctions Agency (CSA) & National Institute for Health and Welfare (THL) signed a formal contract on partnership in May 2016
The contract contains:
Principles of collaboration
Annual meetings between Director Generals
Regular operational and formal meetings between CSA & THL & The Unit for Prisoners’ Health Services
Appointed members from all organisations
Detailed responsibilities listed –some modifications still in progress
Mutual development activities on-going and plans in process

14. Lessons learned from the Transfer Project
Final report (available only in Finnish, sorry…)
”The devil lies in the details”: budget figures were not detailed enough > difficulties for budgeting 2016 & 2017
ICT operational environment in the prisons > difficulties to separate and thus provide the health staff proper ICT environment > special arrangements needed
some operational hick-ups in the previous administration brought into daylight > tender & contracting procedures re-established
E-health possibilites unused > catching up work started

15. Overview/Jaana Leipälä
Current state
Overview/Jaana Leipälä

16. Prisoners in Finland in 2016
Type of prisoner
Average daily number
Sentenced prisoners
2478
Fine default prisoners 57
Remand prisoners
585
Total
3120
Female
229
Foreign
537

17. Health Care Services for Prisoners in a nutshell
Annual budget ca 17 million €
(real estate & security costs not included)
Staff: ca 200 person-years (py)
National executive functions unit 3 py
27 prison outpatient clinics:
ca annual patient visits
Oral health care at 12 locations: 6000─7000 annual visits
Somatic inpatient care : 40 beds
(specialized inpatient care purchased from public hospital districts)
Two units for psychiatric care: 55 beds in total
National medicine center serving all functional units
Goal: To provide high quality health services for all prisoners in all prisons in timely manner
Treatment follows national guidelines

18. Prisoners’ health in figures
Health much worse than that of average population; female prisoners even in worse shape
Average life expectancy only 47 years (average for Finnish men 78 years, women 84 years)
Most common diagnoses are alcohol and substance abuse, mental health problems, hepatitis
90% lifetime substance abuse disorder
70% mental health problem
50% chronic somatic disorder
50% positive Hepatitis C antibodies
Psychotic disorders among prisoners have increased 10-fold in (Jüriloo ym. Nordic Journal of Psychiatry 2017)
Jaana Leipälä

19. Up-coming future developments
WATTU IV: Comprehensive Prisoner´s Health Study
Previous studies in 1985 ,1992, 2006
WATTU IV kick off meeting October 18, 2017
Strategic Development Programme
Jaana Leipälä

20. ACKNOWLEDGEMENTS Merja Mikkola Antti-Jussi Ämmälä, MD
Development Manager
National Institute for Health and Welfare
Antti-Jussi Ämmälä, MD
Director
Health Care Services for Prisoners
National Institute for Health and Welfare

21. Prisoners’ Health Care in Finland - Study Tour Programme
Programme consisting of two consecutive days:
Day 1: Finnish Health Care System, Transfer of the Prisoners’ Health Care from the Ministry of Justice to the Ministry of Social and Health Care, Infectious Diseases, Mental Health, Treatment for drug addiction (programme can also be custom-made, tailored)
Day 2: Prison visit, Presentations of the Criminal Sanctions Agency
Contact persons:

22. Thank You!
Jaana Leipälä