Wednesday, 3 August 2011

Released the prisoned spirit

Who should be responsible for prisoners with HIV and/or TB, or with drug use problems, after their release from prison? That question has resulted in some heated discussions among my colleagues. One makes the reasonable point that released prisoners are no longer the concern of the corrections service. After release, they are the same as any other members of the community, and should therefore be served by community health centres, hospitals, social welfare services and support groups in the same way as anyone else,

But released prisoners surely do have some special needs. One of my colleagues who spent two drug-use terms in the Kerobokan prison ten years or so back recounts his experience. Before release, he knew exactly what he would do after he got out. But once he actually stood outside the prison gate, his mind became blank. Absent any real alternative, he wandered back to his old haunts, and immediately picked up where he left off - except that he had now lost his tolerance for heroin, and was lucky not to overdose. It wasn't long before he was back in his cell.

There have been a number of studies worldwide showing that adherence to antiretroviral therapy (ART) falls drastically among prisoners after release - if indeed they don't drop out. The same is true for those still taking anti-TB therapy. This is not surprising. Therapy in prison is often effectively directly observed, and adherence is better than that among almost any other group of people taking medications. Enforced discipline is developed. But once outside, they lose this support; the discipline is lost. They have to find a referral clinic, visit it regularly and develop their own ways to ensure that they take their medications on time. Most don't.

Those with a drug problem face even greater challenges. If they've been on methadone in prison, they must find the nearest clinic - surely much more difficult to access than the service in the prison. Chances are that without support they won't bother; just like my colleague, they'll return to their old friends, and the sugesti (craving) will immediately take over. And what about the increasing number addicted to meth?

The parole service in the prison does have the task of attempting to identify such needs before release, and referring the prisoner to appropriate services after they get out. Everybody seems to agree that responsibility after release passes to the Social Welfare Service and/or to NGOs. But the former seems to have very limited if any resources for this, while there are few NGOs working in this field, and fewer still are funded for the work. And it is rare for either to actually work with prisoners before release to ensure continuity.

I'm told that recidivism is low in Indonesia, although probably higher among drug offenders. So this may (or may not) counter the argument that more should be done to reduce re-offense. But surely there is a human rights imperative to help ex-prisoners reintegrate into the community, including ensuring their continued access to appropriate health care. Whose job is it?