trauma and detention why doctors are needed pétur hauksson, warsaw, 13 dec 2011
TRANSCRIPT
Trauma and detention
Why doctors are needed
Pétur Hauksson, Warsaw, 13 Dec 2011
Why doctors are needed
For 1. assessing the trauma
and 2. assess the health care services'
approach to and treatment of that trauma
Pétur Hauksson, Warsaw, 13 Dec 2011
Doctors are needed
for
assessing the trauma
Pétur Hauksson, Warsaw, 13 Dec 2011
Psychological consequences
vs
mental health consequences
of trauma/torture
(and trauma without traceable consequences)
Aetiology
risk factors
symptoms
diagnosis
prognosis
treatment
What are we doing?
Medicalizing a human tragedy
A western diagnostic system imposed on “normal” responses to extreme trauma
Post-traumatic stress syndrome (PTSD)
Torture syndrome?
Depression, anxiety disorders, psychosis, substance abuse, neuropsychological
impairment, personality disorders
Dual loyalty of the prison doctor
IndependenceConfidentialityEffectiveness
Trust
Presence of officers during examinations?
Impunity for perpetrators
- a factor in PTSD
Therefore, impunity should be of concern to doctors
Degrading treatment
such as:
isolationovercrowding
impoverished regimelack of outdoor exercise
inhuman material conditions
Degrading treatment
Why oppose?Because it is a
Medical problemor Human Rights Violation?
Message to the authorities
from NPMs with a doctor
and without a doctor e.g. regarding health consequences
of ill-treatment- What about the “consequences” of
degrading treatment?i.e. of being subject to a
violation of human rights. Is a doctor needed for that?
Judicial importance of the NPM's / doctor's statements on health consequences
of ill treatment
e.g. when the ill treatment is accepted and generally used by the same judiciary,
arguments must be strong and persuasive.
We ask prison doctors to not only describe medical findings in the records,
but ALSO the victim's explanation and any allegations there might be,
AND the doctor's opinion on the compatibility of the allegations and the
medical findings.
The same should be expected from the NPMs' doctors
If the NPMs come across a case of injury or physical consequences of suspected ill-
treatment, there must be a way to determine the compatibility.
Non-medical monitors should at a minimum be able to describe physical signs of
possible ill-treatment in detail in order to get an opinion on them from an outside doctor (IMAP?) and ask for their opinion, including
of the compatibility with any allegations.
What about possible mental health consequences of ill-treatment?
Can non-medical monitors be expected to describe the psychiatric signs and
symptoms that might have resulted from ill-treatment?
Is it also possible to describe this in detail and ask the opinion of an outside
psychiatrist?Answer: Yes, to a certain degree.
Health care services
Assessing the quality and quantity of the provision of health care,
including the capability of the services to deal with trauma
properly, confidentially, independently and effectively,
in order to have a preventive effect
Independence from prison management. Under MoJ or MoH?
Staff recruitment.
Doctor-patient relationship
sufficient trust, allowing a preventive role
of health care staff
FacilitiesEquipment
Availability of proper medication
Participation of health care staff in ill-treatment?
E.g. assessing wether the victim can tolerate more ill-treatment
Assessing capacity for isolation
- not conducive to formation of a doctor-patient relationship
The doctor-patient relationship
Why the big fuss?
What can NPMs without doctors do then?
Can they assess mental health consequences of torture/ill-treatment?
Can they assess health care services in prisons?
Many policy matters are not merely medical issues
e.g. prevention of health consequences of ill-treatment.
Is this degrading treatment or not? Who decides?
Limits of the role of the doctor
Others may be more qualified e.g. in assessing whether conditions are degrading
or treatment is adequate
Is a doctor needed?
Depends on the doctor