Correctional health: Visitation of inmates in segregation


It is important that the doctor visit inmates in segregation on a daily basis. There are many reasons why inmates end up in segregation

  • Psychopathy; this is also called antisocial personality disorder (APD) or dissociative personality disorder (DPD). It is characterised by boldness (lack of fear), impulsiveness, meaness. There seems to be two types; psychopathy and criminal psychopathy. The latter has characteristics that make them more prone to violence and other overt antisocial behaviour.
  • Another group that end up in segregation are the inmates involved in gangsterism. They like to categorise other people. You are either for them or against them. This paranoid trait makes their behaviour unpredictable in the clinical setting. Gangs have members that are the “enforcers of gang laws”. ¬†Assault by such members on staff is a risk.
  • Non-conformers; inmates that do not conform with prison rules end up in segregation. They either smuggle with contraband, plan escape or do not obey the rules.
  • Psychiatric inmates; it is important to identify these inmates as they may be in need of psychiatric intervention. The problematic cases are the ones which have psychiatric problems as well as behaviour patterns as mentioned above.
  • Medical conditions; the inmate with hypoglycemia, hyperglycemia, dementia (such as HIV dementia), delirium due to pneumonia or sepsis, sickle cell crisis may end up in segregation due to non-conformance. It is crucial that they be identified and managed appropriately.

There is always the risk of suicide and violent attempts in segregation. Care must be taken in monitoring them closely.

If the risk for violent behaviour during consultation is too high, do not enter the cell if it not an utmost emergency. Delay the visit to a later stage.

A custody member must always be in close proximity during consultation, without overtly compromising confidentiality.

Hunger striking inmates must be moved from segregation to the prison hospital as soon as their health starts deteriorating. If they are not taking in any water the transfer should take place immediately.

If there was “use of force” by custody staff on any of the segregated inmates, they must be examined by the doctor.