Behind the walls: health and psychosocial needs of incarcerated youth in Haiti
When bumping along the streets of Port au Prince, Haiti, you don’t always think about who lives behind the building walls you see from your car. But today, along with Daniel Joseph, the USAID ASSIST Resident Advisor in Haiti, I had a glimpse into life for 129 teenage boys living behind the walls of a juvenile prison, Centre de Reeducation des Mineurs en Conflit avec la Loi (CERMICOL). These boys range in age from 13 to 17 years and have been incarcerated for alleged crimes ranging from theft to rape and murder. Pretrial detainment is a common occurrence with only 8 of the 129 boys having appeared before a judge, resulting in some boys imprisoned for one or two years without a court appearance.
Daniel and I met with Karine Duverger, Program Director, and Pierre Mineuve, both staff in “Health through Walls” (HtW), a USAID-supported program. Since 2001, HtW has been providing health care services in Haiti’s overcrowded, understaffed and under-equipped prison system. A primary focus of this effort is the identification, prevention, and management of infectious diseases, especially HIV/AIDS and tuberculosis. TB testing is mandatory and about 5% of the children test positive for TB. HIV testing is voluntary and 3 of the 129 youth have tested positive for HIV; 10 tested positive for syphilis.
I was impressed to learn that a psychiatrist visits the prison once a week to evaluate children in need of psychiatric treatment. Two of the boys from CERMICOL and 1 girl from a nearby prison that houses both women and girls are on psychiatric medications. I was pleasantly surprised that the children received psychiatric treatment because Haiti does not have an officially approved mental health policy nor is mental health specifically mentioned in the general health policy even though neuropsychiatric disorders are estimated to contribute to 10.7% of the global burden of disease in Haiti (WHO, 2008). Government and donor funding for mental health is extremely low and according to the WHO Mental Health Atlas (2011), there are only about 20 psychiatrists practicing in Haiti (estimated 10.2 million population).
HtW is one of the several organizations that will be working with the Haitian government through the Institut Du Bien-Etre Social et de Recherches (IBESR) and USAID ASSIST to implement the Minimum Care Guidelines for Vulnerable Children adopted by IBESR in November 2014. The guidelines reflect best practices in providing care and support services to vulnerable children and families in the areas of health, nutrition and food security, education, legal protection, psychosocial support, housing, and economic strengthening. Now that the guidelines have been nationally endorsed, USAID ASSIST is providing technical support to IBESR and service delivery partners to implement the best practices throughout the country.
One of the first steps in our work with HtW will be to identify current gaps in care and support for the incarcerated children. There are of course many needs, so we will want to focus in on those that we can realistically address. That process has already begun. In our initial discussions today, Pierre noted that there are significant gaps in psychosocial services for the boys. Though they have a recreation space outside, there is no recreational equipment. A psychosocial evaluation is conducted on the boys but there is no structured follow-up to the evaluation. Many of the boys don’t have basic hygiene items. A few have visitors that will bring them needed products, some will sell their food to other boys to get items they need.
A particularly challenging gap noted by the HtW staff is in services needed to prepare the boys for release from the facility. When the boys are released they don’t have the skills to support themselves. Their families have often made it clear that they are not welcome at home. Some are already fathers. Many don’t have birth certificates and may not even know where their parents are. There is some discharge planning for those with TB or HIV but the planning is limited to control of the disease, not the many other social and economic issues that face the boys outside the prison. The HtW staff estimated that approximately 75% of the boys return to the prison system, sometimes the only alternative to dying on the streets or joining street gangs. Advocating for community responses and resources to address the issues of re-integrating these boys into society will be critical in the improvement process.
This will be an innovative project using improvement methods in an adolescent prison setting. Improvement teams comprised of multidisciplinary stakeholders from the facility, community and government will soon begin to address the identified gaps with this population of children. Adapting the Minimum Guidelines to this context, to the unique needs of this population, is going to be an important learning experience for IBESR and HtW. We look forward to learning with them.
 World Health Statistics 2008, World Health Organization
 Mental Health Atlas 2011 - Department of Mental Health and Substance Abuse, World Health Organization