A/HRC/44/37 of Development and Social Inclusion, the Directorate of Indigenous and Afro-Honduran Peoples and the Secretariat for Human Rights is to improve the delivery of adequate health care in prisons for indigenous persons. That includes measures to ensure prompt diagnosis and treatment of chronic diseases, including tuberculosis. 18 40. In Senegal, the OHCHR Regional Office for West Africa, in partnership with the Observatory of Places of Deprivation of Liberty and the Association of Senegalese Women Jurists, monitored 10 women’s prisons in 2018, interviewing approximately 90 per cent of detainees. The monitoring covered issues related to gender-specific hygiene and health care needs, reproductive health services, women detained with their children, rehabilitation and judicial proceedings. Following engagement with the prison authorities, cardiologists, ophthalmologists, gynaecologists and psychologists were mobilized to provide medical consultations and treatment; the Ministry of Justice committed to document and review all cases of prolonged pretrial detention, including a review of women detained with their children in line with Bangkok Rules Nos. 49–52; and the Director of Criminal Affairs and Pardons committed to implementing measures to review sentencing and raise awareness among judges of applying alternatives to detention. 41. In 2019, the Subcommittee on Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, developed a checklist on health care issues related to the monitoring of places of detention for national preventative mechanisms (CAT/OP/7). Recognising the quality of health care in prisons as a crucial indicator in assessing the risk of cruel, inhuman and degrading treatment and torture, the self-assessment checklist aims to ensure that national preventive mechanisms cover health-care issues comprehensively in order to fulfil their preventive mandate. The checklist consists of six categories of healthcare issues, based on the Mandela Rules and the Istanbul Protocol. Addressing mental health care in prison 42. Addressing mental health care in prison remains a critical challenge. Prisons are not therapeutic environments and in many jurisdictions, mental health services are insufficient or absent. Rules 2 and 5 of the Mandela Rules require prisons to make all reasonable accommodation and adjustments for prisoners with physical, mental or other disabilities, in order to ensure access to services and programmes on an equitable basis. 43. Women offenders often have high rates of prior physical and mental illness and trauma, substance dependency and, once detained, self-harm, and relatively high rates of suicide (A/HRC/41/33, paras. 13 and 16). Rules 12 and 13 of the Bangkok Rules emphasize that mental health issues can become more acute in detention. To address rehabilitative needs, interventions that address gender-specific, individualized psychosocial and psychiatric care are needed. 19 Under the Bangkok Rules, whenever possible non-custodial measures are recommended and sanctions in the case of women who already have a mental disability are preferred (rule 60). 44. In June 2018, the Government of the United Kingdom published a strategy for female offenders. 20 The strategy is part of a whole-system approach to female offenders, which recognizes that female prisoners report poorer mental health than male prisoners (49 per cent of women compared to 18 per cent of men), with higher levels of suicide attempts, psychosis, anxiety and depression. The strategy includes taking a gender-responsive, trauma-informed approach to helping women address factors that bring them into the justice system. In addition, a community sentence treatment requirement protocol has been developed to improve access to mental health and substance misuse services in order to address the underlying reasons for offending. Among offenders serving community orders, overall nearly one third have mental health conditions (29 per cent) with a 46 per cent prevalence among women.21 The protocol recognizes that when a person’s individual vulnerabilities become the reason for offending, that needs to be effectively addressed. Where appropriate, community 18 19 20 See contribution from Honduras (unofficial translation). A/HRC/38/36, paras. 29, 30, 72 and 98. Ministry of Justice, “Female offender strategy” (2018). C:\Users\Veronique.Lanz\Downloads\www.gov.uk\government\publications\femaleoffender-strategy 21 Ministry of Justice, “Vulnerable offenders steered towards treatment”, 10 August 2018. 9