Improving medical facilities in prisons would directly reduce the threat of violence and riots, according to doctors working in prisons around the State.
The Irish Prison Doctors Association (IPDA) said studies had shown that most prison riots were partly precipitated by "the appalling conditions and inhumane treatment" that existed in some institutions.
The doctors have been holding talks with the Irish Prison Service to improve prison healthcare for more than two years. The review was agreed after a bitter dispute over pay and conditions which came to a head when doctors from the Defence Forces were called in after prison doctors withdrew their services.
Asked about the current talks, the Irish Prison Service said "it would not be appropriate to comment on the talks as they are ongoing".
Dr Sohail Rasool, IPDA chairman, said the prison medical services must be brought into line with the primary healthcare facilities available in the community.
He singled out mental health services as an area needing reform.
"The mental health needs of the prison population are huge," he said. "Mental health services are not adequate for the inmates. The whole burden lies upon the prison doctor who tries to refer them to the designated hospital, through the in-reach teams, which have to provide services to all the prisons.
"The added cost of transferring patients to a distant psychiatric hospital is huge, not to mention the waiting period."
He called for adequate resourcing of local psychiatric hospitals to allow prisoners to be treated locally and to link this with training in forensic psychiatry.
Psychiatric illnesses are particularly common among female prisoners, according to Dr Thérèse Boyle, doctor at the Dóchas Centre, the female prison in the Mountjoy complex.
"There is a massive amount of psychiatric disease among women compared with male prisoners," she said.
However, women did not face such long waiting times to be seen.
Dr Boyle and Dr Rasool are two of the 19 full and part-time GPs who work in prisons. They are supported by about 80 prison nurses and 50 medical orderlies.
Dr Boyle said a lot of her time was spent on issues involving drug abuse. A high proportion of the 80 or so women prisoners at the Dóchas Centre have been imprisoned for drugs or drug- related crime.
Dr Rasool said all prisons must be free of illicit drugs because the interaction between prescribed drugs and illicit drugs could have "very serious and fatal consequences".
The incidence of diseases such as hepatitis C and HIV was also higher in prisons than in the general community, Dr Boyle said. "Remember that 80 per cent of people who inject with a needle are hepatitis C positive."
And because the female prison population is young, the incidence of age-related illnesses such as heart disease or diabetes is considerably lower at the women's prison than in the general population.
Dr Boyle said she did not have any major concerns for her own safety at the prison but there was always a nurse with her and a prison officer nearby. "You do get to know when a situation might escalate," she said.
Some prisoners confide in the GP as they see the GP as being outside the prison system, according to Dr Rasool, who works at the Midlands Prison in Portlaoise.
"The doctor could be the only person at times [ with whom] the prisoner could come and discuss private matters in confidence and shed tears," he said.
"It is an area of medicine that you could do a lot and gain great achievement and personal satisfaction, because you are dealing with multiple problems of medical, psychiatric, social and psychological natures all together."
