Comments
Comments
We strongly advise that you avoid lying to the prisoners or pressurising them to accept treatment since such acts are unlikely to promote a positive doctor-patient relationship. Failure to be truthful could also leave you open to criticism with the regulatory body for medicine for misleading patients and compromising their rights. If you fail to be open, their lawyers or other people may tell them about their right to refuse treatment and you will have lost credibility with the prisoners. It must be acknowledged that there is not an easy answer in this situation but the strategy we would recommend is that you seek to win the prisoners' trust by being frank and open with them. They may refuse treatment initially when they understand that it is not compulsory but they are more likely to respect you and listen to your advice in the long term if they believe it is honest. If they come to trust you, they may see that when you recommend a treatment for them, you have their best interests in mind and you are not just thinking about ease of management.
If, on the other hand, you concentrate on trying to persuade a couple of them to accept treatment (as suggested in answer d), they are likely to perceive that you are trying to manipulate the group dynamic or they may become even more resistant if they feel bullied. It is important to understand the psychology of the individuals and try to create opportunities for them to think about coming to terms with their past offending behaviour without necessarily appearing 'weak' or losing face in front of the group. They already know, as well as you do, that they will not get parole unless their behaviour seems to have been addressed and so, at some point, they will need to think about that even if you do not push them to do so.
Expert advice from psychologists may help you to find ways of engaging with the prisoners without appearing to manipulate, pressure or judge them. Some of them are likely to have suffered abuse themselves as children but, as a group, they avoid acknowledging to themselves that they have seriously harmed others by their behaviour. They need opportunities to talk about the past and realise the hurt that has been caused. Part of what unites them and gives them a feeling of strength may be the sense of 'us against them'. If you show that you do not despise them, as the other prisoners do, and you respect them as individuals, the sense of 'us against them' may be weakened in a positive way. Bear in mind, however, that telling these prisoners the truth and showing respect for them may cause you problems with your medical colleagues and prison staff. You need to be prepared for that and not expect to be popular at least until you can show positive results from your 'softly, softly' approach.