TREATMENT OF DRUG OFFENDERS IN THE
MAURITIUS PRISON SERVICE
Deepak Roomesh Gunnoo＊

I. SITUATIONAL ANALYSIS ON SUBSTANCE ABUSE IN MAURITIUS
Mauritius is a small developing island1 in the Indian Ocean with a population of around 1.35 million andwith a population growth rate of 0.59%. Of this population 43.75% is composed of the age group 25-54, bothmale and female included. With a 5% of GDP expenditure on education, the total population literacy rate is
92.7%2.
According to Natarajan (2016)3, developing countries are more prone to various types of crimes ranging
from very simple to the most complex offences including sex trafficking, murders and drug trafficking. The
author further stated that most serious offences around the world have been recorded in developing
countries. As in all developing countries, the incidence of crime is fairly high in Mauritius. During the year
2016, statistics4 showed a decreased of 3% in the number of drug offences perpetrated in 2016 in contrast to2015, resulting in the stabilization of the drug offence rate to 2.7 per 1000. In 2016, out of the 3,370 drug
offences reported, 57% were gandia (Cannabis) related offences, 25% heroin related offences, 5% forsedatives/tranquilizers and 1% for buprenorphine. The remaining 12% represented other types of drugs
which included mainly synthetic cannabinoid, methadone and hashish. During a study carried out in 2015 by a
Non-Governmental Organization (Pils. mu, 2018)5, it was reported that more than half of Mauritians
interviewed (N = 600) stated their lives were somehow directly or indirectly influenced by the drug problem
across the island. Furthermore, the organization stated that drugs topped the list of social problems in the
country due to the fact that more and more complex types of drugs including synthetic substances werebeing easily introduced into the drug market. As mentioned earlier, Cannabis is more rampant over the islandand is consumed by people from all walks of life in the Mauritian society. This is because most Cannabis
consumed by Mauritians is being cultivated and produced locally. However, the perception of the Mauritian
population towards Cannabis is diverse as it generates mixed emotions and feelings.
 36% think that cannabis is harmless if a reasonable amount is consumed;
 33% think that cannabis is harmful; 34% think that cannabis must not be considered as a crime and must be treated just like cigarettes
and alcohol; 46% claim that the law must make a difference between cannabis and other illegal substances;
However, the use of heroin and other intravenously administered substance are still rampant over theisland.

Senior Hospital Officer, Mauritius Prison Service.
http://www.ssr.org/DevelopingCountries
2
Indexmundi.com. (2018). Mauritius Demographics Profile 2018. [online] Available at: https://www.indexmundi.com/mauritius/demographics_profile.html [Accessed 22 Apr. 2018].
3
Natarajan, M. (2016). Crime in developing countries: the contribution of crime science. Crime Science, 5(1).
4Statsmauritius.govmu.org. (2018). Statistics Mauritius - Crime, Justice and Security Statistics - Year 2016. [online] Available at:
http://statsmauritius.govmu.org/English/Publications/Pages/CJS_Stats_Yr2016.aspx [Accessed 22 Apr. 2018].
5
Pils. mu. (2018). [online] Available at: http: //pils. mu/wp-content/uploads/2017/03/TNS-Image-and-perception-of-drugs-inMauritius.pdf [Accessed 22 Apr. 2018].
＊
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II. LEGAL FRAMEWORK TO ADDRESS SUBSTANCE ABUSE IN MAURITIUS
A. Political Will
Political activities have an influence on national policies targeting the fight against drug abuse andtrafficking6. Therefore it is obvious that political will is an indispensable factor towards tackling drug
problems in a society. In June 2017, according to a Government Press release7, the Prime Minister Hon
Pravind Kumar Jugnauth reiterated his determination and commitment to deploy all means to combat thesurge of drugs which is causing enormous harm to the Mauritian society.
In the same breath, Dr. Abdool Reychad, consultant, United Nation Office on Drug and Crime (UNODC),
expressed satisfaction regarding the fruitful discussions with the Prime Minister on issues of drug trafficking
and crime, approaches to prevent drug proliferation targeting both local and foreign drug dealers and their
networks as well as drug consumers.
In that context, the elaboration of the National Drug Control Master Plan was the focus of a three-day
workshop held from 31 May 2017 to 02 June 20178 under the aegis of the Prime Ministerʼs Office incollaboration with the UNODC. Various stakeholders including government officials and Non Governmental
Organizations participated in discussions. In January 2018, the Prime Minister announced the setting up of a
National Drug and HIV council to strengthen the fight against drug abuse, drug trafficking and drug lords,
and HIV/AIDS9.
B. Dangerous Drug Act
Thanks to committed political will, the legislature has enacted law enforcement policies against drugtrafficking and abuse. The Dangerous Drug Act10 was enacted in year 2000 and later amended in 2003. The
fundamental aim of the Act is as follows:
To consolidate the law relating to dangerous drugs and to make further and better provision for thecontrol of dangerous drugs, the treatment of addiction, the prevention, detection and repression of drugtrafficking, the prevention of laundering of drug money in Mauritius, the sentencing of drug-traffickers,
seized assets of drug offenders to be vested in designated institutions, restriction of bail and minimum
penalties in respect of certain serious drug offences and the punishment of persons making false
statements in relation to drug offences.
C. Drug Control Master Plan for Mauritius
The National Drug Control Master Plan shall empower institutions, communities and individuals in their
response to drug trafficking and use through law enforcement, prevention, harm reduction and treatment fora safe and healthier Mauritius while maintaining human rights.
The master plan shall target specific areas, namely drug supply reduction, drug demand reduction, harm
reduction and coordinating mechanisms among the various drug fighting stakeholders.

III. INCARCERATIONAs a main component of the criminal justice system, the Mauritius Prison Service is entrusted with the
Ryder, D. (2008). Political and legal institutions and their influence on drug policy: an Australian perspective. Drug and Alcohol
Review, 27(4), pp.374-379.
7
Govmu.org. (2018). Republic of Mauritius- UNODC pledges assistance to elaborate Drug Control Master Plan for Mauritius.
[online] Available at: http: //www. govmu. org/English/News/Pages/UNODC-pledges-assistance-to-elaborate-Drug-ControlMaster-Plan-for-Mauritius.aspx [Accessed 24 Apr. 2018].
8
Govmu.org. (2018). Republic of Mauritius- Elaboration of a Master Plan to fight drug scourge in Mauritius. [online] Available at:
http: //www. govmu. org/English/News/Pages/Elaboration-of-a-Master-Plan-to-fight-drug-scourge-in-Mauritius. aspx [Accessed
26 Apr. 2018].
9lexpress.mu. (2018). PravindJugnauth: «Un National Drug and HIV Council sur pied cette année». [online] Available at: https://www.lexpress.mu/article/323880/pravind-jugnauth-un-national-drug-and-hiv-council-sur-pied-cette-annee [Accessed 24 Apr.
2018].
10
Apps.who.int. (2018). [online] Available at: http://apps.who.int/medicinedocs/documents/s18370en/s18370en.pdf [Accessed 24
Apr. 2018].
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main duty of keeping prisoners in custody after they have been convicted by the Judiciary. An averageamount of Rs 775 was spent daily to maintain a detainee in 2016 on the Island of Mauritius11.
A. The Mauritius Prison Service
The Mauritius Prison Service (MPS) is a public service and is under the aegis of the Ministry of Defense
and Rodrigues. The MPS comprises ten penal institutions, including one in Rodrigues and one modern prison
named Eastern High Security Prison. Prison institutions are classified as high, medium and low security
prisons in terms of security rating. The more the security is high, the higher the wall, barbed wire fencing,security checks, dog surveillance, use of metal detectors and the more searches of prisoners and premises. On
the other hand, a low security prison will be one which provides low security measures, open conditions forinmates and opportunity for outside labour and contact visits with relatives. It also includes one prison forfemales and one for juveniles. The Mauritius Prison Service12 is accountable for protecting the public bykeeping detainees in safe custody while exercising a duty of care. In order to meet national and international
norms, changes are brought at regular intervals. It aims at achieving this through investment in staff
development and support. It also aims to manage their resources effectively and efficiently, to work to clear
objectives, to value diversity and to provide a healthy environment where rehabilitation takes place. These
are the main missions of the Mauritius Prison Service.
B. Statistics on Drug Offenders Detained in Penal Institutions
Table showing the number of persons (male) convicted for drug offences from 1990 to 2016
Year

HeroinGandiaOpium

Others＊

Total

Total numberof Detainees

Percentage

1990

62

92

6

2

162

969

16.7

1991

74

88

0

10

172

998

17.2

1992

95

61

1

3

160

887

18.0

1993

177

74

0

0

251

1025

24.0

1994

255

97

0

5

357

1162

30.7

1995

326

110

1

6

443

1276

34.7

1996

338

127

2

6

473

1428

33

1997

242

139

3

11

395

1378

29

1998

124

161

0

14

299

1228

24.35

1999

153

123

1

7

284

1044

27.2

2000

234

128

-

7

369

1305

28.2

2001

310

154

-

12

456

1672

27.2

2002

369

136

-

16

521

2110

24.7

2003

404

121

-

9

540

2295

24.1

2004

372

97

-

222

691

2400

28

2005

344

50

-

249

643

2323

27

2006

315

59

-

202

576

2423

23

2007

227

40

-

311

578

2626

22

2008

305

97

-

352

754

3032

25

2009

162

67

-

431

660

3517

18

Statsmauritius.govmu.org. (2018). Statistics Mauritius - Crime, Justice and Security Statistics - Year 2016. [online] Available at:
http://statsmauritius.govmu.org/English/Publications/Pages/CJS_Stats_Yr2016.aspx [Accessed 26 Apr. 2018].
12
Prisons. govmu. org. (2018). Mauritius Prison Service - Goals and Objectives. [online] Available at: http: //prisons. govmu.
org/English/AboutUs/Pages/The-Minister.aspx [Accessed 24 Apr. 2018].
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2010

103

111

-

398

612

3551

17

2011

97

104

-

340

541

3250

17

2012

53

43

-

381

477

2905

16

2013

102

96

-

126

324

2710

12

2014

57

113

-

91

261

2437

11

2015

116

115

-

-

231

2725

8.47

2016

110

129

-

65

304

3434

8.55

Source: Mauritius Prison Service13
Table showing the number of persons (Female) convicted for drug offences from 2001 to 2016
Year

HeroinGandiaOpium

Others＊

Total

Total numberof Detainees

Percentage

2001

15

06

-

-

21

59

35.6

2002

17

04

-

03

24

99

24.2

2003

18

07

-

09

34

103

33

2004

17

04

-

08

29

78

37.2

2005

17

04

-

08

29

80

36.3

2006

10

02

-

16

31

93

33.33

2007

10

-

-

08

18

87

20.7

2008

16

01

-

16

33

103

32

2009

11

02

-

12

25

123

20

2010

14

01

-

12

27

112

24

2011

11

15

-

14

40

122

33

2012

7

7

-

23

37

125

30

2013

7

-

-

19

26

124

21

2014

7

2

-

6

15

92

16

2015

5

6

-

14

20

86

23

2016

9

2

-

4

15

112

13.4

Source: Mauritius Prison Service14
C. Induction Procedure
1. History Taking through Motivational Interviewing
The main purpose of induction procedures is to take over the convicted person who is about to discover
the penal world. The induction process mainly revolves around interviewing the detainee to elicit relevant
information in connection to his or her substance abuse history. On the very first night, the detainee isconfined according to his/her physiological needs.

Prisons.govmu.org. (2018). Mauritius Prison Service - Total number of persons (male) convicted for drug offences from 1990 to
2016. [online] Available at: http: //prisons. govmu. org/English/statistics/Pages/drug-offences-Male. aspx [Accessed 25 Apr.
2018].
14
Prisons.govmu.org. (2018). Mauritius Prison Service - Number of persons (Female) convicted for drug offences from 2001 to
2016. [online] Available at: http://prisons.govmu.org/English/statistics/Pages/drug-offences-Female.aspx [Accessed 25 Apr.
2018].
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2. Health Screening
On admission to the prison, every detainee is seen by a doctor who assesses the detaineeʼs general health.
All detainees are offered Provider Initiated Counselling and Testing as screening procedures for HIV. Subject
to clinical observation by the Prison Medical Officer, further pathological and radiological tests are requested
as and when needed. The same process is observed when he is released. During the period of detention,
whenever the need arises, the detainee can be seen by the doctor at the prison hospital or dispensaries forany health problem. In addition, detainees requiring specialist treatment are referred to public hospitals.
D. Sentence Planning
A sentence plan is made for prisoners serving long-term sentences. Sentence planning is in fact a planabout how a detainee will spend the time in prison. It is concerned with addressing the different needs ofdetainees while making optimum use of their time in prison. It aims at providing programmes to suit theirneeds, to keep them busy, to prevent them from being idle and to help them to lead a useful life after theirrelease from prison. The sentence plan is the key tool for identifying what an offender will do during theirsentence, based on an assessment of the factors associated with their offending, thus enabling prison
authorities to achieve the aims of the sentence.
It is also concerned about placing prisoners in institutions with varying degrees of security. The first day
a person is imprisoned, he is detained in a high or maximum security prison depending on the gravity of thecase. When reaching fifty percent of his term of imprisonment, he is transferred to a medium security prison
and at the last stage of imprisonment; he is once more transferred this time to a low security prison, thereby
planning for his release and facilitating reintegration in the society. Unfortunately, no such facility is available
for women. However, rehabilitation programmes exist; they are also employed outside prison walls. A new
open facility for women is now open to ease detention of female detainees in view of enhancing therehabilitation process.

IV. REHABILITATION OF DRUG OFFENDERSThe MPS offers a range of rehabilitation programmes to inmates with a view to provide them with new
skills to facilitate their integration in society after release. The programmes range from educational,
vocational, spiritual and also life skills.
Since January 2012, the Mauritian authorities have launched a raft in the prisons of the island, to allow
inmates to acquire skills, to regain their freedom. 1,060 prisoners in six prisons in Mauritius are now
benefiting from this programme of rehabilitation through labour, which has an annual government envelopeof 7 million rupees. Inmates eligible and subject to strict discipline where the work is honoured are paid at therate of Rs 20-30 per day for their efforts in learning of a work which is an effective passport for personal
reintegration into civilian life.
Training workshops with the key qualifications, such as cooking, baking, masonry, tailoring, carpentry, arethus provided to prisoners of Mauritius to eventually reduce the recurrence rate, once outside.
A. Lotus Center
The Lotus Center is an in-house rehabilitation centre which saw the light of day in 1985. However, due to
its reduced activities, the project was re-engineered in 2018 by the prison authorities in collaboration with the
National Agency for the Treatment and Rehabilitation of Substance Abusers (NATReSA), the National AIDS
Secretariat and various Non-Governmental Organizations15.
The Lotus Programme is a Residential Rehabilitation and Day Care programme in prisons across theisland which aims at helping detainees to be free from addiction, encouraging them to participate inrehabilitation programmes to gain greater self-awareness to live a drug free life, and preparing their re-entry
in the community with the involvement of stakeholders. It is a new era in the Prison Department where an
integrated approach is adopted to treat substance abusing detainees based on medical and therapeutic
Le Mauricien. (2018). RÉHABILITATION DES DÉTENUS: Réouverture du Lotus Centre à la prison centrale - Le Mauricien.
[online] Available at: https://www.lemauricien.com/article/r%C3%A9habilitation-des-d%C3%A9tenus-r%C3%A9ouverture-dulotus-centre-%C3%A0-la-prison-centrale/ [Accessed 26 Apr. 2018].
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community models combined with a multi-disciplinary concept.
In the same line, a new Lotus Center was put in operation in October 2017 in collaboration with the
Ministry of Health & Quality of Life at the Eastern High Security Prison which is the most recent penal
institution of the island having a capacity of around 1,000 detainees. According to the Health & QL Minister,
who proceeded for the inauguration in presence of the Commissioner of Prisons, his Ministry is working inclose collaboration with the Prisons Department to better handle detainees who use drugs. The Lotus
Programme, he added, will help the Prison Department achieve one of its goals, that is, making detainees
drug-free and substance misuse-free so that they can have better opportunities when they leave the prisonsand there is less chance of them reoffending on their release16.
B. Non-Governmental Organizations
In order to sustain the activities of the Lotus Center in view of addressing the needs of illicit drug users
among Mauritian detainees, the support and collaboration of various NGOs are sought due to their expertisein relevant fields.
C. Sensitization and Awareness Campaigns
Sensitization and awareness campaigns are mostly run by Prison Hospital Staff. As from the induction
phase, awareness is raised among newly admitted detainees, and they are sensitized about the salient healthissues orbiting around their incarceration. As an ongoing educational programme for detainees, prison nurses
are called upon to deliver health education to inmates undergoing the rehabilitation programme in the Lotus
Center. Issues such as the function of the human body, pathology in connection with substance abuse, HIV /AIDS, non-communicable diseases among others are discussed with inmates.
D. Vocational Training
Various skills are provided to prisoners. The aim is to reshape them and provide others with new skills.
They can use these skills to earn a living on release. Numeracy and literacy are also provided to those whoare in need. And where an in-prison business partner is involved in providing work, they will help design thevocational skills delivery that supports that, exactly as they would outside. Moreover, these partners employ
some of the prisoners on their release.
A prison that is a place of work and industry will instil in offenders the disciplines of working life: order,
timekeeping, working within deadlines, being managed and overseen. These are skills that employers want,
for they comprise the elements of responsibility which make lives normal. When allied to vocational skills, exoffenders who have gained these ʻlife-skillsʼ ̶ the fabric of responsibility ̶ become more attractive potential
employees and better husbands, parents, neighbours and friends.
Facilities are provided to prisoners who wish to study further. The MPS provides prisoners who are
studying advanced courses with electronic tablets and internet facilities.

V. THERAPEUTIC TREATMENT OF DRUG OFFENDERS IN PENAL INSTITUTIONS
Prison contains the largest concentration among the most at risk population which are over-represented
within the prison community. The marginalized and vulnerable groups such as injecting drug users,
commercial sex workers, mentally ill and HIV/AIDS inmates are all compounded within prison. The majorityof prisoners have multiple health problems.
There are high turnover and mobility rates among the detainees. The average stay is short and the return
rate is high, thus making the prison population a significant vector of inward and outward transmission of
HIV and other infectious diseases. Imprisonment is a unique opportunity for all aspects of health promotion,
health education and disease prevention. Thus, prison health staff has to take an active role in the prevention,
as well as the care, of mental and physical health problems and provide the foundation of a healthy
environment. As a major service provider of a high-risk group population, prison could seize this opportunity
Govmu.org. (2018). Republic of Mauritius- Mauritius Prison Service must contribute to eradicate drug problem, states Minister
Husnoo. [online] Available at: http: //www. govmu. org/English/News/Pages/Mauritius-Prison-Service-must-contribute-toeradicate-drug-problem,-states-Minister-Husnoo.aspx [Accessed 26 Apr. 2018].
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to attend to their health care needs and provide care support and treatment programmes aimed at reducing
and changing high-risk behaviour patterns during incarceration and after release.
A. Substance Abuse
Problematic drug users are among the most vulnerable among prisoners, and are over-represented within
the prison population, often due to a growing trend towards the criminalization of drug use and possession
and the use of custodial sentences for drug-related crime.
B. Harm Reduction Strategies
1. Methadone Substitution Therapy
Since November 2006, about 5,000 drug users have been induced on methadone at the national level, andprisons had registered about 3, 310 that have been detained and that 346 among them are currently on
Methadone Substitution Treatment in prison. Since December 2011, detainees were induced on methadone at
the prison level and 324 among this group have already been induced. There is a weekly intake of 5 induced
on methadone. Diversion of methadone is becoming a recurrent feature in prison. About 115 cases ofdiversion of methadone have been reported since implementation.
C. Treatment of People Living with HIV/ AIDSThe Mauritius Prison Service has hosted 51.9% of national cumulative HIV positive cases, among which
about 33% are injecting drug users. The daily average of HIV/ AIDS inmates in prison is about 394,
representing 16.4% of the actual prison population. Prison had registered 1,508 detainees on anti-retroviraltreatment (ARV) and that 300 among them are still serving prison sentences. HIV diagnosed detainees are
given adequate treatment and follow up. Patients are seen regularly by HIV physicians; pathological tests arerequested on each subsequent medical consultation and treatment is tailored for each patient.

VI. CHALLENGES
A. Inadequate Resources
The treatment of illicit drug users in prison is a multi-disciplinary approach and involves complex
activities such as prevention, screening, sensitization, and treatment, care and support. The Mauritius Prison
Service has established an effective therapeutic psychosocial approach that relies on funding from externalorganizations like the Global Fund to sustain the treatment of drug offenders in its various penal institutions.
B. Lack of Trained Personnel
The involvement of prison personnel, especially the prison hospital staff, is indispensable for the optimum
delivery of care to drug offenders. The prison staff is trained in correctional services and general healthservice but is not adequately trained to provide specific and up-to-date care and support to illicit drug users
detained in prisons.
C. Gang Affiliation and Peer Pressure
The affiliation to prison gangs among detainees is a current practice. In so doing, detainees are most of thetime subject to peer pressure which influences the treatment of patients. Irrespective of their intrinsic
motivation, detainees who have opted to benefit from substance abuse treatment often halt their treatment
due to peer pressure.
D. Availability of Illicit Drugs and Relapse
There are a significant number of traffickers detained in prisons. Hence the availability of illicit
substances allows drug users to obtain their daily dose with ease. The fact that these people are sustaining
their addiction, they are not interested in health services and treatment offered to them by the MPS. On theother hand, illicit drug users who have been recruited in substance abuse treatment programmes are often
subject to relapse due to the availability of their preferred illicit substances.
E. Access to Prevention Commodities
Illicit drug users are prone to developing adverse health conditions such as blood-borne communicablediseases namely HIV and Hepatitis. Furthermore, some detainees often engage in high risk sexual activities
which may have health related consequences. Illicit drug users do not currently have access to preventioncommodities, such as sterile needles and syringes and condoms for safer sex.
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F. Aftercare and Recidivism
The high recidivism rate17 in the Mauritius Prison Service impacts greatly on the treatment of drug
offenders in the various penal institutions of Mauritius. Detainees who have successfully completed theirsubstance abuse treatment in the prison are not taken care of when they are reinstated in the society. Withan accrued negative perception of the society towards ex-detainees, these persons often revert to their illicit
activities and come back to prison where they are influenced by their peers and restart illicit drug use.

VII. WAY FORWARD
In order to curb the negative pressure exerted by the above-mentioned challenges, with a view ofpromoting the treatment of illicit drug users in the Mauritius Prison Service, the prison staff has come up
with a few potential solutions to address these challenges.
A. Advocacy
The MPS has a dedicated Strategic Planning and Research Unit which needs to co-opt active participationof a staff member from the prison health care team to participate in research, the analysis of current situationand drafting of reports and documents for submission to higher authorities, policymakers, and unilateral,bilateral, international organizations. There is a need to advocate with judicial legal authorities in view ofpromoting alternatives to imprisonment such as non-custodial care of illicit drug consumers.
B. Capacity-Building of Staff
The MPS should train its personnel, especially the health care personnel in substance abuse, motivational
interviewing techniques, counselling, and social work among others to empower them to deliver optimum
health care service to the detainees. Therefore, capacity-building and empowerment should be thefundamental pursuits of the MPS to be better equipped to treat illicit drug users. With an optimal advocacy
level, the MPS may consider application for scholarships or training with international organizations in thefield under study.
C. Training of Peer Support
One of the best ways to fight gang affiliation and peer pressure is the implementation of an intramural
peer support network18 for each institution. These peer support groups will be responsible to create a healthy
relationship between inmates thereby instilling the element of trust among them. In this way, the applicationof health processes to treat illicit drug users may be more accepted.
D. Supply Reduction
The application of more rigid security measures to halt the entry of illicit substances inside prisons shallbe a focal activity of the Mauritius Prison Service. Decreasing drug supplies will certainly entail an increasein the need for medical care to palliate withdrawal, resulting in more detainees soliciting health care service.
E. Setting Up Harmonized Programmes Including Stakeholders
Consultative workshops must be held involving the various stakeholders fighting the drug scourge andaiming at giving out treatment and care to illicit drug users. There shall be a harmonized programme toshare confidential information of patients with external agencies such as rehabilitation centres, the national
HIV/AIDS units in view of reducing loss to follow up and to sustain treatment initiated in prison once a
detainee is released, which could represent an effective and efficient aftercare bridge.
F. Setting Up of a Dedicated Rehabilitation Centre
The setting up of a comprehensive centralized rehabilitation centre for the provision of care support andtreatment of illicit drug users detained in prison should be considered. The centre shall be a drug free unit
whereby clients shall be cared for in their cognitive, affective and physiological dimensions.

Globaljournals. org. (2018). [online] Available at: https: //globaljournals. org/GJHSS_Volume11/9-Trends-in-Incarceration-andRecidivism-in-Mauritius.pdf [Accessed 26 Apr. 2018].
18
Pacenterofexcellence.pitt.edu. (2018). [online] Available at: http://www.pacenterofexcellence.pitt.edu/documents/prison%20
based%20peer-15.pdf [Accessed 26 Apr. 2018].
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VIII. CASE STUDYAs the treatment of illicit drug users revolves around therapeutic intervention coupled with strong
psychosocial support, the application of the Health Belief Model is an ideal approach to cater for the healthneeds of illicit drug users incarcerated in the Mauritius penal institutions.
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict healthbehaviours (UniversiteitTwente, 2017)19. This is done by focusing on the attitudes and beliefs of individuals.
The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels
working in the U.S. Public Health Services. The model was developed in response to the failure of a freetuberculosis (TB) health screening programme. Since then, the HBM has been adapted to explore a variety oflong- and short-term health behaviours, including sexual risk behaviours and the transmission of HIV/AIDS
and drug addiction.
This present case study reports the intervention of prison hospital officers to address the issue of drug
addiction among a group of five prison inmates with history of substance abuse. The intervention was
extended on a six months period and was conducted in collaboration with the Prison Medical Officer, prison
psychologist and welfare officers. The programme encompassed medical care to cater for physiologicalsymptoms such as withdrawal and psychosocial support to enhance their morale.
The five inmates were recruited in the programme through peer contact tracing method and the inclusion
criteria were firstly, a history of substance abuse through intravenous use, and secondly, their remaining
sentence to be served should be more than six months representing the span of the programme and toprevent loss to follow up.
The programme was based on the application of the Health Belief Model, and all the constructs of themodel were applied in a very efficient and effective way. The HBM was spelled out in terms of fourconstructs representing the perceived threat and net benefits: perceived susceptibility, perceived severity,
perceived benefits, and perceived barriers. These concepts were proposed as accounting for peopleʼs “readinessto act.” An added concept, cues to action, would activate that readiness and stimulate overt behaviour. A
recent addition to the HBM is the concept of self-efficacy, or oneʼs confidence in the ability to successfully
perform an action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit thechallenges of changing habitually unhealthy behaviours, such as being sedentary, smoking, or overeating anddrug abuse.
The programme was launched through a focus group discussion whereby it was carefully explained andthe participants were reassured.
During that initial phase of the programme, all participants were encouraged to discuss their perceived
susceptibility with regard to their risky behaviour and their health. At first, they all averred that they areused to injecting drugs, and they found no reason to worry because they have been doing that for over a
couple of years and that nothing bad happened to them. The participants were then embarked on asensitization and awareness programme for two weeks where adequate information and education werecommunicated to them. As the perception of threat is dependent on the level of knowledge, the participants
were able to shift from a low perceived threat to a high one, thus increasing their perceived severity andsusceptibility about intravenous drug use.
The participants were aware of the impending dangers of injecting drugs, and they averred they wereprone to the very serious HIV infection which could affect their health with detrimental impact on their lives
and activities of daily living. Besides, they were also very much aware of the threat of the Hepatitis C virus
and the various physiological impacts of injecting drugs. On the other hand, they were also aware of harmful
health effects that may include inflamed and/or collapsed veins, puncture marks / track lines, skin infection
̶ abscesses, cellulitis, necrotizing fasciitis, bacteria on the cardiac valves, endocarditis, and other

UniversiteitTwente. (2017). Health Communication | Health Belief Model. [online] Available at: https: //www. utwente.
nl/en/bms/communication-theories/sorted-by-cluster/Health%20Communication/Health_Belief_Model/
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cardiovascular infections, swelling of the feet, ankles, and legs secondary to poor peripheral blood flow.
While the above are general injection-related health effects, there are some other dangers common to
drugs prepared with many adulterant chemicals, binders and other toxic substances. Black tar heroin, forexample, which is named after its tar-like consistency, contains a large amount of additives and contaminants.
These can cause local inflammation, clog blood vessels and contribute to widespread damage to the liver,kidneys, lungs and brain. The participants were very much aware of the severity of the consequences of
injecting drugs and that has given rise to a very strong perceived severity about injecting drug.
The next construct to be explored was their perceived susceptibility. Due to their increased perceived
severity, the participants were concerned about their state of health. They believed that since they regularly
indulged in injecting drugs, they were prone to develop adverse health problems. Furthermore, they had
shared needles with their friends, putting them at higher risk of contracting the HIV and the Hepatitis C
viruses. The participants were anxious of contracting HIV/AIDS and Hepatitis. They feared they would
develop the conditions and were very apprehensive of the need to undergo anti-retroviral treatment.
On the whole, all the five participants had a high perceived threat with regards to their health-related
behaviours. Since they were all aware of the threats they were facing and showed interest in modifying their
behaviour, the Methadone Substitution Therapy was proposed to them. It is to be noted that MST induction
is carried out in the prison setting itself and therefore would be easily accessible to the participants. After
explaining the benefits of such treatment to the participants, it was observed that their perceived benefits ofquitting intravenous drug abuse and starting Methadone Therapy had increased. They were encouraged dueto the fact that they could stay away from all the dangers of injecting drugs and at the same time they could
palliate their cravings for drugs and the high feeling.
Now that they had very high perceived benefits, the programme was becoming more challenging because
these participants were evolving in a prison setting and that various barriers could hinder their behaviour
modification. The issue was discussed with them, and it was obvious that they had a high degree of perceived
barriers. They stated that they fear not being able to sustain their actions and that they could in a certain
way find it difficult to adapt to their new lifestyle. They also averred of having tried to stop using intravenous
drugs but could not manage the withdrawal effectively due to the cost implication with regards to food andmedicinal items. The participants were reassured that they shall be given all the necessary facilities andsupport to help them embark on their health behaviour modification.
In order to facilitate the detainees to effectively and successfully be induced on MST and quit injecting
drugs, the programme coordinator advocated for certain privileges from the prison administration, whichwere acceded to. Thus some modifying variables were identified and addressed. The participants werehoused in a self-care dormitory away from other detainees. They were given facilities such as late nighttelevision, refrigerator, kettle and additional milk and food items. Thus they were placed away from peerpressure and they felt more comfortable. That enhanced their motivation to quit injecting drugs.
As cues to action, various strategies were employed. Health-related posters were placed in their
dormitory to remind them of the dangers of drug abuse and of the advantages of quitting and that ofMethadone Substitution Therapy. As the participants had a fairly high perceived severity and susceptibility
and benefits and at the same time their perceived barriers were reduced, the intensity of the cues to action
could be lower. Once in a while, rehabilitated drug addicts were invited to motivate the participants.
During the implementation phase of the programme, that is, around the second month, the participants
were placed on the MST and were followed by the Medical Officer, while the Psychologist and the Welfare
officers provided psycho-social support to them. The detainees were not indulging in injecting drugs andwere very adherent to MST. They showed very little signs of withdrawal due to their tailored treatment
plan. By the end of the fifth month, the participants stated that they were not thinking about drugs but about
their future, and they thanked the prison personnel for their support. They were released from prison andthey maintained their treatment as their self efficacy was very high.
However, due to harsh societal conditions for released detainees, two of these participants relapsed into
injecting drugs and were re-incarcerated.
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As a conclusion, according to Taylor (2006)20, the development of the Health Belief Model was ofpioneering significance in the early 1950s. Systematic analyses using the full range of components that it
today incorporates might cast light on the impact of social and other factors associated with inequalities inhealth, and the reasons why individuals and groups may not take up health improvement or protection
opportunities.
However, the HBM is not in itself clearly or adequately specified, and the available evidence indicates thatin practice its application appears to be inadequate for such purposes. Further, although the HBM may be
used to derive information that may then prompt interventions designed to change health beliefs andbehaviours, using the model itself cannot inform decision making as to how such interventions might best be
structured.
The value of the ʻperceived threatʼ element serving as a central indicator of behavioural motivation in the
HBM has been questioned. So has the phenomenological orientation of its design. Notwithstanding
components like perceived barriers and demographic and socio-economic descriptors, as normally applied
this model may be taken implicitly to assume that people are rational actors, driven by their conscious
perceptions of the world. This may misleadingly suggest that health behaviours can always best be
understood as being under volitional control, rather than in a large part determined by combinations ofcircumstantial reality and individualsʼ habitual, emotional, unconscious and/or otherwise non-rational
reactions to the external world. The research identified provides evidence that the overall explanatory powerof the HBM is limited, even simply as compared to that of alternative social cognition models.

prezi.com. (2018). HEALTH BELIEF MODEL. [online] Available at: https://prezi.com/1jprhmxjqg0j/health-belief-model/[Accessed 24 Apr. 2018].
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