We are Integritas Healthcare, the Christian faith-inspired medical organisation with a heart for detainees of all faiths and none.

We do this through five services that spell the word ‘heart’ - healthcare, expertise, advocacy, research and training.

Based in the UK and the Philippines for more than a decade, we concentrate on countries with poor human rights records or no developed offender healthcare system.

With others, we look towards a day when all of our world’s 11 million+ detainees receive holistic care and humane treatment.

We were born in 2012 as the brainchild of Drs Mark and Rachael Pickering, two English family medicine specialists (known in the UK as general practitioners) experienced in offender healthcare.

They wanted to make a values-driven response to the fact that some companies were making money-driven bids to deliver offender healthcare of varying quality within English police stations and other places of detention.

Our first commercial income came from providing family medicine services (known in the UK as general practice) to a high secure prison, and performing Mental Health Act assessments for those possibly requiring compulsory hospitalisation due to the risk of them risk of harming themselves or others.

Within three years, we branched out in spending our commercial income on helping detainees in countries with poor human rights records or no organised offender healthcare.

We’re often asked if we’re a registered charity, and the answer is no - not at this time. We are charitable but we are not a registered UK charity. In 2012 we incorporated through the UK Companies House as Integritas Healthcare Community Interest Company (CIC), number 8055441. This legal entity enables us to be not just commercial but also charitable in the broadest sense of the word - making income from high quality, low cost healthcare contracts and giving away as much money as possible. The downside to this legal form though is that, unlike a registered charity, we can neither apply for the vast majority of grants nor collect Gift Aid from the UK government.

In 2021 we incorporated through the Philippine Securities Exchange Commission (SEC) as Integridad: Heart for Detainees Inc. as a non-profit, non-stock company, number CN202101566. This legal entity is the nearest Philippine match to the British notion of a charity. Its board has the authority to administer our affairs in the Philippines and across the the rest of the Western Pacific and South-East Asia.

Mankind has used imprisonment for more than five millenia. And although things are still pretty grim in places, overall down the ages, conditions have become less inhumane and punishments less barbaric. For example, most countries now provide some food for their prisoners, and - unlike in Roman times - no modern country executes prisoners by forcing them into combat with trained gladiators! We have international rules about the standard minimum treatment of prisoners. Torture has been condemned - officially at least. And many countries have developed guidelines to decrease the arbitrariness of judges’ sentencing.

Yet many countries still have inhumane laws. And even where laws are humane, the rule of law isn’t always king. Within the criminal justice kingdom, the rich and powerful often escape justice, and the poor and weak often suffer injustice. Even within the particular realm of offender healthcare, ideas and standards of professionalism vary wildly.

Whatever the wrong is, it’s happening because of a lack of integrity - the quality of being honest and having strong moral principles that you refuse to change. We chose our name because many medical terms originate from Greek or Latin, and integritas is both Greek and Latin for integrity. We had to choose a separate name for our Philippine organisation, and chose integridad as it is both Spanish and Tagalog for integrity.

Our heart has always been for detainees, and other vulnerable patient groups who are at greater risk of ending up behind bars. Yet our array of services developed over time.

Healthcare and training always have been, and always will be, the beginning and end of what we do. Healthcare came first - caring for high secure prisoners and assessing the severely mentally ill. Then we started training, spontaneously teaching those working around us and allowing interested medical students to shadow us as we did our clinical work.

Our expertise and advocacy services developed over time, in response to the fact that we were encountering detainees who had been ill-treated by the authorities, were being treated in poorly functioning healthcare systems, or were receiving poor medical care from other practitioners. And our research service was born out of our efforts to ensure that we delivered evidence-based offender healthcare.

Before we knew it, we were providing five sets of services - healthcare, expertise, advocacy, research and training - that happily in English abbreviate to the acronym heart. Our heart for detainees was beating loud and clear!

Our decision to migrate right across the globe to the Philippines was the result of much prayer and research.

For starters, we decided to adopt the principle of taking the profit we made on commercial offender healthcare in the UK, which has a high standard of state-sponsored offender healthcare and spending it all on delivering humanitarian offender healthcare in states where detainees are not so fortunate.

We then researched which country to conduct a pilot project. We drew up a ranked short-list of five non-European Low and Middle Income Countries (LMICs), using eight criteria:

• calculable risk to personnel

• cultural acceptability of our strategic plan

• inability or unwillingness of local healthcare professionals to deliver services

• lack of state-organised offender healthcare

• linguistic ease

• presence of high degree of human rights infringement

• suitable local Christian NGO for initial partnership

• tolerance of the Christian faith

The Philippines scored highly across the board, and this Amnesty International report was particularly influential in our decision marking. After an initial research trip during Easter 2015, the Philippines won out as our preferred country for a pilot project. We committed to funding a year-long pilot project on the western side of its capital island of Luzon. And a decade later, we’re still there.

We considered this question as part of our emergency planning, as COVID-19 took hold of the world. What were we best at, what was most needed during the pandemic, and what should we let go of? Our thinking on this matter ended up getting on our eighth birthday as an Early Years Report.

At first our HIC income was able to support all of our LMIC activities. By 2017 our humanitarian expenditure was consistently matching our commercial income - we truly were non-profit! Then the pandemic hit and within three months our commercial income had collapsed. We considered folding, yet the need for our services was even greater during the pandemic. So we decided to continue in faith and we even we launched a new service to police detainees! Today this service forms the platform for our modern-day healthcare and advocacy services. And we continue to survive financially through faith in God’s provision.

Yes. We welcome volunteers of all faiths and none who are respectful of our Christian ethos. Approximately 50% of our short-term trainees (such as elective students) are non-Christian. That said, all of our longer-term client-facing volunteers and all of our staff are practising evangelical Christians; we invoke the occupational requirement within the UK Equalities Act 2010.

Absolutely not! By the very fact that they are deprived of their liberty, detainees are vulnerable. We never coerce anyone, let alone vulnerable clients, and we have clients of all faiths and none. Our care model is that of holistic care - treating and taking care of each patient as a unique whole body. This involves a bespoke assessment of their physical, social, environmental, psychological, cultural and religious needs.

We are responding to the fact that Christ mandated his followers (that is, Christians) to serve the marginalised - vulnerable patient groups including detainees. We do believe that the Christian faith is good for people but we never force it onto clients. What we do provide is holistic offender healthcare, delivered in the spirit of integral mission.

In general we are wary of short-term missions. In the Philippines, the established culture of ‘medical missions’ is having huge down sides including delaying the long-term development of government-provided community healthcare. We support the principles of the Brocher Declaration. And so, with rare exception, we neither organise nor participate in one-off short-term missions. Instead, we plan to provide stability through continuity of care, and to work in harmony with whatever government-provided healthcare is in place.

We do have short-term members of personnel:

• Ultra short-termers - such as OJTs - are with us for less than two weeks.

• Unlike many other agencies, we use the word short-termers to mean people like elective students, other trainees and general volunteers who are with us for more than two weeks but less than three months.

• Those with us for more than three months are regarded as staff.

Regardless of their title and exact duration of stay, we deploy short-termers safely by embedding them within our local teams.