Health vs Justice

Health and Imprisonment work in constant tension.

Health and wellbeing, as described by Aboriginal people, is about Connection -to community, to family, to culture and to country.  

Imprisonment is about Disconnection from society. 

In our Australian prisons and youth detention centres these two processes are basically working at cross purposes. 

Prisons in Australia by design are unhealthy places. They are places to exclude people. Security needs trump health needs every time.

We cannot meaningfully promote the wellbeing of prisoners when they are disconnected from community. In Australia a ‘healthy prison’ is a contradiction in terms. In future posts we will look in some detail at alternatives.

We can advocate for access to Medicare in prisons, clean needle programs or access to therapeutic programs; we can talk about the opportunities in prison to assess and manage a captive population’s health needs, but we are fundamentally missing the point of what health is about. Health is largely constituted and sustained by healthy relationships.

Prisons in Australia are not places that can model or support healthy relationships.

In 2001, in one of the most comprehensive studies in the world at the time, NSW researchers conducted a study of the health of prisoners in their prisons.  This study built on earlier work and included information about mental health and cognitive functioning. They found that overall prisoners were significantly less healthy than their counterparts in the community. Of particular note were the high levels of mental health problems, head injury, intellectual disability, hepatitis C and smoking. These trends continue.

Given the high turnover of people moving through prisons, prison health services are tasked mostly with managing the acute health risks for prisoners rather than the overall health needs. Even when chronic health concerns are identified and treated the chaotic path for many prisoners post-release means many are lost to follow up.

Health services in prisons have a constant fight to deliver a service.

Services only really make sense when they are provided by in-reach from community, with an aim to establish positive relationships, and to build connected pathways to the community health and social services that can be sustained post-release, where the real work happens.

When we consider mental health, or more broadly brain health in prisons, we open up a whole world of pain.  Many prisoners have substantial undiagnosed mental health and cognitive concerns before entering prison, often not acknowledged or treated. See Mental Health, Cognitive Health, Trauma and Substance Misuse. Forensic units can see and treat only a fraction of the clients at risk.

Some years ago we interviewed a number of Aboriginal prisoners and family members to try to better understand how they viewed the health impact of imprisonment. In our unpublished report, ‘There’s nothing out there for us,’ we found that health was less defined in terms of physical health, and overwhelmingly, concerns related to experiences of loss, including loss of identity and cultural connection, isolation and loss of important relationships. Issues relating to emotional distress, suicidal behaviours, and drug use featured strongly. The shortage of practical supports and friendly faces to help cope with prison, release and re-establishing life in the community were also repeatedly identified.

For Aboriginal prisoners, the sensible approach is for health and wellbeing services to be provided by Aboriginal controlled health services. One of the big challenges though is that, apart from a few isolated examples, Aboriginal controlled services are grossly under-resourced to do this demanding work, both the prison-in reach and the community-based integrated justice support. The task is made even more difficult by the work involved in un-doing the harms and lasting negative impacts resulting from periods of incarceration. The first few months post-release are an extremely high risk time.

Offenders in regional and remote locations are particularly poorly served.

Aboriginal-controlled services need to create highly skilled and well-resourced teams, comprising cultural workers and experienced practitioners to support people with some of the most complex needs in community.

More on this in future posts.