The Australian Medical Association today joined growing calls on all Australian governments to commit to setting a target for closing the gap in the rates of Aboriginal and Torres Strait Islander imprisonment.
The call comes in the AMA’s 2015 Report Card on Indigenous Health, which sees a clear link in the poorer health and justice outcomes experienced by Aboriginal and Torres Strait Islander people in Australia, and stresses the need to invest in Aboriginal community controlled health organisations and an Aboriginal and Torres Strait Islander workforce. It says:
It is not credible to suggest that Australia, one of the world’s wealthiest nations, cannot solve a health and justice crisis affecting three per cent of its citizens.
The AMA call follows the recent promise that a Shorten Labor Government would support justice targets, justice reinvestment and other measures to “close the justice gap” and address the over-incarceration of Aboriginal and Torres Strait Islander people.
It also comes as a Western Australian coronial inquiry is hearing distressing details about the death in custody last year of Ms Dhu, the 22 year old Aboriginal woman held at the South Hedland police station for unpaid fines. See this tribute from Labor Senator Sue Lines.
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Excerpts from the AMA 2015 Report Card on Indigenous Health
The AMA cites latest estimates that Aboriginal and Torres Strait Islander people will live around 10 years less than non Aboriginal and Torres Strait Islander people, and evidence that the imprisonment rate of Aboriginal and Torres Strait Islander peoples is 13 times greater than non Aboriginal and Torres Strait Islander peers. It says:
Among the divides between Aboriginal and Torres Strait Islander peoples and non-Indigenous people in Australia, the health and life expectancy gap and the stark difference in the rates of imprisonment are among the most well-known.
This Report Card treats the two gaps as connected. While acknowledging the complex drivers of imprisonment in any individual’s case, it considers the ‘imprisonment gap’ as symptomatic of the health gap. In particular, the AMA believes it is possible to isolate particular health issues (mental health conditions, alcohol and other drug use, substance abuse disorders, and cognitive disabilities are the focus of this report card) as among the most significant drivers of the imprisonment of Aboriginal and Torres Strait Islander peoples, and target them as health issues as a part of an integrated approach to also reduce imprisonment rates.
Further, this Report Card examines how the situation is compounded by a health system and prison health system that, despite significant improvements over past decades, remains – in many critical areas – unable to respond appropriately to the needs of Aboriginal and Torres Strait Islander prisoners.
The Report Card says the year 2016 marks two anniversaries that make its findings and recommendations timely:
- the 25th anniversary of the Royal Commission into Aboriginal Deaths in Custody (RCIADIC)
- the 10th anniversary of the 2006 AMA Indigenous Health Report Card, Undue Punishment? Aboriginal and Torres Strait Islander People in Prison: An Unacceptable Reality.
It calls for a national target for ‘closing the gap’ in the rates of imprisonment of Aboriginal and Torres Strait Islander peoples, arguing the case in the context of the Australian Government’s Indigenous Affairs priorities (employment, school attendance and community safety) and controversial Indigenous Advancement Strategy.
A prison record, after all, can be a major barrier to employment.Families with members in prison are put under tremendous financial and emotional stress with the major impact being felt by children – potentially affecting school attendance andperformance. Further, inherent in reducing imprisonment rates is reducing violent offending by Aboriginal andTorres Strait Islander people, and thereby making communities safer. As noted, acts of violence are the most common reason for the imprisonmentof Aboriginal and Torres Strait Islander people,at double the rate of their non-Indigenous peers. And fellow Aboriginal and Torres Strait Islander people are all too often the victims.
It notes the growing movement in Australia advocating for justice reinvestment, including by the Just Reinvest NSW campaign and Change the Record and in the call for a trial from the Senate Legal and Constitutional Affairs Committeee in 2013.
The AMA supports this call, but would like to see a greater commitment to justice investment principles being used to fund early intervention and diversion efforts, particularly for people with mental health problems, substance use disorders, and cognitive disabilities, in Aboriginal and Torres Strait Islander communities.
It recommends that governments adopt an integrated approach to reducing imprisonment rates and improving health through much closer integration of Aboriginal Community Controlled Health Organisations (ACCHOs), other services and prison health services across the pre-custodial, custodial and post-custodial cycle, and says key elements of this approach would be:
- a focus on health issues associated with increased risk of contact with the criminal justice system and imprisonment. In particular, mental health conditions, alcohol and drug use, substance abuse disorders and cognitive disabilities;
- service models that incorporate both health care and diversionary practices. These models would be developed by ACCHOs working in partnership with Australian governments and prison health services. Such would define the roles, and integrate the work of, ACCHOs, other services and prison health services to provide the integrated approach;
- preventing criminalisation and recidivism. The former, by detecting individuals with health issues that can put them at risk of imprisonment while in the community and working with them to treat those issues and prevent potential offending; and
- continuity of care. That is, (a) from community to prison – with a particular focus on successfully managing release. And (b) post-release (from prison to community) – with a focus on successful reintegration of a former prisoner into the community and avoiding recidivism. Important elements ofcontinuity of care include access to health records, and individual case management as available.
It says a critical part of this approach is likely to involve:
- expanding the capacity of ACCHOs and other services as required to establish and/or build on existing interdisciplinary mental health and social and emotional wellbeing teams that can work effectively with or coordinate health care for people at risk of imprisonment while in the community and work to divert them from potential contact with the criminal justice system;
- ensuring that these interdisciplinary mental health and social and emotional wellbeing teams are connected to, or include, culturally competent professionals to work effectively with mental health disorders, substance abuse disorders, and cognitive disabilities; and
- supporting prison health services to be able to deliver a culturally safe and competent service including by employing greater numbers of Aboriginal Health Workers and Indigenous health professionals, and working in partnership with ACCHOs or other services.
Because Aboriginal and Torres Strait Islander peoples tend to come into contact with the criminal justice system at younger ages than their non-Indigenous peers, a major focus of this integrated approach is on the health, wellbeing, and diversion from the criminal justice system of Aboriginal and Torres Strait Islander children and adolescents. Culturally-based approaches have been identified as effective in working with this cohort in areas like suicide prevention.
The AMA anticipates that the integrated approach it is recommending would incorporate access to Elders and cultural healers as a core component.
It says the recommendations further develop the AMA’s 2012 Position Statement on the Health and Criminal Justice System that states Aboriginal and Torres Strait Islander peoples should ‘have full access in prison to culturally safe primary health care, including management of chronic illness, social and emotional wellbeing, mental health, and drug and alcohol problems’, that their culture are ‘respected in the design and provision of health and medical care in prisons and juvenile detention facilities’; and that Aboriginal and Torres Strait Islander prisoners have access … ‘to community elders and to relevant representatives of their communities to address their cultural beliefs and needs’.
It is the AMA’s hope that this Report Card will help build momentum for a national integrated approach to reducing both the Aboriginal and Torres Strait Islander health and imprisonment gaps – one that understands both as aspects of each other. Such an approach is aligned with the integrated, whole of life, and holistic approaches that Aboriginal and Torres Strait Islander peoples have long called for as responses to both.
It is not credible to suggest that Australia, one of the world’s wealthiest nations, cannot solve a health and justice crisis affecting three per cent of its citizens.
The high rates of health problems among, and the imprisonment of, Aboriginal and Torres Strait Islander peoples should be a priority social justice and human rights issue in this context.
The AMA Indigenous Health Report Card 2015 is available at https://ama.com.au/2015-ama-report-card-indigenous-health-closing-gap-indigenous-imprisonment-rates
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