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Investigation of inadequate healthcare in prisons highlights importance of cultural safety and Aboriginal-led solutions

Introduction by Croakey: An inquiry into healthcare for Aboriginal people in prisons in Victoria has raised wider issues for prison and policing systems around the country, about the importance of reforms to ensure access to culturally safe healthcare and to conditions supporting connection with culture and the cultural determinants of health.

The investigation by the Victorian Ombudsman also underscores the importance of prison health reform being driven by the experiences of Aboriginal people and organisations, and to ensure Aboriginal models of healthcare are provided by Aboriginal-led organisations.

While some Aboriginal Community-Controlled Organisations work in prisons in Victoria providing various programs, no prison uses an ACCHO as the primary provider of healthcare for Aboriginal people, the report said.

“Despite commitments at every level of government to Aboriginal peoples’ self-determination and Aboriginal-led solutions, the experiences of Aboriginal people in prison are often missing from discussions about policies that affect them,” reported Ombudsman Deborah Glass.

“We spoke with Aboriginal people in three prisons about their healthcare experiences. It is crucial for the Government to listen to their voices now, instead of waiting to hear these stories during a coronial inquest.

“What we heard reflected that for Aboriginal people, health is holistic and includes not only physical but mental, social, emotional, cultural and spiritual wellbeing.

“We heard about a yearning for cultural connection. About the devastating impact a lack of cultural and family connection in prison can have, and what a huge difference it makes when they do receive cultural support with their healthcare needs.”

Glass recorded the investigation’s deep gratitude to two Aboriginal health experts, Professor Megan Williams and Jack Bulman, for their contributions, including leading discussions with Aboriginal people in prison.

Williams provided public health and cultural expertise and devised the cultural safety framework for the investigation. She led discussions with Aboriginal women at Dame Phyllis Frost Centre (DPFC), along with a female Yorta Yorta member of Ombudsman staff.

DPFC granted permission to bring in and work on a canvas painting with Aboriginal women. The canvas, featured above, was designed by Yulang in collaboration with Gamilaraay and Warlpiri artist Jessie Waratah, and signified a strengths-based approach to engagement, not beginning with concerns or negatives.

Its theme, ‘For Our Elders’, affirmed the 2023 NAIDOC Week theme and the sense of being cared for and caring about Aboriginal people across generations.

According to Williams and colleagues, time together working on the canvas was also used to deconstruct the misconception of prison being separate from the general community; it is a setting of the community.

“The painting was designed to serve as a visual connecter across the settings and to be retained as a record of our discussions, as Aboriginal knowledge systems require,” records the report.

Participants’ stories and contributions were organised under three headings: connection to culture, Country and spirituality; connection to family and community; and physical, emotional and mental wellbeing.

Below are extracts from the report by Professor Megan Williams and Jack Bulman (published with their permission).


Megan Williams writes:

I’ve visited and worked in prisons and on prison-related health issues since the mid-1990s, including asking Aboriginal people about their experiences of healthcare and reviewing state and national data about health.

I knew to prepare well for asking Aboriginal women about health services in the Dame Phyllis Frost Centre visit. I’d written a report for the inquest of the death of 37-year old Gunditjmara, Yorta Yorta, Dja Dja Wurrung and Wiradjuri woman Veronica Nelson, been an expert witness as part of the medical conclave at the Coroner’s Court, and reviewed reports and records from DPFC. I’d also contributed to the Cultural Review of the Adult Custodial Corrections System in Victoria.

As Wiradjuri like Veronica I had cultural and professional responsibilities to be trustworthy, open-minded, and also aware of preconceived ideas.

One very useful strategy was developing a collaborative artwork in the community with Gamilaraay and Warlpiri artist Jessie Waratah.

Entitled ‘For Our Elders’, this was designed to be taken to DPFC with permission, to create a neutral, inspiring focus for us as Aboriginal women coming together.

The painting was literally a visual reminder for us to keep bringing into view Aboriginal cultures and protocols because Aboriginal women in prisons have the right to experience and use these, including in healthcare, as in the general community.

The gaps in cultural models of healthcare were very obvious. The confusion and disconnects described seemed to result in and perpetuate unmet healthcare needs.

These ranged from treatments partly in place but not able to be continued, worries about pains and symptoms, worsening of chronic conditions, isolation and depression, and sheer stress of uncertainty including about health service access.

All the domains of Aboriginal peoples’ holistic definition of health had stories of current and likely future unmet need.

Quality of care and workforce cultural capabilities, cultural responsiveness of services and systems-level planning – multiple and compounding barriers come to mind. Prevention and health promotion – perhaps there are some possibilities but punitivity and restrictions in the setting produce many barriers.

Hearing about dehumanising experiences is always disturbing, but the gaps in policy framework implementation and their evaluation perhaps even more so.

• Professor Megan Williams is Principal of Yulang Indigenous Evaluation, an Aboriginal-led business that reviews and develops policies to reduce discrimination against and uphold the rights of Aboriginal people, and carries out cultural safety reviews of organisations and services, and also a director and member of Croakey Health Media.


Jack Bulman writes:

I have done various work in jails across Australia in the past 15 years, and for me going into the jails in Melbourne and asking about access to health services, I was really shocked at the inadequacy. Some months later I am still remembering the visits and the issues. I still can’t believe the differences and disparities and how much worse it was than I thought it would be.

There are peoples’ truths and real truths and three sides to a story but to hear the sameness of the stories that were talked about in the places visited said to me there really were very real issues to address.

It was a real eye opener despite doing a fair bit of work in prison about how much power prison guards have. Even the fellas who had made complaints talked about how hard it is to complain, and there was a sense of fear if they did make a complaint, what the repercussions would be for them. They said they were not sure what the Ombudsman’s office could do.

Some of the young lads – remembering them, there is just a lot about hope and not much about actual action. One of the young lads was talking about how his prized possession was a picture of his young daughter but he was not allowed to have it in his cell. He said he understands there could be predators in prison and pictures of children could be an issue for them but doesn’t really understand how that applies to him and where he was in the prison and for how long etcetera. It’s become a real wellbeing issue for him, and he is that distressed that he had self-harmed. The loss of hope was and is a real wellbeing issue.

Another issue raised by a number of fellas was about detoxing and seeking drug and alcohol rehabilitation – they talked about such conflicting messages about how to get onto programs and what it means for loss of privileges. They said it was a real catch-22 situation about whether to go on medication or do programs or whatever else and were finding it hard to comprehend the information.

The different needs of people who are young compared to people who are older – that was really worrying. There was a fella who was in his fifties who had all these different health conditions … but he didn’t know exactly what was happening. He was focussed on being released in a couple of weeks and worried about going to a regional area, being returned to a place he was not from and didn’t know what could be done to change that. He was concerned he was going to be lost, again. It was about his recovery too, already being clean and abstaining from alcohol and drugs – he was worried about going to a place with no support what that means for his recovery. We just had a yearning to be there and talk more but we couldn’t, and they didn’t seem to have enough support.

These lads wanted to yarn. They wanted to tell their story, but were unsure what this would do for them if they did. Some lads had even resorted to calling a code saying they had chest pains to enable them to be seen by a medical officer. This is fraught with danger as everyone is put in lockdown and causes anger among everyone.

We know there are trust issues – not sure which staff to trust and who really does what and roles seem to blur. Trust is fundamental to wellbeing. These fellas need to see good stuff happening too or hope and trust is lost. When we lose hope, we become hopeless.

All in all, a sad state of affairs, and yes people need to be held accountable for what they have done, but there is the fundamental basic human rights that everyone is entitled to.

• Jack Bulman, a Muthi-Muthi man of south-western New South Wales, has worked in men’s health for the past 15 years. He has been Chief Executive Officer of Indigenous health promotion charity Mibbinbah Spirit Healing since 2009. Mibbinbah seeks to help Indigenous people take their rightful place, whatever that may be, in both Indigenous and non-Indigenous society, as a means of improving their health and the health of those with whom they live, work and play. He holds a degree in health sciences from La Trobe University and was awarded a Master of Philosophy by University of Melbourne for his thesis on First Nations fathering.


Further reading

Statement by VACCHO: Victorian Government dismisses lived experiences of Aboriginal people in prisons

“VACCHO is staggered that the Victorian Government continues to dismiss the inadequate healthcare of Aboriginal people in prisons as they seek to avoid accountability rather than taking responsibility.”

Statement by Victorian Aboriginal Legal Service: Scathing report on substandard prison healthcare for Aboriginal and Torres Strait Islander People

“People in custody deserve healthcare that matches the standard of healthcare in the community. Aboriginal and Torres Strait Islander communities have been advocating for culturally safe healthcare in custody for many years. Substandard prison healthcare remains a significant driver of Aboriginal deaths in custody.”


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