Introduction by Croakey: Aboriginal Community Controlled Health Organisations (ACCHOs) should be funded to provide comprehensive, holistic and culturally safe primary healthcare in prisons, and training for prison staff should be improved, according to Associate Professor Sophia Couzos, Public Health Medical Director of the Queensland Aboriginal and Islander Health Council (QAIHC).
Her article below provides important context for a #CroakeyLIVE online webinar on Tuesday, 28 May (5pm-6pm AEST).
Please register here to join the discussion on improving healthcare in prisons, with panel members including Julie Tongs OAM, Dr Mark Wenitong and Jack Bulman, and moderator Professor Megan Williams. We thank and acknowledge the webinar sponsor: Girra Maa Indigenous Health Discipline at the UTS Faculty of Health.
Sophia Couzos writes:
Currently, prison healthcare services in Australia are delivered by either state or territory bodies or by private corporations and are not a Commonwealth responsibility.
Unless there is specific state government funding for the delivery of healthcare, private healthcare providers cannot deliver health services in custodial health settings as they are unable to bulk bill Medicare for the services delivered (Medicare is funded by the Australian Government, not the states).
The Pharmaceutical Benefits Scheme (PBS) is also funded by the Australian Government. Medications dispensed to people in prison are not covered under the PBS, except for medications that fall under Schedule 100 of the PBS, known as the Highly Specialised Drugs Program.
The majority of Aboriginal and Torres Strait Islander community-controlled health organisations (ACCHOs) in Australia are not provided with funding to deliver primary healthcare and support to prisons.
According to the Australia Institute of Health and Welfare report, The health of people in Australia’s prisons 2022, there are “only a few prisons in Australia that facilitate visits by ACCHOs”. The report said 76 percent of participating prisons reported never receiving visits from ACCHO and/or Aboriginal medical service health professionals.
QAIHC believes prisoners should have better access to the holistic, culturally safe care that ACCHOs can provide in the prison system.
We urge both the Federal and Queensland Governments to review how Australia’s ACCHO sector can be better integrated with the criminal justice system to support the delivery of culturally safe, effective, and relevant healthcare and support to Aboriginal and Torres Strait Islander people in custody nationally.
ACCHOs understand the unique needs, challenges, and solutions Aboriginal and Torres Strait Islander communities require.
Barriers to healthcare
There are many barriers to Aboriginal and Torres Strait Islanders seeking culturally safe, effective service healthcare delivery and support in prisons in Australia.
These include:
- Difficulty navigating the prison healthcare system.
- The current prison healthcare model is based on acute healthcare treatment, and prevents inmates from accessing holistic, long-term, preventative care.
- A high number of people who are in custody or are in contact with the criminal justice system have a history of adverse childhood experiences. It is also common for this group to have had multiple life experiences of trauma and violence, including physical and sexual abuse. Aboriginal and Torres Strait Islander prisoners with this history do not always have access to prison healthcare staff who have had cultural awareness and trauma-informed training.
- Using multiple information record systems to support inmate care – from state and territory providers and corrective services. This is time-consuming, inefficient and a barrier for delivering quality, preventative healthcare.
- Distrust of institutional care because of both personal and historical experiences.
Culturally-centred care
All prison staff should have compulsory and comprehensive cultural awareness and trauma-informed training.
A high number of people who are in custody or are in contact with the criminal justice system have a history of adverse childhood experiences. It is also common for this group to have had multiple life experiences of trauma and violence, including physical and sexual abuse.
Prioritising the physical, mental, social, emotional, neurodevelopmental, and spiritual health and wellbeing of people in prison is crucial for narrowing the health gap and reducing over-representation in the justice system.
This will necessitate a system-wide shift to a largely therapeutic model of operations in custodial settings.
A crucial piece of this is more active involvement of ACCHOs, who are best placed to provide culturally centred holistic care to Aboriginal and Torres Strait Islander peoples, so that funding must be urgently directed to the sector to facilitate partnerships in this area.
ACCHOs provide non-judgemental, culturally safe care, provide continuity of care, provide another link to reintegration into the community, and can be a cultural touchpoint for inmates who are only experiencing a westernised institutional existence.
Involving ACCHOs in prison care will help meet Targets 10 and 11 of the National Agreement on Closing the Gap, which is to reduce the rate of Aboriginal and Torres Strait Islander young people (10-17 years) in detention by at least 30 percent by 2031. It also supports priority reforms 1, 2 and 3 of the National Agreement.
Recommendations
QAIHC recommends the following actions:
- Local negotiations with ACCHOs to enhance the quality of prison healthcare being delivered to those in custody. ACCHOs can provide primary healthcare that is comprehensive, holistic and culturally safe.
- State-Commonwealth negotiations are needed to enable access to the MBS and the PBS for the delivery of prison healthcare services in custodial settings.
- The utilisation of one information record system for prison healthcare that incorporates information from state and territory providers and corrective services.
- Released prisoners have a substantially higher risk of death than the wider community and are particularly vulnerable to hospital admissions for mental disorders and injury and substance misuse. Access to comprehensive prison healthcare post-release is a critical intervention that can be facilitated through the continuity of care with ACCHOs.
Further reading
Read an article previewing the #CroakeyLIVE webinar, Improving healthcare for First Nations people in prison: what will it take?
By Professor Megan Williams and Jack Bulman, Investigation of inadequate healthcare in prisons highlights importance of cultural safety and Aboriginal-led solutions
See Croakey’s archive of articles on justice and health.
