Tough times: supporting the health of prisoners on release
Time in prison can give some marginalised members of the community access to much- needed health services; but those gains are soon lost on release.
The health needs of Australia’s prison population are complex. Many people entering the system are acutely unwell, largely due to social and economic factors such as high levels of unemployment and drug and alcohol addiction, plus insecure housing, illiteracy and innumeracy. These can create a significant barrier to seeking appropriate diagnosis and care.
The Australian Medical Association (AMA) reported in 2012 that ‘as a group, prisoners and detainees have far greater health needs than the general population’. Many who enter the system live with mental illness, chronic and communicable disease, injury, poor dental health and disability. Indigenous Australians and prisoners with intellectual disability are over-represented in the prison population.
An Australian Institute of Health and Welfare (AIHW) report, The Health of Australian Prisoners 2015, indicated that one in two prison entrants was unemployed in the 30 days before entering prison, and two in three had not studied beyond Year 10. The same report found that one in four prisoners received medications for mental health related issues while in prison, and three in four entered prison as smokers.
Professor Stuart Kinner, head of Justice Health Unit at the Centre for Health Equity at the University of Melbourne, points out that incarceration is yet another symptom of an already marginalised population.
‘Incarceration, by definition, isn’t a choice,’ says Kinner. ‘It’s certainly not something that people, with rare exceptions, would choose. Yet from a public health perspective we tend to think of it as separate to all of the other health problems that can be responded to.’
From bad to better healthcare
Prisoners in Australia are excluded from the National Disability Insurance Scheme, Medicare and the Pharmaceutical Benefits Scheme, which Kinner says is in ‘direct contravention of our obligation to provide equivalent care to people in prison under the “Nelson Mandela Rules”.’
These are the recommended principles and practices for the treatment of prisoners, as set out by the United Nations.
The Public Health Association of Australia recommends that ‘standards of health-care service delivery in criminal justice settings should be comparable to those in community settings’.
Despite some reservations around policies, Kinner says the health and wellbeing of prisoners can actually improve when they are in the system.
‘This is partly because their health is so terrible when they come in,’ he says. ‘And partly because we do a few things to address their health needs and remove opportunities for poor health.’
Some of the provisions are quite simple, such as housing and food. Prisoners can also benefit when they quit smoking and drinking, and improve their nutrition and exercise.
The AIHW’s 2015 report notes that prisoners being discharged are more likely to rate their mental and physical health as generally good, than those entering prison.
The AIHW also states that health experiences of prisoners are largely positive: ‘Prison may provide an opportunity for people who don’t usually access health services to do so; indeed prisoners typically use health services much more extensively in prison than in the community.’