A mental health crisis is sweeping through prisons, with half of all inmates diagnosed before being incarcerated, according to new Australian data.
A new report has highlighted the importance of quality healthcare before, during, and after a person is imprisoned, shedding a light on the life-changing capacity of respectful and consistent consultations.
The Australian Institute of Health and Welfare’s (AIHW) ‘Health of people in Australia’s prisons’ report revealed 51% of inmates surveyed had a previous diagnosis of a mental health condition, including alcohol and other drug use disorders.
Almost one-third of prison entrants had an education level of Year 9 or below, and in the 30 days before entering prison, 43% were homeless and 46% were unemployed.
Three quarters reported using illicit drugs at least once during the previous year, one quarter had a parent behind bars, and 48% expected to be homeless upon release.
Associate Professor Tom Turnbull, Chair of RACGP Specific Interests Custodial Health, told newsGP the new data proved that those in prison need high-quality services to return to good health and reduce their risk of offending.
‘People in the community who have a mental illness or use substances fall through the gaps, disengage in care, get in trouble, and end up in custody,’ he said.
‘We reengage these people into treatment with the assistance of our forensic mental health colleagues, address substance use including opioid use disorder, apply for NDIS supports, and transition people upon release into community mental health services and drug and alcohol services.’
Of the 371 prison entrants surveyed, 60% reported seeing a doctor or GP in the community in the previous 12 months, and more than two-thirds of those discharged from prison reported they could easily see a medical professional, a GP or nurse, while in prison.
GPs were also the most common healthcare profession they were referred to after an initial health assessment on entering prison.
Dr Tim Senior, Chair of the RACGP Prison Standards Working Group, told newsGP for most GPs, their experience with the prison population will be those who are at risk of going into prison or have a history of being incarcerated.
‘For many GPs when they see people who are coming out of prison, particularly if they have been in for a long time, often they’re not sure how to navigate the health system,’ he said.
‘They might not know how you make an appointment with the GP, or what you do with the prescriptions, or where you go for blood tests, or how you make an appointment with a specialist, let alone being able to afford it.
‘So often, people need a bit more help just navigating a complex health system because they may not have done that before if they went [into prison] when they were very young or if they’ve been in a long time.’
Earlier this year, the RACGP launched its new Prison Standards after they were updated for the first time since being launched more than a decade ago.
They were altered to bring about a greater focus on culturally safe care and an emphasis on outcomes.
That update comes as Aboriginal and Torres Strait Islander people currently account for 31.8% of all people in prison, despite representing just 3.8% of the total Australian population.
The new AIHW data found one quarter of prison entrants had one or more parents or carers in prison when they were a child, and this was more than twice as likely among Aboriginal and Torres Strait Islander people entering prison.
Dr Senior, who is also a medical advisor for RACGP Aboriginal and Torres Strait Islander Health, said Indigenous Australians continue to be over-represented in prisons.
‘It’s not because they’re committing more crimes … I think the most common reason for being in jail is not being able to afford to pay a fine,’ he said.
‘People go to jail, and then on top of that, for Aboriginal people, the rates of Aboriginal deaths in custody are still high.
‘We still keep seeing the same problems of interaction with the justice system and it can end up being physically harmful to Aboriginal and Torres Strait Islander people.’
More encouragingly, most discharged people surveyed were happy with the healthcare they received in prison, with 72% rating it as ‘good’ or ‘excellent’.
Around 80% said their physical and mental health improved or stayed the same while in prison.
Associate Professor Turnbull welcomed this news, but said significant changes were needed to ensure those in custody have access to all healthcare offerings available.
‘People in custody generally are unable to access the MBS and PBS, and hence are reliant on what services their state or territory can provide,’ he said.
‘Sometimes there are consequential gaps, due to lack of access to MBS services, PBS, and high-cost medicines to better support throughcare and release, this is something … the Department of Health and Aged Care needs to address.’
His advice for GPs was to get to know the custodial health services in their area.
‘The GPs working there are very happy to take phone calls, follow up and provide any clinical information you require, or answer any questions,’ Associate Professor Turnbull said.
‘We are also happy to take any feedback to make the handover process better.
‘GPs are the key to people engaging with healthcare after release, this is the opportunity for engagement in ongoing primary healthcare which we know reduces reoffending.’
Dr Senior agreed, saying health improvements can be made through ‘really good primary care’.
‘That means being patient centred not disease focused,’ he said.
‘So many of these people will have multiple healthcare needs, including mental health, so being willing to see that and treat people, be willing to form an ongoing relationship so you get to know them quite well and they get to trust their own GP.
‘Just having a GP they feel they can trust to provide patient-centred care and holistic long-term care can help in solving some of those problems.’
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