Current challenges confronting correctional health services

According to a story reported by the ABC, a recent report by the Australian Institute of Health and Welfare “indicates Australian prisoners have much higher rates of mental and physical health issues than among the general population“. This report also stated that “37% of prisoners about to be released said their health was a lot better than when they entered prison“.

As the health needs of prisoners become increasingly complex, three of the speakers at the upcoming 4^th Annual Correctional Services Healthcare Summit 2013 share their opinion on the key challenges associated with working towards health promotion in a correctional environment.

Dr Fraser K Moss, Principal Prison Medical Officer, Health Services Directorate, Department of Corrective Services, Western Australia
Given that correctional health services have now become the default institutional carer of persons with a mental illness or a mental health problem, our greatest challenges are related to dealing with the tiers of increasing management complexity. Whilst some jurisdictions are working diligently toward implementing and resourcing services there are inevitable gaps and opportunities for improvement.

Firstly, under relentless pressure to medicalise unacceptable behaviours, we are challenged to define the boundaries of our care. Unfortunately the universalisation of abnormalities by the DSMs 4 & 5, provide little support for rationalising the scope of care we are expected to provide and the optimal distribution of our limited resources. .

Then we are challenged by the dominance of the misguided non-directive and non-judgmental philosophies of contemporary psychology and sociology. We deal with the reality of a demographic which has been judged by a Judge and then directed with force to detention for correction – not for coercion or persuasion. Further we have a statutory requirement and a duty of care which hold us responsible for the health and mental health wellbeing of those in detention. Hence we are expected to ensure compliance with health and mental health treatments and if health or life is endangered then to compel compliance.

Next we have the challenge to implement validated screening and diagnostic tools across a broad spectrum of clinical disorders such as PTSD; FASD; Organic Brain Damage (due to trauma – intrapartum, physical, Post-Concussion Syndrome  or toxins such as solvents alcohols and drugs) ;   intellectual disabilities; clinical psychoses, and the other mental illnesses.

Next, across this spectrum of these diagnoses, we are challenged to provide best-evidenced, cognitive, operant, behavioural, social and chemical interventions in a physically appropriate and  socially managed therapeutic environment.  Further these interventions need to be evaluated and the success in reducing or eliminating offending behaviour must be quantified.

The final challenge is perhaps insurmountable. We are challenged by the complexity of a coordinated release for each individual to an appropriate, safe, fulfilling, non-criminogenic community home with ongoing clinical care.

The over-riding challenge, of course, is to obtain the political commitment to provide the human and financial resources to respond to the needs of our patients and to implement the necessary services. Plans for responding to challenges need to be developed by clinicians, and designated ‘Not for Discussion –  For Implementation Only ‘, and   thus diverted from  endless revisions at the hands of bureaucrats.

Phillip Goulding – SRN, BBA, GdBA, MBL, Williamson Community Leadership Felllow (2008) Wintringham (Specialist Aged Care), Deputy General Manager
Australian Aged Prisoners are more likely to have (than their younger counter parts) :

• A referral for further medical assessment on entry into prison
• A need to visit (and to actually visit) a prison medical clinic
• Need to visit the medical clinic more often multiple medical conditions such as arthritis, hypertension and diabetes
• mental health conditions and treatment
• test positive for hepatitis
• not increase weight whilst in prison
• report to a doctor or a nurse because of an accident whilst in prison
• have prescribed medication
• report that their health had deteriorated whilst in prison

Older Australian prisoners are visiting prison clinics more often and for more health problems each time (Abridged from The Health of Australian Prisoners 2012 – 2012).

The key challenge, is to promote the different and complex care needs of the ever increasing aged prisoner population, so aged prisoners care needs can be met in contemporary and fiscally viable way.

Dr Ed Heffernan is the Queensland Director of Forensic Mental Health Services and a Senior Lecturer in Psychiatry with the University of Queensland
An irony exists that sees many health practitioners believe that correctional health is an unrewarding and undeserving field in which to apply their skills. The reality of course is that this is an area of great health need, where treatment margins can be significant, health challenges are interesting and dynamic, and the potential contribution to public health is vast. Therefore, while there are many health challenges recognised in the correctional environment (including co-occurring health conditions, high rates of transitional morbidity and mortality, ethical complexity, and the need for cross-sectoral collaborations), two key, overarching challenges are a priority: strategic leadership and workforce development.

To activate development in these areas correctional health must become recognised by the community as an important public health issue, in turn, this will drive attention of governments and promote the necessary policy, resource and governance debates. Custodial health has a tendency to be an ‘out of sight, out of mind’ problem. To enhance community awareness clinical, correctional and research leaders must promote the existing evidence base and target it to appeal to a broad set of agendas from ethical to practical: enhanced individual care; application to national and international health and ethical standards; reduced recidivism; reduced public health system burden; decreased costs; and improved community health. Through marketing these platforms and influencing health policy, health and correctional leadership can be empowered to provide the necessary governance and resources to enhance the correctional health environment and drive workforce development.

Dr Fraser Moss, Phillip Goulding, and Dr. Ed Heffernan are presenters at the upcoming 4^th Annual Correctional Services Healthcare Summit 2013 on the 29-30 August 2013 in Melbourne. They will be speaking on the general practice screening for ear health and hearing at a juvenile detention centre, best practice support model for older prisoners, and the public health challenge of mental disorder among people in custody respectively.