The Victorian prison system is overloaded and rapidly expanding.
On 31 May 2017 there were 7,104 prisoners in the Victorian prison system, compared with 6,511 on 31 May 2016 – a 9.1% increase over 12 months – with the female prison population increasing at a rate of around 13%. For Aboriginal and Torres Strait Islander Victorians, imprisonment rates have been expanding by 15 – 22% per year, over the last five years.
The composition of prison populations has also changed in recent years through changes to bail and parole arrangements. Many folks are spending significant time incarcerated on remand. In the 2017 March quarter, 33% of prisoners were unsentenced, a 6% rise over the quarter. This has created new pressures and a misalignment between reintegration programs and demand.
While there have been important investments in infrastructure and improved access to mental health services in the corrections system in Victoria, there are major shortcomings in approaches to reintegration for prisoners. The impact on individuals, families and communities of failure to effectively support reintegration costs us all.
Health related factors predict re-incarceration.
According to the 2013–14 COAG report, within two years of release 42.8% had returned to prison under sentence. Breaking this cycle requires a shift from policies that punish to ones that prepare and support people as they return to their communities.
Currently there are numerous barriers that prevent people from accessing health care after prison. Many people leave prison desperately ill equipped – with inadequate planning, poor social support, a lack of familiarity with the system, no identification and chronic ill health. The Victorian Ombudsman’s 2015 Report found that 42% of people expect to be homeless on release from prison.
People exiting prison often have to find their own services, but they can be disoriented, with low self-esteem, and out of touch with family, friends or health carers. Stigma about being a former prisoner can be overwhelming, which acts as a barrier to maintaining or accessing treatment. Given that former prisoners often overdose soon after release, there is a critical need to boost awareness of harm reduction services such as needle exchanges and pharmacotherapy. While prescriptions are provided, this frequently represents a missed opportunity for a comprehensive assessment of need and a plan for care.
The development of trusting, ongoing relationships with service providers before and after release is vital to supporting people to access required care. The quality of contact with health service providers is also important. There is growing evidence that people experiencing disadvantage experience shorter consultations, less health promotion and greater focus on prescribing medication.
Building effective pathways to care need to be based on a deep and sensitive understanding of the nature of the prison experience – the psychological distress and disorientation, the social anxiety and alienation. They also need to be predicated upon a social determinants of health approach. Without money and without somewhere to sleep, the opportunity for engagement with health, and other services can be severely limited. There are also critical cultural influences that inform perspective and experience. It is dangerous and damaging to generalise experience of some communities to others. Much greater effort is required to appreciate the specific meaning and experience of incarceration in the context of ethnicity, faith and refugee or immigration experience for example.
People recently released from prison need to be supported to access services through pre-release interaction, development of relationships and explicit commitments for support and connection. From a health service providers perspective this can be thought about as a chronic disease management approach, since many prisoners have a number of significant health conditions and often have a ‘care plan’ for these whilst incarcerated. This provides a vital opportunity to plan for ongoing connection post release. This does need to be actively facilitated and requires active commitment and engagement of providers on the inside. Few of us will visit new and unfamiliar providers simply because we are told too, and prisoners are even less likely to do so.
Peer workers the key to successful transition
cohealth is committed to improving its understanding of the health and social support needs of people exiting prison by engaging with people who have experienced the transition from prison back to the community.
This is based on the recognition that many of the people, families and communities we serve have prison experiences. Too ignore this is to miss vital influences on health and well being. We understand also that folks will not share this experience or seek our support unless we make it okay to do so.
We have great insight available to us in our peer workers and we need to draw on this in our effort to improve system navigation, pathways to care and the design of programs and services.
We also need to advocate strenuously for programs that aim for reintegration and facilitate effective transition. This means programs that integrate social support such as housing, income and education with health related interventions, like mental health and substance use and other chronic conditions that produce the poor health status of these groups.