Custodial Medicine

An Alternative View On Custodial IndigenousHealth

Custodial Medicine

Custodial Medicine

Standards, Guidelines & Charters Guiding Prisoner Management

Standard Guidelines For Corrections In Australia (Revised 2012)1

Standards For Health Services in Australian Prisons, 1st Edition, RACGP2

Royal Commission Into Aboriginal Deaths In Custody Report (RCIADIC) – 19913

United Nations Standard Minimum Rules for the Treatment of Prisoners - The NelsonMandela Rules4

Charter of Human Rights and Responsibilities Act Victoria 20065

Custodial Medicine Correctional Centres – Prisons, Custody Centres & Police Cells

Berrimah Prison, NT

Don Dale Youth Detention Centre, NT

Port Augusta Prison, SA

Port Phillip Prison, Vic

Langi Kal Kal, Vic

Barwon Prison, Vic

Melbourne Custody Centre & Police Cells, Vic

Custodial Medicine

Custodial Medicine• Darwin Correctional Centre (previously Berrimah Correctional Centre)

• Capacity 1048 – as of 30th June 20166

• Minimal to Maximum security, Males and Females, 80 -90% Indigenous

• Situated at Howard Springs - 30km from Darwin

• Complex Behaviour Unit

• Offenders with mental health and behavioural needs

• Unfit to plead or not guilty due to mental impairment

• Mentally ill or have complex mental health and behavioural needs6

• Pre-Release Work Village – previously known as the Lifestyle Unit (LSU)

• Fulltime employment during day

• Education and development programs in the evening.

• Real life, skills in trade and employment - ‘Sentenced to a Job’ program6

Custodial Medicine• Don Dale Youth Detention Centre

• Male and Female youth, remanded or sentenced

• Equal numbers Indigenous & Non Indigenous, M>F

• Situated in old Berrimah Correctional Centre site

• Education - Tivendale School

• Case management - crime prevention, build safer communities & psychological,social & emotional wellbeing7

• Youth programs includes:

• Safe Sober Strong

• Step Up Violence Program

• Changing Habits and Reaching Targets (CHART)

• The Seek Education or Employment not Detention Program (SEED)7

Custodial Medicine• Port Augusta Prison

• Minimum - Maximum security, multipurpose facility

• Capacity – 392, generally males, occasionally mixed

• Largest regional prison in SA

• Expanding to 790 capacity by 2017

• 48% Indigenous population

• Work & training opportunities8

• Industries & Work Gang

• Accommodation unit - ‘Pakani Arangka’ 8

• Dedicated to Indigenous Inmates

• Education & vocational programs, culturally specific

training

• Established as a result of RCIADIC with the ABU 19959

Custodial Medicine• Port Phillip Prison

• Maximum security, males

• Capacity – 1087 as 30th June 2016

• Situated at Laverton

• Privately owned

• Tertiary centre

• 20 bed inpatient hospital unit5

• Multiple clinics run daily

• Secondary site

• St Vincent's Hospital - St Augustine

• 13 self sufficient accommodation units5

• Individual Cells – well catered

Custodial Medicine• Langi Kal Kal

• Minimum security, males

• 150km west of Melbourne

• Capacity – 428 as 30th June 2016

• Open plan – expected every prisoner to work

• Protection facility, agriculture/horticulture/woodwork/Landmates, pre-release

• Farming property -> prison -> youth training centre - > prison6

• Sex Offenders, victims of childhood SA, PTSD

• Complex patients – physically and mentally

• Age range , wont travel, prized location

• Psychologists 5/7 – busy

• Single rooms in cottage style or traditional housing

self catering, budgeting

Custodial Medicine

Custodial Medicine• Barwon Prison

• Maximum Security, males

• 448 capacity – at June 2016

• Situated near Lara

• Divided into 4 Accommodation areas

• to ‘optimise prisoner management’

• Acacia, Banksia, Grevillea & Hoya7

• Has a pulse

Custodial Medicine• Melbourne Custody Centre

• Main reception facility in Melbourne when arrested by Police

• Capacity 67 for overnight to short term stays; Capacity doubles for Court

• Males & Females, 2 padded cells

• Located underneath the Melbourne Magistrates’ Court

• If remanded, prisoners usually return to parent Police Cells or ->MAP

• 24/24 Health service

Custodial Medicine• Melbourne Custody Centre

• Custodial Health Advice Line (CHAL) - Victorian Police

• Nursing and Medical support to Urban Police cells daily

• Nursing and Medical support to Rural Police cells 1-2x/52

• Local Doctors & Nurses

• Impress, pack own medication, local pharmacy

• Common presentations

• Drug & Alcohol withdrawal

• Psychiatric presentations

• Regular Medications, OSTP

Custodial Medicine

Custodial MedicinePresentations included:

- PMHx:

Diabetes – non-compliance in community

- HbA1C in range 15 - 18mmol+

Rheumatic Heart Disease

- diagnosis, RDH register

- compliance with treatment, last injection

- Cardiology review

Hypercholesterolaemia

- the talk, medication, compliance

Custodial Medicine

Custodial Medicine

PMHx continued:

Hypertension

- non – compliance

- nil investigations

Renal Disease

- End stage RF/Chronic, acute, acute on chronic

Obesity/Malnutrition

- diet – traditional vs. non traditional

- supplementation

Custodial Medicine

Presentations included:

- Smoking cessation

– NT Smoke free policy 2013

- patches, Quit program

- patchy transition – drugs/teabags smoked

- followed by SA, Victoria

- Tuberculosis

- Migrant population >> Indigenous = Non Indigenous in NT

- regional monthly CDC clinics throughout Territory

- longterm follow-up, medication and Radiological surveillance

Custodial Medicine

Presentations included:

- Skin:

Infections

-Abscesses, Carbuncles (often multiple sites)

- often requiring IV Abtx, followed by oral Abtx

- daily dressings, packing

Eczema/Dermatitis

Rashes, bites

- ENT :

Ears – acute OM, chronic OM, acute/chronic OM + perforation

Custodial Medicine- Psychological:

Anxiety/Depression/Sleeping

– pre-court, pre-existing, incarceration related, family/relationship issues, pre-release

Psychiatric Diagnoses

– schizophrenia, drug-induced psychosis, borderline PD, other

Forensic Psychiatric assessment

- RAPID re past treatment, face to face - if judgement impaired, hallucations etc

Regular medications

- Depot, oral medications, non-compliance, prn (aggression/withdrawal)

Custodial MedicineDrug & Alcohol:• Affected/Intoxicated

- difficult to manage in Police cells -> MCC

- difficult to transport by G4S – medically ‘at risk’; unprotected airway -> A&E

- masks other complicating pathologies – esp. head injuries, altered GCS

• Withdrawal

- ETOH, Opiate, Amphetamines, GHB, BZD, THC, Multidrug, Normal meds

-ETOH & Opiate withdrawal packs 5/7 in Vic

-Amphetamines – drug of choice, withdrawal treated in NT & SA

Custodial Medicine Blood Borne Viruses

Mandatory screening in NT

• At least 60% Hepatitis C positive, consistent with global incarceration rates

• Unless incarcerated within last 3/12

• Right to refuse

Voluntary screening in SA

• 30% Hepatitis C positive

• Hepatitis B, C and HIV – numbers are increasing in custody

• Hepatitis C oral therapy – compliance will increase, incidence will decrease

• Sexually Transmitted Infections• Custodial setting –> method of notification

– CDC, patient presentation, message from home

• Regional differences – Chlamydia, Gonorrhea, Syphilis

Custodial Medicine• Self harm/suicide attempts

• Patients ‘at risk’• Isolated, minimal stimulation/clothing

• Any staff member can put the patient ‘at risk’• Must be assessed by 3 members of staff on a daily basis

• Medical, Mental health and Senior Correctional staff

• Need at least 2 staff members to remove patient from ‘at risk’

Sorry cuts – not to be confused with self harm Cultural, grieving

Spirit – wellness check Cultural, may need ALO

Custodial Medicine Medical Chits

Dietary requirements

Diabetic, allergies, vegetarian, low fat/cardiac

Supplements – Magnesium, Zinc, Steroids (!)

Footwear

Slides/new sneakers

Podiatrist – orthotics, own sneakers (waiting list, generally 6/12)

Glasses

Requires Optometry review (waiting list, generally 12/12)

Bedding

Blanket/Mattress

Medical Certificates

Summary Custody is a harsh, life changing environment

For many – it is a chance to break the drugs/alcohol/violence/crime cycle, it is a happyplace, a place of wellness, exercise, chance to sit around & catch up

Place of manipulation, drug knowledge & unpredictability

‘Guidelines’ - not a daily resource

Provide alternative view point to Custodial Health

Custodial MedicineWhat can we improve on in the future?

Forensic Mental Health

Drug and alcohol withdrawal management

Custodial Medicine

Thank you

Custodial Medicine References1. Standard Guidelines For Corrections In Australia Revised 2012

2. Standards For Health Services in Australian Prisons, 1st Edition, RACGP

3. Royal Commission Into Aboriginal Deaths In Custody Report (RCIADIC) – 1991

4. United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules); 17 December2015; www.penalreform.org/wp-content/uploads/1957/06/ENG.pdf

5. Charter of Human Rights and Responsibilities Act Victoria 2006, section 21-27

6. Darwin Correctional Centre; www.nt.gov.au/law/prisons/darwin-correctional-centre

7. Don Dale Youth Correctional Centre; www.correctionalservices.nt.gov.au/don-dale-youth-detention-centre-darwin

8. Aboriginal Services Unit; Corrections SA www.corrections.sa.gov.au/aboriginal-services

Custodial Medicine References cont..9. Port Phillip Prison; Corrections Victoria www.corrections.vic.gov.au/home/prison/port+phillip+prison.shtml

10. Langi Kal Kal Prison; Corrections Victoria www.corrections.vic.gov.au/home/prison/lamgi+kal+kal+prison.shtml

11. Barwon Prison; Corrections Victoria www.corrections.vic.gov.au/home/prison/barwon+prison.shtml