Do programs for Aboriginal and Torres Strait Islander people leaving prison meet their health and social support needs?

First Nations, Inuit and Métis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review

In Canada, approximately 52% of First Nations, Inuit and Métis (Indigenous) peoples live in urban areas. Although urban areas have some of the best health services in the world, little is known about the barriers or facilitators Indigenous peoples face when accessing these services. This review aims to fill these gaps in knowledge. Embase, Medline and Web of Science were searched from 1 January 1981 to 30 April 2020. A total of 41 studies identified barriers or facilitators of health service access for Indigenous peoples in urban areas. Barriers included difficult communication with health professionals, medication issues, dismissal by healthcare staff, wait times, mistrust and avoidance of healthcare, racial discrimination, poverty and transportation issues. Facilitators included access to culture, traditional healing, Indigenous-led health services and cultural safety. Policies and programs that remove barriers and implement the facilitators could improve health service access for Indigenous peoples living in urban and related homelands in Canada.

First Nations Peoples in the forensic mental health system in New South Wales: Characteristics and rates of criminal charges post-release

BACKGROUND

It is well established that First Nations Peoples in Australia are overrepresented within the criminal justice system. However, First Nations Peoples appear to be comparatively underrepresented in the forensic mental health system, and little is known about their outcomes once released from secure care.

OBJECTIVE

To compare the characteristics and rates of repeat criminal justice contact for a criminal charge of First Nations and non-First Nations forensic patients in New South Wales.

METHODS

Data on the sample were extracted from the New South Wales Mental Health Review Tribunal paper and electronic files matched to the Bureau of Crime Statistics and Research Reoffending Database. Characteristics of First Nations and non-First Nations patients were compared using univariate logistic regression analysis. Univariate and multivariate Cox proportional hazard regression was used to determine predictors of post-release criminal charges.

RESULTS

Key differences in the sociodemographic, clinical and forensic characteristics of First Nations compared with non-First Nations forensic patients were identified. The time to first criminal justice contact following release was significantly shorter for First Nations forensic patients (p < 0.01).

CONCLUSION

The findings of this study confirm that First Nations forensic patients have distinct and complex needs that are apparent at entry to the forensic mental health system and that their poorer criminal justice contact rates following release from secure care indicate that these needs are not being adequately met either during treatment or once in the community. Responses to these study findings must consider the complex and continuing impact of colonisation on First Nations Peoples, as well as the need for solutions to be culturally safe.

Impact of dual diagnosis on healthcare and criminal justice costs after release from Queensland prisons: a prospective cohort study

BACKGROUND

People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective.

METHODS

A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs.

RESULTS

Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6-4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6-5.0), compared with no past diagnosis of either mental illness or substance use disorder.

CONCLUSIONS

People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison.

Preparedness and Readiness Against COVID-19 Pandemic in Prison Institutions and Detention Centers in Southwest Ethiopia

BACKGROUND

Prisons and detention centers in Ethiopia lack adequate hand washing, personal protective equipment, and quarantine areas. As a result, they are vulnerable to the expansion of the COVID-19 pandemic. Despite its high risk for the COVID-19 pandemic, no study has been made to assess the preparedness and readiness in prison institutions and detention centers.

METHODS

A cross-sectional study design mixed with a qualitative approach was conducted from May 1 to June 30, 2020. A total of four prison institutions and 17 detention centers were included in the study. A simple random sampling technique was employed to select the institutions. The data were entered into the EpiData and exported to SPSS Windows version 22 for data management and analysis. Descriptive statistics was employed for the quantitative section and content analysis was used to analyze the qualitative data.

RESULTS

Five out of 17 detention centers and three out of four prison facilities did not fulfill the standards related to human rights. Almost all detention centers and prison facilities did not implement recommended activities of risk assessment and management of COVID-19. In addition, none of the prison facilities and detention centers had quick access to laboratory tests for suspected cases. Neither the prison facilities nor the detention centers had a contingency plan for the COVID-19 pandemic. Moreover, all staff working in prison facilities and detention centers mentioned that training regarding COVID-19 had not yet been given. However, in all prisons and detention centers, preventive measures such as physical distancing, utilization of hand washing facilities, wearing masks, and keeping respiratory hygiene were not practiced.

An examination of chronic ill-health and lifestyle factors among inmates: searching for the healthy immigrant effect in New South Wales Prisons

PURPOSE

The purpose of this paper is to compare the rates of chronic health conditions and lifestyle factors between Australian-born and overseas-born inmates and to uncover predictive relationships between lifestyle factors and health outcomes for both groups.

DESIGN/METHODOLOGY/APPROACH

Data are presented from a cross-sectional study based on a sample of inmates from correctional sites in New South Wales (NSW). The inclusion of results here was guided by the literature relating to the healthy immigrant effect.

FINDINGS

Results indicate that a higher proportion of Australian-born inmates consumed alcohol at higher levels and were more likely to smoke on a daily or almost daily basis than overseas-born inmates. Australian-born inmates were also more likely than overseas-born inmates to have been diagnosed with cancer, epilepsy or hepatitis C. Physical activity predicted the number of diagnoses for Australian-born inmates while physical activity and smoking frequency predicted the number of diagnoses for overseas-born inmates.

PRACTICAL IMPLICATIONS

Overseas-born inmates make up a considerable portion of the prison population in NSW. A better understanding of those health and lifestyle factors that distinguish them from Australian-born inmates provides important insight regarding health promotion and the planning of service provision for those providing health care in this space.

ORIGINALITY/VALUE

Comparison of the health of immigrant and native-born prison inmates has not been undertaken before and promises to provide important information regarding those factors that distinguish a sizeable minority in the prison population.

Well-being and mental health interventions for Indigenous people in prison: systematic review

BACKGROUND

Indigenous people are overrepresented in prison populations of colonised justice systems, and Indigenous prisoners in these countries are at a particularly high risk of poor mental health and well-being. There is an acute need to ensure the access of these groups to culturally appropriate, evidence-based interventions.

AIMS

To conduct a systematic review, evaluating quantitative and qualitative evaluations of mental health and well-being interventions designed for Indigenous people in custody.

METHOD

A search of relevant peer-reviewed journal articles to August 2019 was conducted. The focus was on colonised countries under a Western model of justice and health, including Canada, Australia, New Zealand and the USA. The review utilised Scopus, Web of Science, PubMed, PsycNET, EBSCO, Proquest Criminal Justice Database and Informit.

RESULTS

Of the 9283 articles initially found, only three quantitative and two qualitative evaluations of mental health or well-being interventions for Indigenous people in custody were identified. None were randomised controlled trials. Culturally based interventions appeared to have high acceptability and potential for increased recovery from trauma, reduced alcohol-related problems and lower reoffending. However, no studies quantitatively assessed mental health or well-being outcomes.

CONCLUSIONS

As yet there is no high-quality evidence on the impact on mental health and well-being from interventions specifically for Indigenous prisoners, although existing studies suggest programme features that may maximise acceptability and impact. There is a moral, social and practical imperative to build a strong evidence base on this topic.

Holistic Conceptualizations of Health by Incarcerated Aboriginal Women in New South Wales, Australia

While there has been extensive research on the health and social and emotional well-being (SEWB) of Aboriginal women in prison, there are few qualitative studies where incarcerated Aboriginal women have been directly asked about their health, SEWB, and health care experiences. Using an Indigenous research methodology and SEWB framework, this article presents the findings of 43 interviews with incarcerated Aboriginal women in New South Wales, Australia. Drawing on the interviews, we found that Aboriginal women have holistic conceptualizations of their health and SEWB that intersect with the SEWB of family and community. Women experience clusters of health problems that intersect with intergenerational trauma, perpetuated and compounded by ongoing colonial trauma including removal of children. Women are pro-active about their health but encounter numerous challenges in accessing appropriate health care. These rarely explored perspectives can inform a reframing of health and social support needs of incarcerated Aboriginal women establishing pathways for healing.

Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic

OBJECTIVE

Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia.

METHODS

A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016.

RESULTS

One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available.

CONCLUSIONS

The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.