The United Nations standard minimum rules for the treatment of prisoners (the Mandela Rules) state:
"Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status."1
Custodial health in this curriculum refers to the provision of high-quality general practice care in correctional facilities, police cells and immigration detention centres.
Immigration detention centres may accommodate a number of distinct populations, including individuals who have been detained in correctional facilities and released into immigration detention prior to their deportation back to their country of origin, as well as individuals seeking asylum. The issues facing this latter group are covered in ‘RA16 Refugee and asylum seeker health contextual unit’.
Individuals in custody experience a different prevalence of physical and mental health conditions compared to the rest of the population. There has been a gradual increase in the Australian prison population over the past 10 years to more than 33,000 in June 2014, and over 90% of this population is male.2
Individuals from vulnerable communities constitute a large proportion of the population in custodial settings. Such vulnerable groups include individuals with low education levels – 46% of individuals in custody did not complete Year 10, 57% were unemployed and 43% were homeless prior to their imprisonment. Aboriginal and Torres Strait Islander people made up 27% of the Australian custodial population in 2014. Another marker of disadvantage is that 28% of individuals had at least one parent imprisoned during their childhood.3
In regards to health indicators and risk factors, in 2014 16% of individuals reported self harming prior to imprisonment, 84% smoked cigarettes, 54% reported high risk of alcohol-related harm prior to imprisonment, and 43% reported head injuries with loss of consciousness.3
Prevalent conditions in Australian prisons include a mental health diagnosis in 46% of the prison population and substance use issues. In 2012, 70% of Australian prison entrants reported illicit drug use in the previous 12 months, 44% reported intravenous drug use and 20% had shared equipment, which assists in explaining high rates of hepatitis C (22%) and hepatitis B (19%). Thirty-two per cent of individuals in custody reported a diagnosis of a chronic disease.3 When combined with anecdotal evidence of the commonality of minimal motivation to address health issues and low levels of health literacy in prison populations, it is clear that general practitioners (GPs) working in these environments require specific skill sets to deliver effective care and to improve health outcomes.
The evidence demonstrates that individuals in custody are more likely to access healthcare when needed (39%) than they would in the community (9%), and typically perceive that they have better health on release from custody (57%) than when they were imprisoned.3 Key factors in optimising health outcomes on release include provision of high- quality communication with community health providers, and empowering individuals with information and support to continue to prioritise their health.4