News

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GPs and better health outcomes for people in prison

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The delivery of healthcare for people who are in prison is set within a distinct environment for a vulnerable population.
 
Custodial health in Australia: Tips for providing healthcare to people in prison provides 10 practical tips:

• Understand the benefits of good healthcare for prisoners
• Respect and advocate for the rights of prisoner access to healthcare
• Keep safe – Physically and professionally
• Undertake a good clinical assessment
• Expect challenging behaviours
• Take care when prescribing
• Develop special skills
• Document, document, document
• Connect with external providers
• Support patients to connect with the community when released from prison

People in prison often arrive with existing physical and mental health issues. They also experience higher rates of these issues than other members of the community:
 

• One in two prison entrants were unemployed in the 30 days before entering prison
• Three in four prison entrants smoked tobacco
• Once in four people in prison received medications for mental health-related issues while in prison
• Two in three prison entrants used illicit drugs in the 12 months prior to prison.

Custodial health in Australia: Tips for providing healthcare to people in prison states that, ‘All of society’s most disadvantaged groups are concentrated in one place’. According to Associate Professor Tom Turnbull, Chair of the RACGP Specific Interests Custodial Health network, this provides an opportunity to target high-risk groups.
 
‘Providing care to people in custody is an opportunity to provide effective primary healthcare to a vulnerable population, to improve the health and wellbeing of a group in our community that the general public tend to be less interested in and concerned for,’ he told newsGP.
 
‘Custodial healthcare is the perfect opportunity for a GP or general practice registrar to hone their consulting skills and strengthen their professional boundaries to provide effective healthcare in a unique environment.’
 
Associate Professor Turnbull also sees opportunities for people in prison – who may not routinely access quality healthcare – to engage in preventive care and screening.
 
‘This is a perfect opportunity to improve the health of the individual, and at the same time the wider public health benefits of, [for example], preventing transmission of infections such as hepatitis C,’ he said.
 
‘[People in prison] are screened for mental illness, sexually transmitted infections and blood-borne viruses upon reception into custody. They are all offered hepatitis A and B vaccinations and can also access general dentistry and other allied health services.’

Associate Professor Tom Turnbull believes the provision of high-quality healthcare in prison can set up positive outcomes once patients are released from prison. (Image: Corporate Photography Melbourne)
 
Associate Professor Turnbull believes the healthcare provider’s role is to not only ensure delivery of high-quality care for people in prison, but also to support them to connect with the community once released.  
 
‘Most people in custody will be eventually be released and will become someone’s neighbour,’ he said.
 
‘Our aim is to ensure they are healthier at the time of their release than when they were received into custody, to give them the best opportunity to prevent recidivism.’
 
The new RACGP resource also covers recommendations to best support patients for positive outcomes once released from prison, including prevention of suicide risk, substance abuse and self-harm.
 
Associate Professor Turnbull highlights some measures that can be put into place to provide effective health services in prisons – and improve on existing ones. These include people in prison being eligible for the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) – other than Section 100 medication, such as HIV and hepatitis C treatment.

‘An opportunity for enhancing access to healthcare for [people in] prison, particularly in preparation for release into the general population, would be to change the Commonwealth Health Insurance Act 1973 to ensure that they can access MBS and PBS-funded healthcare services,’ Associate Professor Turnbull said.
 
‘This would reduce inequity and improve the existing services.
 
The responsibility for the provision of healthcare to people in prison currently lies with each state and territory government. Associate Professor Turnbull sees potential for improvement through benchmarking of prison-based health services between jurisdictions.
 
‘This will ensure transparency around agreed quality measures,’ he said.
 
‘Examples could include timely access to primary healthcare, mental health care services, hepatitis C treatment, and medication-assisted treatment for opioid dependence.’
 
The RACGP’s additional resource for providing healthcare to people in prisons, Standards for health services in Australian prisons, is due for update in 2020 and is designed to support GPs to achieve better health outcomes for people in prisons.

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