Introduction
Prisoners and detainees are members of the general population: they come from and usually return to the community. Justice Health fulfils a valuable role in improving the health status of this group while also minimising the health consequences of incarceration on individuals, their families and the general community. As unfortunate as an individual's interaction with the criminal justice system may be, it does provide unique opportunities to improve the health status of a group who on the whole experience poor health and have had minimal contact with health services in the community.
Since the mid 1970's when we were know as the Prison Medical Service, Justice Health has grown rapidly and expanded services both within and beyond the walls of NSW correctional facilities. The service has incorporated projects that aim to assist with continuity of care after release and diversionary programs, especially in the areas of mental health and drug dependence. Recently the service has also taken on responsibility for the provision of health care to all detainees within the Juvenile Justice System. This expansion is recognition of the specialist expertise and benefits that Justice Health can bring to the provision of healthcare to individuals interacting with the criminal justice system.
In all contexts, Justice Health must work closely with a number of other organisations. Partnerships are therefore essential for the delivery of quality health services and the achievement of our values and objectives. The Department of Corrective Services, the Department of Juvenile Justice, NSW Health Department, Area Health Services, Community Controlled Aboriginal Health Organisations, the NSW Police Force, the Attorney General's Department, Universities, community groups and advocacy groups are foremost amongst the organisations whose partnership we appreciate and seek to foster.
Our commitment to providing the best possible health care to our clients remains our key focus, and we are confident that through the efforts of our dedicated and professional staff we will continue to provide a service that leads the way in international best practice for those who come into contact with the criminal justice system.
Community Profile
The Adult Criminal Justice System
The Department of Corrective Services (DCS) is responsible for the custodial management of all adult inmates in NSW. At the end of June 2004, Justice Health was providing a range of health services to a daily average of 8,750 full-time inmates. This reflects an average annual increase of around 5.5% inmates per annum over the last five years.
The window of opportunity for Justice Health to provide healthcare to individuals is usually brief, as only approximately 10% of all receptions receive a sentence over six months. In addition, inmates rarely spend their entire sentence within the same correctional centre, with nearly 146,000 movements between correctional and court centres annually interrupting continuity of healthcare.
Inmate Facts (source: 2001 Inmate Health Survey)
- Most inmates are male, as females make up only 6% of the inmate population.
- 19% of male inmates and 32% of female inmates are Aboriginal and/or Torres Strait Islander, compared with 2% of the general community in NSW.
- 50% of males and 30% of females warrant mental health referral for major depression.
- 40% males and 64% of females are hepatitis C positive.
- 50% of males and 75% of females were unemployed in the six months prior to incarceration.
- 50% have not achieved School Certificate level of education.
- The average age of inmates is 33 years for males and 31 years for females.
The Juvenile Justice System
The Department of Juvenile Justice (DJJ) manages young offenders by means of supervision within the community or within Juvenile Justice Centres under remand or control (sentenced) orders. Under the Children's (Criminal Proceedings) Act 1987 and associated legislation, young offenders are defined as aged between 10 and 18 years. Depending on the security and risk level of a detainee, offenders can be transferred into the adult correctional system when they turn 18 years of age, though in special circumstances older offenders may remain in the care of DJJ.
Our juvenile clients commonly report experiences of neglect and physical, emotional or sexual abuse. This is particularly the case with young women. Many detainees report that they have experienced significant relationship problems in their families, leading to periods of homelessness and a large number leave school before completing year 8. Due to their educational deficits and poor self-esteem, most have limited employment choices and report feeling powerless and socially isolated. Many abuse alcohol and other drugs, seeking refuge in a delinquent peer group.
The average daily number of juveniles being cared for by the Department of Juvenile Justice is approximately 300, however numbers are declining as a result of diversionary programs to manage offenders in the community. In addition, there are over 650 children on community orders on a daily basis. In total, the Department of Juvenile Justice assists approximately 3,000 young people per year who are remanded in police cells or Juvenile Justice Centres.
Detainee Facts (source: Young People in Custody Survey 2003)
- 41% identify as Aboriginal and / Torres Straight Islander.
- 42% report having been physically abused, 10% sexually abused, 38% had experienced emotional neglect and 34% physical neglect.
- 19% of males and 24% of females had seriously considered attempting suicide at some time in the past.
- Overall, 28% of young men and 56% of young women have been diagnosed with asthma.
- 32% of young men and 30% of young women have mild hearing loss.
- 43% of participants have a history of parental imprisonment and 11% had a parent who was currently incarcerated.
- 17% of young men and 47% of young women had injected drugs in the twelve months prior to custody.
- Almost 90% of all detainees have used cannabis and most adolescents report having consumed alcohol and being drunk at some time in the past.
The History of Justice Health
The Justice Health has its origins in the first European settlement established in Australia in 1788. The health of the penal colony was managed by the Colonial Medical Service, which remained responsible for the medical supervision of convicts until 1836. Subsequently the Prisons Act gave prison governors direct control over healthcare provided to inmates. This continued until 1968 when control of the Prison Medical Service was transferred to the NSW Department of Health.
In 1969 two nurses were employed to deliver healthcare to inmates at the Long Bay Correctional Complex. Gradually the Prison Medical Service grew to have a nursing presence at each of the correctional centres around NSW. In 1978 the Nagle Royal Commission made a recommendation that health services to inmates be provided by the NSW Health Department. In the early 1990s, during a period of reform to healthcare delivery in correctional centres, the Prison Medical Service became the Corrections Health Service and in 1994, the service was designated a statutory health corporation. In 2004 the service became known as Justice Health, in recognition of the work we do in the community and courts as well as in correctional facilities.
Recent Milestones
- 1994 - The Corrections Health Board was convened.
- 1997 - The first Justice Health Inmate Health Survey was carried out.
- 1998 - The Metropolitan Medical Transit Centre was established to accommodate patients who need outpatient specialist care.
- 1998 - The Community & Court Liaison Service commences, providing assessment to Courts for the diversion of mentally ill from gaol.
- 1998 - Justice Health commenced service delivery to NSW Police Cell complexes at four locations.
- 2001 - The service achieved accreditation with the Australian Council on Healthcare Standards.
- 2002 - Approval was given to build new Prison and Forensic Hospitals at the Long Bay Correctional Complex.
- 2002 - The Correctional Centre Release Treatment Scheme is piloted in rural and metropolitan locations.
- 2003 - Justice Health assumed responsibility for the health care of all Juvenile Detainees in NSW.
- 2003 - The second Inmate Health Survey was published.
- 2003 - Justice Health Mental Health Service gained accreditation from the ACHS Justice Health Mental Health In-Depth Review.
- 2003 - Justice Health wins a Gold Premiers Award for our Community & Court Liaison Service and the NSW Health Baxter Award in Continuity of Care for our Correctional Centre Release Treatment Program.
- 2004 - The Centre for Health Research in Criminal Justice commences operation.
- 2004 - The name of the service is changed from Corrections Health Service to Justice Health.
- 2004 - The Correctional Centre Release Treatment Scheme is given a silver Premiers Award.
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