Organisations in Focus
Western Australia Department of Justice Health Service
From Derby, up in the West Kimberley region, down to Albany in the Great Southern region, the Western Australia Department of Justice, previously the Department of Corrective Services, manages nearly 7,000 adults and juveniles at 15 public, and three privately operated correctional facilities in Western Australia (WA).
The Department of Justice’s key responsibilities and obligations revolve around:
- Providing offender management services that protect the community
- Giving offenders the interventions they need to make a positive difference in their lives and reduce their involvement in the criminal justice system
- Supporting offenders to become responsible citizens by adopting law-abiding lifestyles, and
- Promoting crime prevention.
The health of prisoners is poor and health inequalities are very marked. Prisoners have a greater risk of mental health problems, self-harm, addiction, and chronic and communicable diseases than the general population. Their lives are often further complicated by difficult social and personal issues such as unemployment, low educational attainment and even homelessness. This means that prisoners have significant and complex health needs, sufficiently poorer than the general community and are often long-term or chronic in nature. The relationship between health and social influences on offending and re-offending behaviour is complex. In some areas, there is a clear link with health issues offering the prospect of reducing offending and re-offending rates through health-related interventions.
With the exception of WA, health services provided within correctional facilities come under the respective State and Territory Health Departments. WA correctional facilities health services fall within the Department of Justice and are independent of the WA Health Department. WA offenders are provided access to evidence-based primary health care, mental health and Alcohol and Other Drug (AOD) services, delivered by competent registered health professionals at a standard comparable to what is available to the general community.
Prisoners and young people in detention are excluded from receiving Medicare and Pharmaceutical Benefits Scheme subsidies, with responsibility transferred to State and Territory Governments.
For many offenders, going to a correctional service may be the first time in a while that they are seen by health professionals.
A dedicated team of doctors, nurses, mental health and AOD staff, and visiting health specialists including psychiatrists, dentists and other allied health professionals provide health services across all WA correctional facilities. The health centres are supported by a central office team that set strategic direction, policy and procedures, provide program coordination and evaluation, quality assurance and improvement.
Fifteen of the publicly operated prisons and two of the privately operated prisons in WA are accredited with QIP against the Royal Australian College of General Practitioner (RACGP) Standards for health services in Australian prisons (the Standards). The Standards are designed to support health services to achieve better health outcomes for people incarcerated in Australian correctional facilities or detained in custody. Although General Practitioners providing healthcare in prisons face the usual challenges of general practice, they also face a range of additional complex issues such as the need to balance privacy and confidentiality with safety and security and patients at risk of self-destructive behaviour and the Standards are reflective of these circumstances.
For the Department of Justice, every element of a patient’s primary, secondary and tertiary health care must be meticulously planned. Accreditation assists with maintaining, reviewing and improving numerous systems and processes. Two key challenges constantly faced by the Department of Justice in delivering health care are and balancing patient privacy with security.
As with any other health service, patient privacy is protected. When managing privacy in a typical healthcare service, clinical staff will simply close the door when conducting an appointment with a patient without giving this a second thought. In the complex environment of custodial settings, there are many considerations to address before a door is closed; there needs to be a balance between safety of clinical staff and privacy of a patient.
Depending on the security status of a patient, circumstances may call for a third party custodial officer to be present within the consultation, the door may need to stay open, or the consultation may take place in a room with a glass window or door, so the patient is always in sight of the third party, but their privacy remains intact.
A majority of WA correctional facilities do not have 24 hour medical care on-site, but do have rostered coverage for set hours of the day. This includes medical staff providing care via video-conferencing, and an after-hours e-consultation system where on-call medical staff responds to medical issues via email. There are strict protocols in place to ensure a timely response to all issues.
While some States and Territories have acute care facilities within correctional facilities, in WA prisoners are transferred to external hospitals for emergency and acute care and various outpatient specialist clinics. Although it is in the best interest to have each patient involved with their own healthcare as much as possible, for security reasons, this may not always be possible. For example, a patient cannot know the time of their specialist appointment, or know which hospital they may be taken to. This is to ensure security is maintained for the protection of the community, while still meeting the patient health needs efficiently.
The Department of Justice’s on-site accreditation survey of the publicly operated correctional facilities included four QIP Assessors. Conducted over two full-days in the head office initially, an additional two weeks across each of the 15 locations within the state. Since completing their first round of accreditation against the Standards, the Department of Justice have expanded their patient awareness and the need to constantly evaluate service delivery and models of care while also improving systems and processes. The WA Department of Justice Health services must endeavour to meet the particular health and care needs of their vulnerable population in order to make a significant impact, improve health, change lives and reduce health inequalities.
