Access to culturally safe and effective healthcare is a basic and fundamental human right which extends to people in prison and youth detention facilities. First Nations people are over-represented in both prisons and youth detention facilities and often have complex health needs. 

State and territory governments have operational responsibility for the provision of healthcare in places of detention and the operations of their detention facilities. This report highlights the health and wellbeing inequities experienced by First Nations people in prison and detention facilities. It provides recommendations for governments to achieve real and sustained action to complement existing state and territory-led work, and to provide a more coordinated, national approach to system reform of healthcare in places of detention.

Key findings

• Governance, design and delivery of First Nations health services varies across jurisdictions and locations with limited involvement from Aboriginal Community Controlled Health Organisations.
• Healthcare in places of detention is rarely proactive, holistic or driven by a First Nations model of care.
• Initial assessments are not effective in comprehensively identifying complex health needs and informing ongoing care.
• There is a lack of adequate services to support people with disability, mental health issues and other complex needs.
• In the majority of cases, health services are not available to people on remand.
• Inadequate funding arrangements lead to limited access and poorer quality healthcare than available in the community.
• Trauma is not well understood by correctional and clinical staff.
• There is widespread stigma associated with accessing mental health and alcohol and other drug services.
• Existing complaints mechanisms are not trusted to raise concerns or report breaches in human rights.

Recommendations

1. Health and justice ministers agree to a set of national reform principles to drive action.
2. Health and justice ministers investigate evidence provided to the review and take steps to cease any practices that violate prisoners’ rights.
3. Establish a National Partnership Agreement to govern the reform of First Nations health services in places of detention.
4. Implement a national program of work for First Nations healthcare in places of detention, led by the National Partnership Agreement.
5. Facilitate the leadership of the Aboriginal community-controlled health sector in the policy, design and delivery of health services in partnership.
6. Health and justice ministers pilot alternative, therapeutic models of custody for First Nations people, prioritising mothers and young people.