People who go to prison experience some of the poorest health outcomes of any group in the community. Indigenous overrepresentation in the Australian prison system, and the fact that Indigenous people experience a range of poor health outcomes at much higher rates than their non-Indigenous counterparts further exacerbates the problem. Substance use disorders and mental illness in particular are normative in the prison population. Prisons in Australia, and the health services that are provided within them, are the sole responsibility of the states currently, with prisoners being uniquely excluded from receiving Medicare and Pharmaceutical Benefit Scheme-funded services and treatment during incarceration due to the operation of s 19(2) of the Health Insurance Act 1973 (Cth). There is overwhelming evidence that prison mental health services are not currently fit for purpose, with many people leaving prison with untreated mental illness and substance use disorders, resulting in a spike in fatal and non-fatal overdoses, and substance-related injuries in the period shortly after release from prison. Previous reports have found that prison mental health and counselling services are under-resourced and unable to meet demand. This paper will discuss how the Commonwealth Health Minister could exercise their discretion under s 19(2) of the Act to help improve outcomes in both Indigenous and mental health for people who go to prison, without a major shift in policy, or costs, from the current position.
Craig Cumming is a Research Fellow, currently undertaking a PhD at the School of Population and Global Health at the University of Western Australia. Originally coming from a Law and Criminology background, he has been involved in research focusing on the health of people who have contact with the Justice System since 2011. He has spent several years attending Police lockups and prisons to interview detainees and prisoners in person. His work has primarily focused on drug and alcohol use and mental illness in this population. Craig consults with a number of consumer and community groups as well as government departments to ensure that his research is guided by community need and policy priorities. His work has included providing evidence to the West Australian Government’s Methamphetamine Task Force, as well as the Commonwealth Parliamentary Joint Committee on Law Enforcement’s Inquiry into Crystal Methamphetamine.