HON ALISON XAMON (North Metropolitan) [10.22 am] — without notice : I move —

That this Council —

(a) recognises the health needs of men, women and children in Western Australian prisons and in Banksia Hill Detention Centre;

(b) acknowledges that people in custody are entitled to receive the same level of access and quality of health care as the general population;

(c) notes that prisoners and young people in detention are excluded from Medicare; and

(d) calls on the state Labor government to call on the federal Minister for Health to end prisoners’ exclusion from Medicare .

I wanted to move this motion today in particular to draw members’ attention to this issue. A lot of discussion is occurring on what is happening to state and federal funds. I think we have a very serious issue in this state around how the goods and services tax is calculated. I have personal issues around the way other states’ income from pokies is excluded from the GST distribution calculation, but that is a discussion for another time. I do not agree that Western Australia should be penalised for implementing appropriate social policies and not trying to make money out of other people’s misfortunes.

One of the issues I particularly wanted to bring to people’s attention today is the effects of decisions made in the past to exclude people in our prisons and detention centres from being able to access Medicare. This has resulted in a significant financial impost on the state and has also resulted in some quite serious adverse health implications for people, some of whom are the most vulnerable in our state. The purpose of this motion is to see whether people agree that this issue needs to be brought to the federal government’s attention and be subject to negotiation. I believe it is unfair for the state to be left with this cost and, as I say, a massive personal and community cost is being paid as a direct result. People in our prisons, and children and young people in Banksia Hill Juvenile Detention Centre do not have access to Medicare. That is something people are often not aware of and are very surprised when they hear about it. That means that the cost of providing health care to 6 092 men, 684 women and 134 young people in our prisons or juvenile detention centres in Western Australia is being footed by the state, which is a ludicrous situation. The Greens strongly maintain that all Australians should have access to Medicare and it should not matter where in Australia they are.

Prisoners and young people in detention are excluded from Medicare due to section 19(2) of the Health Insurance Act 1973. This section provides that where health services are being provided by, on behalf of or under an arrangement with any government entity, whether federal, state or territory, Medicare is not available unless the federal Minister for Health grants an exemption to the section. The purpose of this section is to avoid double dipping, but the effect of it does not at all deal with what actually happens. This provision is premised on the notion that the states and territories will provide equivalent health services for people in custody and therefore bear the cost.

I maintain that access to health care is a basic human right that people should not lose just because they have been sentenced to a period in custody. We know that punishment in our justice system is about loss of liberty but it should also be an opportunity for people to be rehabilitated. We need to ensure that prison does not undermine other human rights. Australia has endorsed the United Nations Standard Minimum Rules for the Treatment of Prisoners, called the Nelson Mandela Rules, and in doing so has committed to provide equivalent health care for people in prison and youth detention. Rule 24 states —

1. The provision of health care for prisoners is a State responsibility.

By that I mean government, not the state of Western Australia —

Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.

Although younger men make up the bulk of the Western Australian prison population, we need to remember that the Health Insurance Act provision impacts also on vulnerable children, women and older people who are in prison and detention across the state. I maintain that there are many compelling reasons for providing good health services in our prisons, but the services being delivered in our prisons at the moment are not good. The bulk of offenders enter custody with some of the worst health profiles in the country. In every health indicator — infectious diseases, chronic respiratory and heart conditions, intellectual disability and addiction — we know that people in prison are already well behind the average of the general population. Prisoners often have significant and complex health needs that are often very long term or chronic in nature. Many prisoners have complex histories of disadvantage that encompass family violence, unstable housing, limited education, unemployment and economic adversity. There is also a higher rate of risky health-related behaviours including smoking, illicit drug use, harmful alcohol consumption and unsafe sexual practices. With almost half of prisoners unemployed before entering jail, one-third never having completed year 10 and one-quarter homeless, prisoners rate very poorly in the social determinants of health. Correctional settings are unique places to detect health problems, initiate care and promote health in a way that is unlikely to occur in the community. This has important health implications for the communities to which prisoners return. On its website the Department of Corrective Services states —

For many offenders, going to prison is the first time in their lives they are seen by health professionals.

Yet, we know that the highest number of complaints and concerns received by the Independent Visitors for the Office of the Inspector of Custodial Services last year related to health services in our prisons.

I also want to talk about mental health services in our prisons. There is an extremely high prevalence of mental illness among prisoners and detainees, and this has been identified as a central factor contributing to offending and particularly recidivism. I am sure that recidivism is of particular concern to some members in this place. The rate of co-occurring substance use and mental illness is also disproportionately high amongst prisoners and particularly elevated amongst women prisoners. Time spent in custody provides an opportunity for prisoners and detainees to finally receive appropriate psychiatric diagnoses and interventions, including medication regimes. However, mental health services for prisoners, including treatment and withdrawal programs for drug and alcohol addicts, are massively overstretched and do not even remotely meet demand. This is being exacerbated by unprecedented levels of overcrowding. The Australian Medical Association recommends that mental health services in prisons should be adequately resourced to provide appropriate screening assessment and therapeutic procedures, including for co-occurring mental health and substance use disorders. As I said, we know that improved mental health reduces recidivism, so if we do not use that opportunity and address the mental health and untreated addiction of people in our prisons, the revolving door between prisons and the community will continue. I also add that better mental health services make prisons safer, both for other prisoners and the people who work there. Again, the Office of the Inspector of Custodial Services found that prisoners with mental health concerns and intellectual disability were significantly overrepresented in staff assault incidents, with prisoners recorded as having some form of psychiatric illness in almost 40 per cent of the assaults analysed by the office. There is also a disproportionately high level of Aboriginal imprisonment, and failure to properly fund health services to people in prisons and detention centres disproportionately impacts on the health and wellbeing of Aboriginal people because of this appalling overrepresentation of Aboriginal men, women and children in our justice system. WA imprisons more Aboriginal people per capita of the Aboriginal population than any other state or territory and I think this is a terrible statistic that is made even worse if we do not take the opportunity to address health inequalities when people are in custody.

Women are particularly vulnerable in our prisons and the lack of health care is having a very specific impact. Women in custody very often have histories of violence and abuse perpetrated against them, and also they may be the primary carers of their children. If their health needs, and particularly their mental health needs, are not present, it raises very big concerns when they are released. It impacts on the capacity to secure stable accommodation, and very often these women, once they have been incarcerated, will have had their children taken into child protection for the time they are in prison. If they have also not had the underlying mental health issues addressed during that time in prison, it may be some time before those children are ever returned to their mother. This adds an additional cost to the state because it means that there are children who continue to be held in care. From a long-term perspective we are also creating a vulnerable population of children who not only have a mother with mental health issues, so they are a child of a parent with mental illness, they can go on to have higher rates of mental health issues, which again is a cost to the state apart from the human cost. If women’s mental health needs are not met in prisons, it is more difficult for them to get a job, their chances of reoffending are higher and they have a very high risk of ending up in custody again. It is bad for the community, because offending has continued, and it is bad for the taxpayer because keeping people in prison is a very expensive exercise. From my perspective this is a no-brainer. We know that if we address women’s mental healthcare needs, we will stand a much higher chance of ensuring that families are able to get back together, that crime rates will reduce and that women will stay out of prison, which will reduce the overall burden on our welfare system and also the state budget.

Young people in detention also have specific healthcare needs and prevention and early intervention can be particularly effective at this age. I also mention that another looming health challenge is the rapid ageing of our prison population. In the last decade across Australia there has been a 140 per cent increase in the inmate population aged over 65. All these prisoners are bringing a whole range of unique health challenges, notably diabetes, dementia and, increasingly, a range of disabilities. The idea of enabling access for prisoners to Medicare is starting to get increasing agreement. Again, I note that the AMA in particular is starting to really speak out about this. For a while the AMA has been saying that it believes prisoners should retain their entitlements to Medicare while in prison and it has been lobbying on this. The AMA states —

The loss of Medicare and PBS entitlements while in prison is inconsistent with best practice in throughcare, and serves to exacerbate the cycle of ill-health experienced by prisoners and detainees as they move between prison and the community.

The AMA has also raised the issue of prisoners needing to reapply for their Medicare number upon their release. When we think about the lack of health care they have received in prison, this can be practically challenging for a number of prisoners and it becomes additional barrier for prisoners engaging in health-seeking behaviours upon release. Again, it is not good for the community and certainly not good for those people. It also hampers information exchanged between prison and community health services. It has been noted that exclusion from Medicare means there is no financial incentive for community health service providers, such as Aboriginal community – controlled health services, to enter prisons, particularly in rural and remote areas. These services are really important, and their provision of culturally appropriate care could be of real benefit in the custodial environment. They know how to deliver these services and deliver them really well. I am particularly thinking about Aboriginal young people in Banksia Hill Detention Centre, many of whom are thousands of kilometres away from family, community and country.

It is generally acknowledged, including by the Department of Corrective Services, that health services provided in prisons should be of a standard commensurate with those provided within the community. I have said before that that was always intended to be the expectation, but it is clear that this is currently not the case. One of the reasons this is not the case is that the federal government has denied access to Medicare to prisoners and young people in detention. Again, I maintain that quality health care and mental health care is not only a human right, but also makes good economic sense in the long term. We know that prevention, early diagnosis and intervention is cheaper and more effective than waiting till people turn up in emergency departments, or waiting for people to continually offend and end up back in our prisons.

I recognise that there is not a lot of sympathy when we talk about prisoners, and particularly when we talk about the rights of prisoners and their access to services. I understand that a “lock them up and throw away the key” mentality often dominates a lot of public discourse. I get that. But I maintain that this is an area that we absolutely should hear about. The reason for that is, as noted by the Inspector of Custodial Services, prisons deliver a human service; they are not a warehouse function. The failure to allocate funding to provide high-quality health care in prisons is a false economy. The longer illnesses and diseases go on, the greater the ultimate costs of treatment, as well as the flow-on in other areas. Failing mental health and untreated substance abuse is perpetuating the cycle of ill health and disadvantage, and is a recipe for reoffending. We need to ensure that all Australians have access to appropriate and quality health care, regardless of their circumstances. According to the Department of Corrective Services’ “2015 – 16 Annual Report”, 11 817 patients received health care in prison, but of course the services they received were not necessarily all covered by Medicare. That represents a significant cost to Western Australia.

I note that ending prisoners’ exclusion from Medicare is supported by, as I have mentioned, the Australian Medical Association, the Public Health Association of Australia Inc, and the Royal Australian and New Zealand College of Psychiatrists. I note that there are also some vocal campaigners around this issue, particularly Professor Stuart Aitken of Griffith University.

Before I finish I would like to acknowledge the challenges of providing health services to people in custody. I want to acknowledge the really good work being done by the people working in that environment — I know a number of them. Some really wonderful people work in custodial health services within Western Australia. I have seen firsthand their commitment and dedication to their work; they show a lot of humour, passion and courage. They are making a positive difference to the lives of the people they work with, to the extent they are able to. My motion today is purely about health care.

[speeches and comments of various members]

HON ALISON XAMON (North Metropolitan) [ 11.11 am ] — in reply: I thank members for their contributions. I appreciate their participating in this important issue. I want to respond to a few of the comments. Again I note that this issue is about the provision of health care. I have not even talked about the lack of dental care within our prisons and also alcohol and other drug treatment services, for example. I also point out that the purpose of this motion is to highlight the fact that the federal government is not meeting its obligations for funding the health care of prisoners in this state and the unfair burden that is placing on the state Department of Corrective Services budget. I note Hon Stephen Dawson’s comments about the moves to transition the delivery of health services from Corrective Services to the Department of Health. I am aware that discussions began under the previous government and that they are continuing now. This is a positive move in the right direction. However, I also note that part of what is holding up those discussions is that the health department has indicated that it is concerned about the cost of being able to deliver those services without Medicare being made available. This is a genuine concern. Even though the move to transition the delivery of health services from Corrective Services into Health will make for a better delivery of services, the cost of that and how the state will bear that cost is still an ongoing issue.

I want to pick up on the contribution of a couple of members who talked about the quality of services within our prisons. I note Hon Nick Goiran’s comment s about the Department of Corrective Services having on its website that prisoners are offered the same level of services. I note also the concern of Hon Charles Smith that prisoners are getting a better level of service. Remembering that one of the key issues of this motion is to talk about cost shifting between state and federal, I will say that, with respect, as someone who has also been working out of prisons, fairly recently, it is my absolute assertion that the level of health services available within our prisons and our mental health services are woefully inadequate. Not only are they not meeting the level of demand for the reasons I have already articulated in terms of the increased level of need within the prison population because of ongoing adverse health issues and a high prevalence of chronic conditions — all of those issues — but they are not meeting even some of the most basic services. This is not about trying to apportion blame. The budget for Corrective Services has continued to blowout, proportionate with the increased number of prisoners, and at some point something needs to give.

I appreciated Hon Stephen Dawson’s comment that if health services were to be funded by Medicare, that would better enable the existing Corrective Services budget to be utilised for rehabilitation services. I completely agree. We would be able to look at increased training opportunities and a range of things that would support people upon release to be able to live better within our community and, very importantly, hopefully not engage in offending behaviour ever again. That is one of the points that is lost when we talk about prisoners and services for prisoners. Ultimately, this should also be about ensuring that our community is safer, and we do not make our community safer if we do not help to break the cycles of people’s lives that are contributing to offending behaviours in the first place.

I stress again that under the Health Insurance Act the Minister for Health has the power to grant an exemption to end a prisoner’s exclusion from Medicare. I listened closely to Hon Stephen Dawson’s contribution and I heard that there was an agreement from this government that this was an issue that was worth continuing to lobby the federal government on. I am pleased to hear that. I hope absolutely that that will be taken up vigorously. I would like to offer the Greens’ support of anything that we can do at either a state or federal level to encourage this move. I assure members that that will be possible.

I pick up Hon Nick Goiran’s comments about the quality of health services in our prisons. I assure Hon Nick Goiran that over the next four years I will most certainly continue to talk about the quality of our health and mental health services for our prisoners and will pay close attention to the provision of services and the number of dollars and how many people are accessing services. The member can rest assured that this is likely to be an issue that I will keep a very close eye on. I maintain that WA should not face the burden of addressing the profound disparities faced by prisoners alone. Western Australia already carries an unfair burden in federal – state finances. I strongly believe that this is the way the federal government can not only start to do more of its fair share, but can ensure that the community ultimately will be safer and also that people in our prisons will finally get the services they need. I commend the motion to the house.

Motion lapsed, pursuant to standing orders.


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