There are 120 correctional facilities in Australia. For the twenty-six year period 1980 to 2006, a total of 1,161 deaths were reported in prison custody, with approximately 37% of those deaths due to natural causes [1] Aboriginal and Torres Strait Islander people are over-represented in Australian prisons. In NSW, Indigenous people make up 2% of the general population but 15% of the prisoner population. [2]
Likely common issues for prisoners
Much of the literature on prisoners and palliative care comes from the US, and acknowledgement is needed of the differences in population and healthcare systems. However, many issues identified in the US are likely to become an increasing challenge in Australia.
Prisoners are more likely to have existing co-morbidities. [3] Women often have greater healthcare needs with 57% of women prisoners in one study with a history of sexual or physical abuse or both, with resulting higher rates of HIV, Hepatitis C. These women were also 16 times more likely to have a psychiatric disorder. [4]
Poverty, homelessness, cognitive defects, learning disabilities, low health literacy and prior limited access to healthcare are also factors to consider. Prisoners have little or no choices regarding decision-making [4], with for example, little or no internet access to search for health information. Advocacy by healthcare professionals may be difficult, and conflict with prison regulations. [3]
Security is seen as a priority and may restrict or delay timely access to external healthcare [3] as hospital transfers are costly and pose security risks. [5] Issues of litigation and liability (inferring neglect) may mean prisoners are sent to hospital to die (in custody), unless they agree to a ‘Do Not Resuscitate’ order. [6]
Inmates who die in prison potentially do so alone [7] as family visits may be limited or families may be estranged. In prison, family may also mean other prisoners. Access to compassionate leave (medical parole) varies, and is likely to be in the last few days of life. [3]
There can be restrictions on care delivery in prison [7], with limited access to urgent facilities, restriction on drugs (due to concerns about addiction) and problems with dispensing drugs (such as breakthrough medication). [3] Prisoners may also be assaulted by other inmates to obtain the drugs they have been prescribed.
Prison medical staff need to work in collaboration with social workers, clinical psychologists, Aboriginal Health Workers and Aboriginal liaison officers [2] and collaboration is also needed between prison staff and community palliative care staff to support continuity of care for those prisoners who are terminally ill. [3]
Death in custody
If a prisoner dies while in a hospital or hospice, they are still considered to be in custody. The room the patient is in at the time of death is considered to be a crime scene and nothing must be touched including the patient, until the investigating officers have finished.
The death then requires investigation by the State Coroner, who will look at the patient’s treatment during the course of their illness to ensure they have received fair and equitable treatment. Further information on coronial processes should be sought from State Coroner's Offices.
Bereavement
The Childhood Bereavement Network (UK) has published a new briefing paper, revealing that bereavement is a major, but often overlooked, issue for young people in secure settings. Studies show that rates of bereavement for young people involved in the criminal justice system are higher than in the general population. As indigenous youth are more likely to be in the prison system it is important that culturally competent bereavement support is provided.
Prison has a certain culture of toughness. Issues such as masculine and / or cultural responses to grief, as well as prison restrictions (such as limited options for attending funerals) can have a strong impact on the ability of prisoners to resolve issues of loss and grief. [8]
Books
Policies and Resources
OARS and Correctional Services
Related CareSearch pages
PubMed Topic Search (Bereavement)
Review Collection (Bereavement)
References
- Joudo J and Curnow J. Deaths in Custody in Australia: National Deaths in Custody Program. Annual report 2006. Research and Public Policy Series No.85. Australian Institute of Criminology
- Holmwood C and Rae D. Prison Health: A different place for GPs. Australian Family Physician 2003. Vol. 32 No.10, 854 -6
- Linder JF and Meyers FJ. Palliative care for prison inmates: “Don’t let me die in prison” JAMA. August 22/29 2007 – vol. 298 No.8 894 -901
- 4 Enders SR, MSW, Paterniti DA, Meyers FJ. An approach to develop effective health care decision making for women in prison. Journal of Palliative Medicine. 2005. Vol.8, No.2: 432-39
- Yampolskaya S and Winston N. Hospice care in prison: General principles and outcomes. Am J Josp Palliat Care. 2003. 20; 290 -6
- Ratcliff M. Dying inside the walls. Journal of Palliative Medicine. 2000. Vol.3 No.4: 509-11
- Courtwright A, Raphael-Grimm T and Collichio F. Shackled: The challenge of caring for an incarcerated patient. Am J Hosp Palliat Care 2008; 25; 315
- Hendry C Incarceration and the tasks of grief: a narrative review. Journal of Advanced Nursing 2009 65(2): 270-8.
This page was created on 22 April 2009 and is due for review in April 2011
Last updated 26 August 2009