The interface between ‘inside’ and ‘outside’ is vital for prisoners Australia is a wealthy and well-developed nation but when it comes to the management of our prison systems we lag well behind Scandinavia and various other countries in the world. This is particularly the case for our First Nations people.

Our custodial statistics tell the story. Aboriginal and Torres Strait Islander peoples makeup: 3% of the general population, 28% of the prison population, 86% of recidivism, 40% of the female prison population, and 98% of youth behind bars in the NT.

There are many reasons for this, including transgenerational trauma. Indigenous prisoners have nearly all suffered from past trauma whether that is physical, psychological, or sexual abuse. That is the medical and psychosocial history they give when asked.

The problem is stark, and the solutions are challenging particularly with the populist ‘tough on crime’ political views behind it. However, the mood may be changing around the Uluru Statement from the Heart process underway in Australia.

The interface between being in prison followed by release is a crucial time when opportunities for rehabilitation are so often lost. Many inmates find this transition very challenging and returning to their home environment can be daunting. Then there is the growing number who are homeless. The return to a jail may even be a choice taken by reoffending.

So, what would be the ideal post-release scenario?

GPs and the primary care allied health professionals they work alongside fulfill a crucial role. For a start the first thing that needs to happen is that they need to re-join the Medicare and Centrelink systems. This is needed to regain the Individual Health Identification (IHI) details before a PBS script can be written or allied health systems can be put in place.

These are significant barriers to gaining appropriate post release primary care. Done well this care is a key to preventing recidivism. How could this be done better?

For a start, for prisoners to have access to Medicare whilst inside would help. Currently they are looked after with health needs in NSW under the auspices of the NSW Justice Health and Forensic Mental Health. The health staff including GPs do an amazing job in this under-resourced field with workforce skills shortages being part of the problem.

If they had the use of the Medicare system at least in part, it would be helpful at least for a few item numbers for mental health and chronic disease and there is a push to make this happen, including by the RACGP.

And then there was this tragic case recently where a Coroner was also pushing for some Medicare access for prisoners.

The other issue is that Medicare access would help for the transmission of vital information to be transferred from a State to a Federal health system. The current arrangement is poor and attempts to fix it have not yet been forthcoming. Medicare has the My Health Record system which may be helpful in solving this problem.

Meantime we suffer with the current clumsy and inefficient situation which is also costly. It costs something like $330 per prisoner per day for our jails. Some of this money could be better used for rehabilitation.

‘Prisons are needed for violent and high-risk offenders, but too many of our jails have a revolving door of low to medium risk prisoners when there is a falling crime rate. Alternatives to prisons need to be found’.

Commissioner Stephen King – Productivity Commission, Nov 2021

In our own broader region, we have the biggest jail in Australia, the Clarence Correctional Centre run by Serco and many inmates are sent to Balund-a, a cattle farm near Tabulam for a 6-month rehabilitation program. If there were more such facilities the need to build more very expensive jails may be less. Certainly, there are other successful working models such as home detention with monitoring and intensive rehab programs around the world.

However primary health care is always vital for them to succeed and having access to Medicare would be helpful in this regard.