BEHIND BARS (PART 5): The Need For Large-Scale Change

The abuse of Aboriginal prisoners with disabilities in Australian jails is confronting, and ongoing. In the final edition of a special five-part series for New Matilda, Michael Brull explores the shocking revelations uncovered in a landmark report written by Human Rights Watch. Click on the links to read the other stories in the series – Part 1, Part 2, Part 3 and Part 4.

Lack of medical care

HRW observed: “All prisoners face delayed or inadequate access to health care due to overcrowding. Prisoners with disabilities, however, face particular barriers accessing specialized services due to lack of proper diagnoses, long waiting lists, negative staff attitudes, and lack of resources.” “Impossibly large caseloads” prevent mental health professionals from providing appropriate care for prisoners, who often have complex needs. Furthermore, “Mental health staff often fail to discuss with prisoners the nature, purpose, risks, and benefits of different types of treatment so that the prisoner is not in a position to make informed decisions on whether or not to consent to the treatment. The effectiveness of their work is also often impeded by antagonistic relations between prisoners and prison staff.”

The difficulties begin with the admission process. When prisoners are taken into prison, “staff do not have the time, training, or tools to effectively identify people with disabilities and their support needs. Both the Western Australia and Queensland Departments of Corrective Services said staff receive initial training on disability and mental health, but there is no specific refresher or on-going training required or provided”.

As staff do not identify the disabilities and needs of prisoners, “prisons fail to provide appropriate and adequate services and accommodations for the particular needs of prisoners with disabilities.” Prisons in “Western Australia and Queensland were not consistently assessing or collecting data on disability” (NSW may be exempt, due to the government refusing to cooperate with HRW). A WA prison nurse said, “There is no disability assessment here. We don’t have time, we don’t have the facilities, and we don’t have the nursing staff. Prison is not set up for people with disabilities.”

A psychiatric nurse observed, “People with disabilities get lost in bigger prisons. If you’re not screaming or kicking, and if your disability isn’t visible, you’re under the radar.”

Once prisoners are admitted, the problem advances to a simple lack of investment in psychiatric and medical staff to support prisoners.

“Human Rights Watch found that prisoners with psychosocial disabilities can wait weeks and sometimes months to see a psychiatrist in Western Australia and Queensland respectively. According to a 2015 report by J.R. Paget, the Inspector of Custodial Services, in New South Wales, the average waiting time to see a primary health nurse was 28 days across correctional centres and over a month to see a doctor. However, the average waiting time to see a psychiatric nurse was 27 days and 42 days to see a psychiatrist. For a bed in a forensic hospital, a prisoner in New South Wales can wait up to 99 days on average.”

A prison officer in WA said, “We desperately need a mental health unit and a proper level of care. Some of these people should not be here. They need proper care.”

The way long-term and complex needs are met is grossly inadequate. Effort is more narrowly focused on what is considered urgent. A woman with a psychosocial disability said, “When lights are turned down, I am not allowed to press the button for Panadol because it is not ‘a medical emergency.’ To them, a medical emergency is a matter of life or death.”

The lack of investment is a crucial part of the lack of care. In WA, “fewer than three full-time psychiatrists rotate between the 17 adult prisons.” One prison staffer explained, “It takes weeks and weeks to be seen [by medical staff]and you’re not even seen by a doctor, but a nurse. Unless a guard likes you and pushes [the medical request]through the system, you don’t get seen.”

The lack of funding also plays a direct role in the kind of care provided. HRW writes that, “People with disabilities may also be refused treatment because of the financial burden on prison administration.” One such prisoner said he was told by his physiotherapist that, “There is nothing I can do for you. This is a budget issue. I can’t keep sending people to the hospital; the ambulance costs $1000.”

As for specialised facilities, these are also grossly inadequate. In WA, there is a single 37-bed facility, to provide for over 6,500 prisoners. Even when admitted, a prisoner “could be sent back to prison before clinically indicated because the waiting lists are long and a prisoner on a court order or in a more critical state will be prioritized”

 

Lack of training, and staff prejudice

Among staff, the primary issues are prejudice and abusive behaviour, and a lack of training for people with disabilities (which, as noted, aren’t properly identified upon entry). HRW explains that:

“In a prison environment that is punitive and fails to accommodate a person’s disability, prisoners with disabilities often struggle to cope and their resulting behaviour is misunderstood by staff. Prison staff acknowledge that people with disabilities can be overrepresented in detention units and that they are not adequately trained on disability and mental health to distinguish between a conduct that stems from the disability or a mental health crisis and one of defiance.

Instead of providing psychosocial support and accommodations for a person’s disability, prison staff can reprimand or punish the prisoner for behaviour that is perceived as ‘disruptive,’ ‘disobedient,’ or ‘acting up.’ Human Rights Watch documented cases of people being sent to a punishment unit after experiencing anxiety or a crisis that medical staff did not manage on time.”

A psychiatrist who worked with prisoners said:

“Custodial staff have little to no training in dealing with people with disabilities…. They are treated in a punitive manner for help-seeking behaviour. For example, a prisoner with an intellectual disability will bang on the door because he is distressed or in pain and is seeking help. But it will be seen as bad behaviour and they will be punished.”

Another psychiatrist observed:

“I haven’t seen anyone with an intellectual disability who hasn’t gotten worse in prison. They are often punished [by staff]when struggling to communicate or seeking help. The staff don’t get that people with intellectual disabilities don’t understand what’s happening. Staff take things personally and then act out in anger against the prisoner.”

 

Conclusion

The HRW report concludes with various recommendations. Some of them may get implemented – there’s a call for a national inquiry, and those types of things are often happy choices for the government, which kick an issue down the road, often don’t require any commitment, and there’s rarely follow up when the recommendations aren’t acted upon.

There are calls for things like ending solitary confinement use against prisoners with disabilities. Presumably, even this won’t be acted upon, because there isn’t enough of an outcry.

It is primarily used because prisons don’t know how to handle people with disabilities, who shouldn’t be in prison in the first place. Now that the report is out, they’re still ill-equipped – in every other way too – to deal with people with disabilities. So solitary confinement is likely to stay, especially given the lack of public understanding of how it effectively amounts to torture.

Other recommendations are wildly ambitious. Additional recommendations include calling on the government to pass a human rights act. Federal and State governments are unlikely to respond on the basis of this report alone. Other recommendations include increasing training of staff, collecting data on prisoners with disabilities, providing adequate resources to prisons to care for inmates and so on.

In a way, there is a lack of political nous to the recommendations. The recommendations are ambitiously pitched, though so many similar reports have been ignored. Yet in a way, this isn’t such a bad thing. Human rights reports can be regarded as a kind of resource for activists to use. This report, like so many others, sets out clearly that there is a serious problem. Fundamentally, prisons are under-invested with the resources to care for prisoners. For this to change, public awareness must be raised, to the point that people desire that prisoners be treated more humanely.

The problem with this is that large sections of the public, including much progressive opinion, want criminals to be treated vengefully. There is satisfaction when a murderer, a rapist, a terrorist or a paedophile is convicted of a heinous crime, and there is an expectation that they will be severely punished. Clamouring for prisons to be more humane will clash with those who want to see harsher sentencing and punishment for, say, rapists.

Ultimately, for these things to change, and people in prison to be treated more humanely, there will need to be a large-scale shift, in the sense of an Australia-wide shift, against treating prisoners badly and punitively. This is a political question, and until it is more widely grappled with, it will not be resolved, because it will take a great deal of pressure to convince Australian governments, state and federal, to treat prisoners more humanely.

What this means now is stories like those told previously. A man with a psychosocial disability being held in solitary confinement for 19 years, because the prison can’t control his behaviour. An Aboriginal man being forced to wear a nappy everyday, because the toilet is so rarely made accessible to him. This is the degrading cruelty our current system delivers.

It has been said that societies should be judged by how they treat their most vulnerable. These reports have provided a sturdy basis for judging Australia.

For the foreseeable future, this is our country.

Click on the links to read the other stories in the series – Part 1, Part 2, Part 3 and Part 4. You can support Michael’s work by subscribing to New Matilda here, donating via the Paypal button below, or sharing this story on social media and with friends and family.