Ruth Armstrong: Compounding problems

ONE of the most memorable articles I shepherded to publication in the MJA was an essay submitted for the Dr Ross Ingram Memorial Competition in 2011.
    
Aboriginal academic and educator Lindy Moffatt wrote about her son’s rapid cascade from illicit drug use to risk-taking, crime, the criminal justice system and prison.

Once in prison, her son developed a psychiatric illness that would see him hospitalised on a forensic order for more than a decade.

While told without embellishment, the story was evocative and has stayed with me all the more because I had the privilege of meeting the author and her son some months later when the essay won the competition.

A case report in the current issue of the MJA, which is the basis of an MJA InSight news story, reminded me of the winning essay, and of the vicious cycle of young people with mental illness being at increased risk of incarceration, with their mental and physical health under further threat when they are in custody.

Strikingly, the MJA report also highlights the risk of lifelong consequences to physical health if mental health problems are not carefully managed in the prison environment.

The risks are particularly acute for young Aboriginal and Torres Strait Islander people, who are currently incarcerated at a 24 times the rate for non-Indigenous youth and make up more than half of all young people in juvenile detention.

Among those in prison, the rates of mental illness such as anxiety, depression, substance misuse and psychosis, are very high: 73% overall for Indigenous men and 86% for women according to a 2008 estimate from Queensland.

Last week’s leaked (then hastily released) Report of the National Review of Mental Health Programmes and Services acknowledges that the system has failed Indigenous people with mental illness.

“Of critical concern is the dire status of the mental health and wellbeing of Aboriginal and Torres Strait Islander people”, the report says. “Indigenous people have significantly higher rates of mental distress, trauma, suicide and intentional self-harm, as well as exposure to risk factors such as stressful life events, family breakdown, discrimination, imprisonment, crime victimisation and alcohol and substance misuse. Service and system responses to these poor outcomes are inadequate, and have generally not been designed with the particular needs of Aboriginal and Torres Strait Islander people in mind.”

The report devotes a section to how this might be addressed, including adding mental health to the Closing the Gap targets, use of mental health and social and emotional wellbeing teams in primary care, and making mainstream services more culturally safe.

Aboriginal and Torres Strait Islander leaders have argued for the past few years that incarceration rates should also be added to the Closing the Gap targets because of the link between incarceration and ill health.

Earlier this month, health news blog site, Croakey, launched a crowdsourcing campaign, #JustJustice, to assemble and publish a body of knowledge about the problems of, and solutions to, the high rates of incarceration in Indigenous people.

In launching the campaign, Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda called the over-incarceration of Indigenous Australians a “public health catastrophe” and encouraged health professionals to engage with this issue by bringing their knowledge and research; their successes and failures to the public debate.

While the pathways to prison are complex, we can no longer view over-incarceration as simply a social issue.

The health sector must be involved in this contested but vitally important area of endeavour if we want change.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight