“The mentally ill, vagrants, discarded and friendless incapables and alcoholics (are) being sent to prison by the courts because the courts (do) not know what to do with them. They should be treated and cared for in institutions for those purposes, not sent to prison.”

Fredrick Neitenstein, Comptroller General of NSW Prisons (1895-1909)

Annual report: Crime and the Treatment of Prisoners in NSW, 1897

A little history

NSW adults in custody

The Network cares for over 30,000 custodial patients annually.

12,769 as at 12 October 2016

Incarceration rates for Aboriginal and Torres Strait Islander peoples are unacceptably high

l  Aboriginal and Torres Strait Islander peoples continue to be over represented within the justice system. Between June 2013 and June 2014, the adult imprisonment rate of Indigenous adults increased by 6.5% to 2,175 prisoners per 100,000 of adult Aboriginal and Torres Strait Islander peoples33.

l  The Indigenous imprisonment rate is 13 times higher than it is for non-Indigenous people in Australia34.

l  This high incarceration rate is reflected in an 88% growth in prisoner numbers among Aboriginal and Torres Strait Islander peoples since 2004. Over the same period the non-Indigenous prisoner numbers grew by 28%35.

l  Aboriginal and Torres Strait Islander peoples tend to be imprisoned for relatively minor matters that are less likely to result in prison sentences for non-Indigenous people. This is reflected in shorter prison sentences for Aboriginal and Torres Strait Islander prisoners (1.2 years) compared with two years for non-Indigenous prisoners in 201436.

Source: Rethinking Justice: Vulnerability Report, Australian Red Cross 2016

Aboriginal people in custody

Source: Prison Population Rate, World Prison Brief, Institute for Criminal Policy Research (2016) http://www.prisonstudies.org/highest-to-lowest/prison_population_rate?field_region_taxonomy_tid=All&=Apply

Global incarceration rates

Total countries: 221 (Rank 1: Seychelles at 799) As at: 10 May 2016

Rank Country Incarceration rate per 100,000 pop

Rank Country Incarceration rate per 100,000 pop

2 United States 693 115 Spain 133

7 Cuba 510 124 Iraq 123

8 Thailand 474 132 China 118

10 Russian Federation 445 136 Canada 114

35 South Africa 292 143 Belgium 105

37 Iran 287 154 Italy 88

48 Israel 256 161 Ireland (Republic of) 81

54 Turkey 238 164 UK: Northern Ireland 78

62 Singapore 219 174 Norway 71

68 New Zealand 202 176 Netherlands 69

97 Australia 152 182 Papua New Guinea 63

102 UK: England & Wales 147 186 Denmark 61

110 UK: Scotland 143 190 Finland 57

111 Nauru 140 193 Sweden 55

113 Portugal 139 202 Japan 47

Adult patients in custody: Health status

NSWCustodialPopula0on AustralianPopula0on

Source:2009JH&FMHNInmateHealthSurvey

Currenttobaccosmoker 75 80 18 15

Hepa00sB+ 28 34 <1

Hepa00sC+ 28 45 1

Depression/affec0vedisorders 33 51 5 7

EveraSemptedsuicide 19 27 2 4

Overweightorobese 55 58 70 56

Heartdisease 19 24 5 4

Asthma 26 40 10 11

Diabetes 4 5 4 4

An ageing custodial population

Source:AustralianBureauofSta0s0cs,PrisonersinAustralia,2005-2015

589 638 680 748 785 800 845 849 901 1,021 1,132

6.2%6.6% 6.7%

7.3% 7.3%

7.5%8.4%

8.9%9.2%

9.7% 9.6%

500

600

700

800

900

1,000

1,100

1,200

5.0%

5.5%

6.0%

6.5%

7.0%

7.5%

8.0%

8.5%

9.0%

9.5%

10.0%

AgedPa2entsinCustody,NSW

AgedPa0entsinCustody AgedPa0entsinCustody(%) LinearTrend

Defini2onofAgedPa2entsinCustody:Non-Aboriginal:55+andAboriginal:45+

Australian Data

Age group Australian custodial population

2000 2010 2015 % increase 2000-15

50-54 848 1,445 1,808 113

55-59 459 825 1,112 142

60-64 281 529 662 136

65+ 218 527 842 286

TOTAL CUSTODIAL POP 21,714 29,696 36,134 66

An ageing population

NSW Data

Age group NSW custodial population

2001 2010 2015 % increase 2001-15

50-54 354 537 607 71

55-59 196 300 403 106

60-64 103 187 213 107

65+ 64 161 286 347

TOTAL 717 1,185 1,509 110

TOTAL CUSTODIAL POP 7,692 10,947 11,797 53

Source:ABS,PrisonersinAustralia,2001,2010,2005-2015

Custodial population growth 2000 – 2010

Country Population cohort Increase (á) / Decrease (â) Percentage growth

USA Prison population (overall) á 17%

Inmates 55yo+ á 181%

England and Wales Prison population (overall) á 34%

Inmates 60yo+ á 128%

Australia

Prison population (overall) á 37%

Inmates 50-54 yo á 71%

Inmates 55-59 yo á 80%

Inmates 60-64 yo á 82%

Inmates 65yo+ á 142%

Ageing in custody: International data

Source:

Proportion of prisoners aged 50 years old+ (internationally)

Country Proportion of prisoners aged 50 years and older

Australia 12%

Canada 20%

New Zealand 13%

United Kingdom 12%

United States 13%

Ageing in custody: International data (cont.)

Source:AdayandKrabill(2012),ABS(2014),HouseofCommonsJus0ceCommiSee(2013),NewZealandDepartmentofCorrec0ons(2014),OfficeoftheCorrec0onalInves0gator(2011)

“.... changing demographics, legislative provisions and duty-of-care obligations will see Corrective Services NSW and the Justice Health and Forensic Mental Health Network, become a significant provider of aged-care services to a growing cohort of aged, frail and chronically ill inmates, many of whom will die in prison.”

NSW Inspector of Custodial Services Report, September 2015

Long term prognosis

NSW Inspector of Custodial Services •  NSWPrisoners–averagehoursoutofcelldeclinedfrom11.4perdayin2010/2011to8.2in2013.

-  Na0onalaverageis10hours.

•  82%ofinmatesplacedinacentreoutsidetheregioninwhichtheylive

-  implica0onsforfamilyvisits,connec0ontocountry,psychologicalwellbeing

•  In2012/13therewere157,044prisonermovementsaroundtheState

-  mostinvolvephysicalmovementofhealthrecords

•  In2014opera0ngconstraintsofCSNSWorJH&FMHNresultedin:

-  59%ofinternalhealthappointmentsbeingcancelled

-  49%ofexternalhealthbeingcancelled

•  Tonightsome2,137inmates(18%)willsleepinfacili0esbuiltintheNINETEENTHcentury.

•  Anauditof7,920cellsfoundthat2,381(30%)werenon-compliantwithrequiredCSNSWFacilityStandardsandwere,ineffect,unfitforpurpose

“Asaresultofovercrowding,qualityoflifeintheNSWcustodialse;ngforbothinmatesANDSTAFFisdiminished.”

•  Older prisoners have a higher prevalence of disease, particularly chronic conditions such as alcohol and smoking related conditions, cerebrovascular and vascular disease, respiratory problems, infectious disease, substance abuse, osteoporosis, arthritis etc.

•  Older prisoners are more likely to lack any form of family/community support

•  Prisons are designed for essentially young, fit, male inmates. Older inmates may have difficulty with:

o  Narrow corridors and steep staircases o  Lack of privacy o  Falls risks

•  Prisoners with dementia/cognitive impairment are more likely to be:

o  unable to understand/comply with instructions/rules o  intimidated/stood-over by younger more aggressive inmates o  fend for themselves in hostile environments

•  Ignored as they are perceived as being “compliant” and thus not in need.

Key issues in older prisoner management

Some negative characteristics

l  “Compliant” so needs ignored

l  “Vulnerable” so exploited

l  “Fragile” so disadvantaged by conditions

l  “Confused” so may fail to be obedient

l  “Despised” if convicted of sex crimes

l  “Lonely” if isolated from peer group

Relevant NSW Health policies

Dementia in prison

Dying in prison

l  No family support

l  Institutionalised

l  Unemployable

l  No savings

l  Pre-technological

l  Prejudice and discrimination

l  Health status

Freeing older prisoners

On entry to custodial care each person gets: l  Comprehensive health screening assessment – inc. medical history, medications, risk of harm/

suicide prevention.

Thereafter: l  Full physical and psychological examination l  Regular physical and mental health assessment l  Medication – managed for maximum effect l  Dental care l  Opioid Substitution Therapy if assessed l  Dialysis or other treatment as required l  Three meals a day l  Regular (safe) place to sleep l  No alcohol and No tobacco This is probably the BEST HEALTH CARE THEY HAVE EVER HAD and probably EVER WILL HAVE What does that say about the our society’s values ?

Values?

A civilised society?

“ThedegreeofcivilisaConinasocietycanbejudgedbyenteringitsprisons.”FvodorDostoevskyTheHouseoftheDead(1862)

“ThemoodandtemperofthepublicinregardtothetreatmentofcrimeandcriminalsisoneofthemostunfailingtestsofthecivilisaConofanycountry.AcalmanddispassionaterecogniConoftherightsoftheaccusedagainstthestate,andevenofconvictedcriminalsagainstthestate,aconstantheart-searchingbyallchargedwiththedutyofpunishment,adesireandeagernesstorehabilitateintheworldofindustryallthosewhohavepaidtheirduesinthehardcoinageofpunishment,CrelesseffortstowardsthediscoveryofcuraCveandregeneraCngprocesses,andanunfalteringfaiththatthereisatreasure,ifyoucanonlyfindit,intheheartofeverymanthesearethesymbolswhichinthetreatmentofcrimeandcriminalsmarkandmeasurethestored-upstrengthofanaCon,andarethesignandproofofthelivingvirtueinit.”

WinstonChurchill,HomeSecretaryHouseofCommons,20July1910

A moral society?

“Naked,andyeclothedme:Iwassickandyevisitedme:Iwasinprisonandyecameuntome.”MaShew25:36

“AndtheKingshallanswerandsayuntothem,Verily,Isayuntoyou,Inasmuchasyehavedoneituntooneofthesetheleastofmybrethren,yehavedoneituntome.”MaShew25:40

StMaShew’sGospel