Winnunga Nimmityjah Health Services means Strong Health 

Julie Tongs Presentation Reintegration Puzzle 2012

8th Annual Reintegration Puzzle Conference25-27 July 2012Lakeside Canberra.
10.05am Keynote Presentation 27 July 2012

Title of Presentation:

Before addressing reintegration challenges on release from prison for Aboriginal and Torres Strait people in Canberra I would like to give you some background to Winnunga Nimmityjah Aboriginal Health Service prison health care and contextualise Aboriginal incarceration in Australia. 
But first I would like to pay my respects to the Ngunnawal people, the traditional owners of the land where we are meeting today.
During a recent Workshop at the Australian Institute of Aboriginal and Torres Strait Islander Studies, to explore the feasibility of Justice Reinvestment in the ACT, Mick Gooda the Social Justice Commissioner, Australian Human Rights Commission provided these statistics:• Aboriginal and Torres Strait Islander adults are four times more likely to be imprisoned than non-Indigenous people;

• In the Northern Territory that figure increases to 80%;
• The female prison population is growing even faster, increasing by 9% in 2010;
• Aboriginal offenders have high rates of recidivism – 73% have a history of prior imprisonment;
• More Aboriginal Australians are likely to return to prison than to be trained in secondary or tertiary education – adding a new meaning to the idea of prisons acting as quasi-colleges for Aboriginal Australians;
• There are 28 more times the number of Aboriginal juveniles in prison than the national rate for young people;
• Ninety per cent of youth in prison in the Northern Territory are Aboriginal and/or Torres Strait Islander people;
• Twenty five per cent of all Aboriginal children have a parent in custody;
• Aboriginal and Torres Strait Islander Australians tend to be charged with offences such as injury with intent and lower level assaults;
• They are highly over-represented in public disorder offences, often charged with offences such as breach of bail conditions and other court orders.

For over eleven years, the Winnunga Medical Director, the late Dr Peter Sharp, together with Aboriginal Health Workers visited Aboriginal people in the Canberra remand centres, the juvenile justice centre and Goulburn and Cooma prisons. Dr Sharp’s legacy is such that Winnunga has run a clinic in the Alexander Maconochie Centre since it opened in 2009. Currently, the doctor is accompanied by an Aboriginal Health Worker who visits two other days each week for art classes, to provide individual case management and to attend pre-release meetings.

Based on our experience of visiting Aboriginal people in prison over many years we realised that we needed to prepare for the AMC opening in Canberra in 2009. We carried out a 12 month Phase 1 study of the needs of Aboriginal people in prison and the needs of their families and published a report in 2007 which introduced a Model of Holistic Prison Health Care.?

The Model has three parts which address:Incarceration which provides holistic care during incarceration and planning for release;Release from Prison which provides post-release health service coordination and family and community reintegration strategies; andManaging the cycle of incarceration which provides early family, and other intervention strategies.

The Model’s central thesis is the importance of developing a strong sense of identity. This is crucial for Aboriginal people in coping with prison and community life, and also linked to good health. The factors contributing to a sense of identity are a person’s environment (whether inside prison or in the community), their safety, community support, and their physical and psychological wellbeing. Health, family and spirituality support these components, while a network of Aboriginal and non-Aboriginal health, community and justice organisations work with Winnunga to integrate and coordinate these strategies in prison and on release.

The Model’s premise is that post-release needs should be addressed as a priority when people enter prison. The focus of imprisonment should be release into an environment which provides employment, accommodation and intensive ongoing support for the offender and their family.
This presents challenges for ACT Corrective Services and organisations like Winnunga and the offender and their family when the return home can be marked by rejection, isolation, and disappointment. In some instances after a short while they are re-arrested and returned to prison. This indicates the need for rehabilitation before and after release and systematic coordination via community based case management to protect people from reoffending.

Last year in a Winnunga Phase 2 study of the needs of Aboriginal people in the AMC and the needs of their families, we interviewed 12 of the 35 Aboriginal people in the AMC, some of their family members, and community support organisations, and we received an indication of the challenges facing ACT Corrective Services in preparing people for release. While one respondent was studying an external hospitality program and worked in the AMC kitchen 4 days each week, and considered that he would obtain work in hospitality on release and would return to his previous accommodation, other respondents were not as positive about life after release.

Notwithstanding the difficulties of satisfying the mix of circumstances in prison, from people with short sentences to people on remand, the challenges for ACT Corrective Services are to provide vocational qualifications such as commencing apprenticeships, including driving licence skills, and life skills programs such as literacy, cooking and parenting prior to release. Art classes and spiritual healing (for example The Marumali Journey of Healing) are essential for Aboriginal people grappling with issues of identity. The Marumali Program was developed by Aboriginal people for Aboriginal people in response to identified needs and has been widely used in prisons in Victoria with success in minimising recidivism. In addition, documents such as identification papers, referrals to services, medical prescriptions copies of medical records and information about applying for assistance are important components of release.

Winnunga visits the AMC 3 days each week. An Aboriginal Health Worker visits one day with a Doctor from Winnunga. The other two days he attends the Art Class and assists Aboriginal people in the AMC to plan for release through individual case management planning. He also sits in at pre-release meetings with other support organisations. Issues to be addressed over this time could include drug and alcohol, anger management, mental health as well as chronic health problems, and the health and social and emotional wellbeing of the family unit.

Other support organisations such as Centrelink, ACT Housing and community accommodation support organisations contribute to this case management plan. However there are significant challenges in addressing barriers to employing former offenders, educating employers, providing financial incentives to create job opportunities, and having sufficient accommodation alternatives all of which result in significant benefit to the whole community.

The continuity of care provided by our Aboriginal Health Workers in the AMC and on release is an important component of the Model’s recidivism philosophy. The challenge that Winnunga faces at this stage is that on release all contact with Winnunga may be severed for a time. Culture and identity are central to Aboriginal perceptions of health and ill-health. How Aboriginal people view wellness and illness is in part based on cultural beliefs and values. At the health service interface these perceptions and the associated social interaction influence when and why Aboriginal  communities access services, their acceptance or rejection of treatment, the likelihood of compliance and follow-up, the likely success of prevention and health promotion strategies, and their assessment of the quality of care.

Stressors such as substance, emotional and physical abuse, poor school attendance, low levels of education, high unemployment with poor job prospects, difficulties finding accommodation, lack of parental involvement or control, poverty, and being young single parents with poor parenting skills, are the problems facing the young Aboriginal people who reoffend.
These stressors exist where mainstream culture is dominant; when establishing their identity as Aboriginal people, whilst balancing their involvement in the Aboriginal and mainstream community; and in facing the challenges for young people coming to terms with who they are. Aboriginal youth are a generation who do not envisage a future; have no apparent social norms; and a deep seated hostility to white society.

Notwithstanding the mentoring received from the Aboriginal Health Worker while in the AMC, and that other members of the family may be Winnunga clients, our research indicates that when released some individuals would rather sever all connections with their experience of prison.
We have arranged for members of the Probation and Parole Board to conduct interviews at Winnunga in trying to maintain our continuity of support. To ensure that such appointments are kept the Winnunga bus collects people at their home address. ACT Housing and Centrelink also conduct regular interviews at Winnunga, and this helps to ease their passage through departmental administrative requirements.

The Aboriginal Health Workers in our Social Health Team provide outreach services within the Aboriginal community. They work with our medical clinical team, which includes psychology and psychiatry, an opiate program, practice nurses, midwifery and dental clinical teams. They conduct numerous programs which present opportunities for community participation and this assists in maintaining family health and social and emotional wellbeing, and family values. They are programs such as Certificate 1 in Automotive Technology, the Winnunga Boxing Club, the Home Maintenance Program, women’s, men’s and elders’ groups, a diabetes clinic, No More Bunda tobacco cessation group, healthy eating classes and the Mums and Bubs Group.

I hope I have given you some insight into the way Winnunga addresses the cycle of incarceration of Aboriginal and Torres Strait Islander people. I would be happy to answer specific questions you may have about the challenges we face at Winnunga or address any particular areas of interest you may have.