Saturday, 19 April 2014

“if you want total security, go to prison. There you’re fed, clothed, given medical care and so on. The only thing lacking… is freedom.” - D. Eisenhower

Prison is a place for criminals. Not for people like you and I. Or is it? Despite working in various prisons (albeit intermittently) over the last seven years I’m no expert on the (ironically labelled) correctional system. What never ceases to amaze me is the seemingly endless supply of people who claim to understand both the system and those contained within it. So I thought I’d attempt to dispel some common myths. Belief systems provide only the perception of security. Both time, or strength of grip are unable to transform a flawed belief system and despite considerable effort - It remains just that.

Working as a GP in a prison is much like general practice in any setting. With a few differences. Higher rates of mental illness, substance use and low socioeconomic status make for some complex medical issues. Contrary to popular belief, inmates do not get better health care than the rest of the community. Nor is it some sort of holiday resort. Prison is a place where no one wants to find themselves but is in fact filled with people. Yes, people like you and me. Most of whom will return to the community - at some point. So their health needs remain complicated on both sides of the rather large barbed wire fence. They are not miraculously ‘cured’ once inside. 

The second part of the holiday resort myth is that people actually want to return to prison. A prison is not designed to be a place of torture. It is punishment via the removal of liberty. Denial of freedom is not a flippant predicament. So do we really believe that people readily volunteer to deny themselves freedom? Having access to medical care and food and clothing in prison comes at a cost most of us would not endure for a moment, let alone months to years. Just think how much we take for granted our ability to visit friends, provide support for family, choose what we eat, choose what we wear and choose when we want time away from others. Similarly, people re-enter the correctional system multiple times for many reasons but largely due to societal barriers. Not because people enjoy the removal of their liberty. 

Let’s imagine for a moment you found yourself on the inside. Locked up for a misdemeanour that resulted in a bad outcome in the presence of alcohol. For arguments sake - you remain convinced it was accidental but admit you have some issues with alcohol. You serve three months for a first offence and then apply for parole. During your ‘inpatient’ stay, you are likely to see the general practitioner once or perhaps twice if you put in repeated requests. You will not be able to access dental services in this time. In addition, you will not be able to access any alcohol or substance counselling, nor will you be able to enrol in a program for substance use rehabilitation or anger management. Unfortunately, this is only accessible by people who are in the system longer than 12 months. Damn. There goes your rehabilitation. But you’re a resilient person and you’ll be out in three months. 

Meanwhile life on the inside becomes a statistical probability matrix.  Prohibited substances (such as opiates, amphetamines etc) are seemingly readily available. But needle sharing is equally as common. You discover 50% of the population has hepatitis C (a blood borne virus). Too bad if you have an opiate addiction in Queensland - the smart state decided methadone is unnecessary. Yet methadone studies reveal a 40% reduction in recidivism rates. Methadone provides continued and controlled access to an opiate instead of trying to buy it on the street. As for NSW, they decided too many people are on the methadone program in prison so it will be capped at a certain number. NSW has employed the car park is ‘full’ model. This means you wait for someone to leave before you can gain access. All of this because there are apparently too few GP’s willing to prescribe methadone in the community. Opiate substitution programs take time and are costly to administer correctly in prison (and in the community). It would seem the costs of untreated opiate addiction and harm reduction measures are someone else’s problem.  Increased funding for prisons is clearly not a popular policy, nor is it a vote winner.  

Three months later you find yourself applying for parole. But your application is denied. A recent high profile case involving an ABC journalist and a perpetrator on parole resulted in this situation for you along with many others. Overcrowding is rampant throughout the system largely due to the revamped parole policy. So you serve the rest of your time inside and then find yourself back in the community, eyes blinking in the headlights. Your rediscovered ‘freedom’ comes with some catches. You have a permanent criminal record. Every time you attempt to gain employment you are faced with a criminal record check. Even renting a property becomes more challenging. Boarding houses with single rooms resemble the dimensions of a segregation cell in prison. But it’s a room and no one asks questions. With no job and reduced accommodation options your seemingly secure world is now far less predictable. Suddenly you belong to a marginalised community. People look at you differently. Their judgement is palpable. But don’t worry, you’re not alone. Indigenous Australians are approximately 2.5% of the entire population but somehow 26% of the prison system. Now you have a new reference point for marginalisation.

So what have you learnt from your relatively short stint inside the prison walls? Was prison a successful deterrent for any future misdemeanour? Do you feel rehabilitated? Are you now welcomed back into your community? Sadly the answer is a resounding ‘no’. Prison theory is just that. The so-called correctional system is failing to correct. Society too is failing in its role. Marginalisation of the vulnerable is everyone’s responsibility to address - not just those in government or the judicial system.  People do not choose prison as the better alternative. This is the myth we tell ourselves to justify the status quo. Freedom of thought is still yours to control (for the moment) - so hold onto it fiercely.  Popular thinking may feel like security. But sometimes, it only serves to loosen your grip.