by E K Wills
No preconceived ideas could prepare me for what I would discover during my 6 months in gaol for a drug term.
The system is another world and we, as health professionals, are guests, not the hosts if you will. We work inside the corrections system and everything requires liaison and is bounded by their governance. This means we only have access to patients if it is granted.
As an employee, you leave the outside world behind you when you have your retina scanned, walk through the metal detector, and walk through those heavy metal doors.
No mobile phones are allowed, which feels like being cut off from the outside world. The rule is not just for inmates. The idea is to limit the temptation to give inmates access to the outside world and no photos are allowed, either.
The first week is violence prevention management training. This is to ensure you how to do a ‘take down’, if necessary, as well as get out of a room, if the door is blocked by a menacing threat. We need to learn how to assess the risk and act accordingly.
Induction includes explanation of the system, which takes a week of learning how to use the two IT platforms needed to do the job. Plus you need to know how the security system works, including personal duress alarms that need to be worn at all times inside the complexes.
Daily life in remand custody:
Usually inmates are allowed to move about the facility in several ways. Either they move in groups under guard or, if they have earned their stripes, they can become ‘sweepers’. This allows them to do chores such as get meals for inmates or clean out rubbish bins and they receive some recompense along with the privilege. But mostly they do it to get out of their cells because the money is less than most kids would get for pocket money.
Otherwise, they are out of cells in the morning for a few hours a time. This is when we can see patients; then they are back in cells between 10:30 and 11:30am for ‘muster'. I believe this is to do head counts. After that, we can see patients till the afternoon lock in, and they are in for the night. This occurs at 2:30pm, sharp, in our facility.
Imagine being in one room from 2:30pm till the next morning every day.
Inmates appear frustrated, angry and bored, seeking out drugs to while away the time with reports of inmates ‘acting out’ in order to go to ‘segro’ (segregation) which gets them a TV in their cell.
Locked in in lockdown
The pandemic finally hit the justice system after 1.5 years of holding it at bay. Inmates are in lockdowns due to staff shortages or isolation for those arriving as 'new receptions’. The cost of drugs escalates exponentially due to lack of supply so inmates are paying up to $1,000 for drugs that usually cost $4.
Instead of doing clinics where patients come to us, we as health staff need to go into each ‘pod’ of cells, don our PPE and review patients at the cell door, through the hatch, behind visors and masks, and in the presence of custodial staff. There is no privacy if the patient is sharing a cell with a ‘cellie’.
Reviews are brief and limited to acute issues. For drug health, patients need assessment for withdrawal after coming in from the community. This needs careful management with death a very real risk. Patients can also be on opioid replacement therapy; and need to be assessed for stability, withdrawal status, or ongoing drug use in custody. This is suboptimal in these circumstances and barely meets criteria for safe practice.
Staff are under enormous stress and reflect the temperament of the environment. This is justice health, which sits within an adversarial judicial system, and the culture reflects this for staff, as well. You need to get used to it in order to fit into the system.
Personal perspective:
I reflect on the system for the patients. I learn that the legal system generally penalises drug addiction and there is limited room for rehabilitation. I hear a story about one gaol in which the community didn’t want inmates to have access to a pool because 'criminals shouldn’t be comfortable’. There was no discussion about therapy or rehabilitation purposes. The pool was already built but had to be filled back in.
I have the opportunity to see the emergence of diversion programs such as Drug Court to help addicts, whose crimes often relate to financing their habit, rather than being hardened criminals. Patients don’t always complete the program, after all it is an addiction that can take multiple attempts to come to grips with, but they can attempt the program again.
Slowly, I feel more comfortable in the system but realise that this is like exposure therapy, desensitising me to the harsh and restrictive environment. I reflect that staff here have also adapted by forming their own coping mechanisms or altruistic beliefs in order to do this work.
I don’t think it is the place for me but I am glad to have had the opportunity to see it ‘from the inside’, so to speak. But every time I walk out the door, leaving the intense security behind me, I spare a thought for those still in the system.
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