Words of Wisdom for Providing GP Care to Justice-Involved Individuals
Recognize Significant Needs:
- High likelihood of significant health and social support needs.
- Common issues: adverse childhood events, social disadvantage, trauma.
- High rates of mental health problems, substance use disorders, disability, communicable diseases, and chronic diseases.
Impact of Incarceration:
- Incarceration is both a cause and consequence of poor social determinants of health.
- Previous experiences of stigma may lead to non-disclosure of full history by patients.
Developing Therapeutic Relationships:
- Be welcoming and use trauma-informed care.
- Be culturally competent and allow time to establish trust.
Post-Release Vulnerabilities:
- High risk of death, health deterioration, substance use relapse, and non-intentional overdose.
- Potential for mental health deterioration and recidivism due to social disruption and isolation.
- Active engagement by GPs can positively impact post-release outcomes.
GP Role Post-Release:
- Provide or facilitate mental healthcare and addiction treatments.
- Implement strategies to minimize harm from risky behaviors, including opioid overdose treatment.
- Ensure safe and appropriate prescribing.
- Link patients to community-based support services.
Continuity of Care Challenges:
- Poor continuity of care when entering or leaving prison.
- New communities, broken support structures, incomplete care in custody.
- Prompt response to medical information requests from prison health services.
- Obtain and review discharge information from prison health service with patient’s signed release.
Managing Substance Use Disorders and Mental Health:
- Initiate mental healthcare plans.
- Recognize substance use disorders as chronic, relapsing conditions.
- Develop comprehensive care plans.
- Make safe prescribing choices.
- Prescribe medication-assisted treatment for opioid dependence and alcohol dependence.
- Link patients to community services and provide resource information.
By acknowledging and addressing these specific needs and challenges, GPs can provide effective and compassionate care to justice-involved individuals, helping to improve their health outcomes and support their reintegration into society.
Background, demographics and population health
- Consider the impacts of the social determinants of health and adverse life events on people involved in the justice system, including young people and women, and understand the demographics of people in prison:
- structural and social factors, including poverty, racism, discrimination, social exclusion
- childhood trauma, including neglect, abuse, household trauma, out-of-home care, parental incarceration
- opportunities for education, housing, employment
- experience of violence, including interpersonal violence and sexual assault
- health factors, including mental health conditions, intellectual and developmental disability
- social inclusion and exclusion, including disrupted family and social networks.
- Recognise incarceration as a social determinant of health.
- Understand how the Australian correctional system works and how healthcare is delivered in custody, including:
- the experiences of people involved with the justice system, including remand, sentencing, parole
- the intersection of the corrective services system and the health services system for people in prison or youth who are in custody
- the delivery of primary healthcare in prisons and youth justice centres, including barriers and facilitators to delivery of healthcare.
- Consider the drivers, the impact and the solutions to over-incarceration of Aboriginal and Torres Strait Islander peoples, including:
- the effects of socioeconomic marginalisation and disadvantage, colonisation, societal and institutional racism
- the importance of access to culturally appropriate care.
Approaches to care delivery
- Use effective communication and create a therapeutic patient–doctor relationship with people involved in the justice system by:
- identifying patients who are involved in the justice system through patient-centred inquiry and establishment of a welcoming practice
- considering the effects of stigma and bias, including stigma related to incarceration in addition to stigmatised health conditions such as substance use disorders
- demonstrating cultural awareness and understanding of cultural safety for people from Aboriginal and Torres Strait Islander backgrounds
- fostering a trauma and violence-informed practice
- considering the patient’s sociocultural context, including health literacy and cultural and linguistic background
- demonstrating effective, respectful and professional communication, including in challenging consultations, such as when patients are distressed or there are mismatched expectations or behavioural concerns.
- Competently manage health conditions that are common in people involved in the justice system, including:
- mental health conditions
- substance use disorders; practise safe prescribing to:
- promote harm reduction
- provide access to medication-assisted treatment for opioid dependence, alcohol use disorder treatment and management of other substance use disorders
- blood-borne viral disease such as HIV, hepatitis B and hepatitis C
- disability, including intellectual and developmental disability, such as foetal alcohol spectrum disorder, autism spectrum disorder, acquired brain injury, learning disability.
| Health Condition | Management Strategies |
|---|---|
| Mental Health Conditions | – Assessment: Conduct thorough mental health assessments, including history, symptomatology, and risk factors. – Care Plans: Develop individualized mental health care plans – Therapies: Provide access to psychological therapies (e.g., CBT, counselling) – Medications: Prescribe psychotropic medications safely, considering interactions and side effects – Follow-Up: Regular follow-up appointments to monitor progress and adjust treatments – Referral: Refer to psychiatrists or mental health specialists as needed. |
| Substance Use Disorders | – Assessment: Screen for substance use disorders using validated tools – Harm Reduction: Educate on harm reduction strategies (e.g., needle exchange programs, safe injection practices). – Medication-Assisted Treatment (MAT): Provide or refer for MAT for opioid dependence (e.g., methadone, buprenorphine) and alcohol use disorder (e.g., naltrexone, acamprosate). – Counselling: Offer or refer for addiction counselling and support groups. – Safe Prescribing: Avoid medications with high abuse potential; prescribe with caution. |
| Blood-Borne Viral Diseases | – Screening: Regular screening for HIV, hepatitis B, and hepatitis C. – Vaccination: Provide vaccinations for hepatitis B (and HPV if indicated). – Antiviral Therapy: Initiate or continue antiviral therapy for HIV, hepatitis B, and hepatitis C. – Monitoring: Regular monitoring of viral load and liver function. – Education: Educate on transmission prevention and safe practices. – Support Services: Connect with support services for ongoing management and counselling. |
| Disability | – Assessment: Comprehensive assessment to identify intellectual and developmental disabilities (e.g., FASD, autism, acquired brain injury, learning disabilities). – Individualized Care Plans: Develop care plans tailored to individual needs and strengths – Multidisciplinary Approach: Collaborate with specialists, including neurologists, psychologists, occupational therapists, and educational support services. – Support Services: Link to disability support services and community resources – Family/Caregiver Support: Provide support and education to families and caregivers. |
- Consider population health and incarceration by:
- undertaking health screening and preventive activities in recognition of the higher risk of communicable and non-communicable disease and risk factors, and the likelihood of previous poor access to healthcare.
- Undertake holistic assessments of people leaving custodial care, and understand the risks as they return to the community, including consideration of:
- continuity of care and transfer of health information
- the risk of health deterioration, in particular relapse to substance use with high risk of accidental overdose, and worsening of mental health and increased self-harm risk
- the effects of social exclusion and benefits of social inclusion
- unstable housing and material social support needs
- the wellbeing of the patient’s family
- the risk of intimate partner violence
- engagement into long-term treatment for physical, mental or addictive conditions
- connection to community services.
- Promote high quality health information management and transfer to:
- ensure appropriate confidentiality, consent and record keeping
- facilitate transfer of appropriate health information when people enter custody.