Cultural safety of health care for First Nations people in prison

The Cultural Respect Framework 2016–2026 defines cultural safety by the experience of the health consumer with regards to the care they are given, and their ability to access services and raise concerns (AHMAC 2016). This includes the treatment of care by the health professional and the client’s feelings of cultural safety.

Cultural safety is about how care is provided, rather than what care is provided. It requires health-care providers to deliver safe, accessible and responsive health care that is free of racism by:

  • recognising and responding to the power imbalance between practitioner and patient
  • reflecting on their knowledge, skills, attitudes, practising behaviours and conscious and unconscious biases (Department of Health 2021).

Objective 3.2 of the National Aboriginal and Torres Strait Islander Plan 2021–31 also outlines that health-care providers must have cultural safety values, behaviours and standards embedded in the workplace culture (Department of Health 2021).

Aboriginal Community Controlled Health Organisations and Aboriginal Medical Services in prisons

An Aboriginal Community Controlled Health Organisation (ACCHO) is a primary health-care service initiated and operated by the local Aboriginal community. An Aboriginal Medical Service (AMS) is a health service funded principally to provide services to First Nations people. It may be either an ACCHO or a state or territory government-run service. Currently in Australia, there are more than 140 ACCHOs and more than 200 AMSs and other Aboriginal and Torres Strait Islander health services (NACCHO n.d [b]).

These services deliver holistic, comprehensive and culturally appropriate health care to the community that controls them through a locally elected Board of Management (NACCHO n.d [a]).

The Royal Commission into Aboriginal Deaths in Custody (RCIADIC) recommended that corrective services, in conjunction with Aboriginal health services and other such bodies, should review and report on health service provision to First Nations people in correctional institutions (RCIADIC 1991).

It was recommended that this review include the involvement of Aboriginal health services in providing mental and physical health care for First Nations people in custody (RCIADIC 1991). This could be achieved through visits to prisons by ACCHOs and AMSs, and by employing Aboriginal health practitioners as members of the clinic staff.

However, ACCHOs in Australia are subject to funding shortages and are often over-stretched in their ability to service the people in their communities (Moran et al. 2014; NACCHO n.d [a]). This limits their capacity to reach all communities in need, including prisons where First Nations people make up a substantial portion of the population. Currently, there are only a few prisons in Australia that facilitate visits by ACCHOs.

Culturally appropriate care reported by prison dischargees

First Nations prison dischargees were asked whether they received a visit from an ACCHO or an AMS while in prison.

Of 200 First Nations prison dischargees, 26% reported receiving treatment or consultation in prison from an ACCHO and/or an AMS (Indicator 3.2.7).

Many prison facilities have First Nations health practitioners and other First Nations professionals or staff to provide culturally appropriate health care.

For those First Nations dischargees who received them in prison, 18% of ACCHO or AMS services were for health care, 7.5% for access to legal support, 7.0% for alcohol and other drugs support, 7.0% for social and emotional wellbeing, 5.0% for housing support, 4.0% for child, family or community services and 2.5% for quitting smoking.

Culturally appropriate care happens in many ways, not just through the ACCHOs and AMSs. Therefore, people in prison were also asked whether they had received culturally appropriate care in prison.

Of 200 First Nations prison dischargees, nearly two-thirds (65%) reported they received culturally appropriate health care in prison (Indicator 3.2.8).

First Nations male dischargees were less likely to report receiving culturally appropriate health care (63%) than First Nations female dischargees (76%).

First Nations dischargees aged 25–34 were the group most likely to report that they received culturally safe health care in prison (68%), while those aged 18–24 were the least likely (61%).

Visiting health professionals from Aboriginal health services

Fifteen per cent of participating prisons received visits by ACCHO and/or AMS health professionals daily, weekly or monthly (Indicator 3.2.9).

Of the 11 prisons that reported receiving visits from ACCHO and/or AMS health professionals, the visits occurred at least weekly in nearly a half of the facilities (45%), at least monthly in 36% of them and daily in 18% of them.

Visiting health professionals from ACCHOs and/or AMSs were most likely to be Aboriginal health practitioners (at 7 prison facilities), but also included counsellors (at 4 facilities), doctors (at 3 facilities), psychologists (at 3 facilities), social workers (at 2 facilities) and alcohol and other drug practitioners (at 2 facilities).

Seventy-six per cent of participating prisons reported never receiving visits from ACCHO and/or AMS health professionals.