Medicine behind bars - Providing medical care to those in custody

Sophie McNamara
Med J Aust
Published online: 6 February 2012

Professor Michael Levy’s interest in the health of prisoners was sparked the very first time he visited a prison, when he was a board member of the then NSW Corrections Health Service in 1994.

“From the first moment that I got engaged in this issue through a committee prison visit, there was just something that lit up in me”, he says.

Professor Levy, who is now director of ACT Justice Health Services, further developed his interest when he spent 2 years working with the World Health Organization in Geneva between 1995 and 1997. He had the opportunity to visit prisons in several countries while working on tuberculosis control programs.

When he returned to Australia in 1997, he and Professor Tony Butler established the very first research centre focused on health and the criminal justice system, the Centre for Health Research in Criminal Justice.

The centre conducted unprecedented inmate health surveys in NSW, Queensland, New Zealand, Victoria and recently the ACT, defining the health needs of those in custody for the first time.

Professor Levy’s current role combines clinical, administrative and academic responsibilities.

A substantial proportion of his time is spent providing direct clinical care to the 250 adult prisoners and up to 30 young people in juvenile detention in the ACT.

Much of the clinical work involves managing drug dependency, including opiate-substitution prescribing, with approximately 75 of the 250 prisoners receiving methadone at any one time.

Hepatitis C and mental health issues are also common concerns among those in custody; however, many prisoners have also neglected their more basic health needs over the years.

“Not a lot of the folk who we get in here have fantastic health-seeking behaviours. All too often, it’s the first time for a long time that they’ve had any sort of coordinated health care. We make plans for ongoing dental treatment, or give them spectacles — that can make a big difference”, he says.

The health workers regularly provide catch-up care to prisoners, such as hepatitis and influenza vaccinations, and screening and treatment for sexually transmitted infections.

“We have an opportunity to intervene and start to refer them through to specialists, and hope against hope they will reconnect with health services once they are released. It sometimes happens but it doesn’t always happen.”

Paradoxically, being in prison can actually be good for the health of some prisoners, because they have access to comprehensive health care and are able to reduce some of their poor health behaviours, such as drug dependency.

“It’s fascinating, it’s rewarding. You see people come in, intoxicated on a cocktail of drugs and, day by day, that intoxication lessens.”

Professor Levy continues to work with a number of research groups, on projects such as making prisons more “child friendly” and harm minimisation in the prison environment.

He is also working on a project looking at the experience of women who are pregnant in custody.

“It’s a contested area. They have very high-risk pregnancies but, in some cases, their lives are so chaotic that there are health benefits of being institutionalised”, he says.

Professor Levy is the only full-time doctor working in ACT Justice Health, with six other doctors working part-time, plus 18 highly qualified nurses. He finds it satisfying that some of the “best GPs in town” choose to work in the ACT justice system for a session or two each week.

Professor Levy, who trained as a public health physician, says the work is incredibly rewarding because there are measurable public health benefits on top of the individual and family-level benefits.

“In terms of public health in general, the gains are pretty minimal in Australia — you can tweak an immunisation schedule here or there but that’s about it ...

working in this setting is a big honour and the potential gains are huge.”

He says it can also be heartening to give families a chance to see “how good these people can be if they keep up with their health care”.

Professor Levy has an eye on training the next generation of prison doctors — since 2002, he has coordinated the custodial medicine module in the Master of Forensic Medicine course run through Monash University.

Professor Levy also works at the School of Clinical Medicine at the Australian National University, where he teaches graduate medical students about justice health, such as the ethical dilemmas of working with people in custody and the complexity of a field where medicine, social justice and the legal system intersect.

“In the general discussion about social determinants of health and health ethics, prison health is where it all comes together.”

Sophie McNamara
  • Sophie McNamara



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