Central Adelaide Local Health Network

SA PRISON HEALTH SERVICE

5th Prison Planning , Design, Construction and Maintenance Conference (2013)

The importance of health inclusion

in the planning

of correctional facilities

Cathi Montague RN, RM, ENB998, MClinNsg, FFCENA

Nurse Management Facilitator, Clinical Care Systems Co-ordination

SA Prison Health Service

@cathimon

#prisonplanning

SA PRISONS – OVERVIEW

Site Location Security ~ Cap.

N=2382

Prisoner Type Health

Cover

Inpt

Beds

Adelaide Remand

Centre

Metro High 267 Male Remand

+ Protectees

24/7

9

Adelaide

Womens’ Prison

Metro

High 160 Female Remand +

Sentenced

14/7

-

Adelaide Pre-

Release Centre

Metro Low 60 Male Pre-release -

Yatala Labour

Prison

Metro

Max 500 Male Remand

+Sentenced

24/7 12

Cadell Training

Centre

Rural Low 161 Male Sentenced 14/7 -

Mobilong Regional Medium 327 Male Sentenced 14/7 -

Port Augusta

Prison

Regional High 481 Male Sentenced.

Female sentenced

14/7 -

Port Lincoln

Prison

Rural Medium 146 Male Sentenced 14/7 -

Mt Gambier Private

Regional

Medium 280 Male Sentenced Private -

PRISONERS…..

Prisoners are punished with a loss of freedom, not the

loss of rights to appropriate and equitable health care

The degree of civilisation in a society can be judged by entering its prisons (Dostoevsky)

It is the discipline NEVER to mistreat the weak that makes civilization great. (Fischer, C, 2010)

Prisoners only hope to access health care

is through the people who are supervising their care (Smith,S 2010)

5

PERCEPTION, BIAS AND JUDGEMENT

> Personal Bias may impose on decision making

risk!

5

‘Unreliable / dishonest / malingerer / dangerous / infected /

unsafe / violent / undeserving’

‘Victims / Unfair / Not dangerous to health staff / deserve better

/ the systems impede their rights (and mine)’

HEALTH

What is YOUR personal model?

– you are the influencers!

> Not important

> Biomedical :

• condition without disease.

• Just OK / managed with medications

• Physical well-being

> Holistic:

• Includes psychological, social, spiritual, cultural and

physical.

CONSIDERED RISK MANAGEMENT

> Avoidance vs Acceptance

> Risk transfer vs Risk Management

> Same same vs different.

8

PRISONERS & HEALTHCARE ENTITLEMENT

IN AUSTRALIA

> UN High Commissioner for Human

Rights - Standard minimum rules for

the treatment of prisoners.

> Standard Guidelines for

Corrections in Australia.

> Correctional Services Act S.A.

• Correctional Services Regulations

> HealthCare Act S.A.

> ???Other legislation interstate 8

9

THE ROLE OF HEALTHCARE IN PRISON

> Primary Health

• e.g. mental health; BBV; womens; ante/postnatal; mens; sexual;;

drugs and alcohol; chronic disease; smoking cessation; ATOD

• Preventative health

> Public Health – Immunisation, Screening, Outbreaks

> Emergency Response

> Inpatient care – acute/ subacute/ ???residential

> Step Up / Step Down

> aged / comorbidities; rehabilitation. Palliative?

> Negotiated Health / Health Advocacy

• Generally nurse driven / led care

• Small M.O. / GP Workforce – impact on clinics?

• No Medicare access

• Challenges ++ Allied Health

9

WHY DO ANYTHING ABOUT IT?

> Core business

• Appropriate, cost effective service delivery

• Workforce planning, support

> Risk management

• Seamless health care. Gaps = RISK

> Improve knowledge, relationships, teamwork

> Increasing risk / litigation related to adverse

health outcomes sustained whilst imprisoned

> Increasing costs related to volume /changing

needs of prisoner / patient population.

HEALTH AND SECURITY –

MUTUALLY EXCLUSIVE?

Security The rumour mill Culture

Health Health literacy Bias

$$$ / funding models Design Habit

Location Multi-agency

Agendas Communication Risk

Priorities and Responsibilities Resources

Co-operation Networks

Influencers

Ownership / Out of sight Facilities

Risk avoidance / acceptance / management

Sometimes, the more things are different,

the more they are the same!

WHY HEALTH?

HEALTH

SECURITY

Sentencing

Disability

Ageing

Mobility

Capacity

Resources

IP&C

Complex

Burden

of

disease

Pain

Cultural

Diversity

Health

Literacy

Inmate

Hierarchy

TBI/

ABI

WICKED PROBLEMS

A problem whose solution

requires a great number of people

to change their mindsets and behaviour

is likely to be a wicked problem

(Wikipedia)

CHALLENGES IN PLANNING

FOR HEALTH IN PRISONS

http://patientsafetyed.duhs.duke.edu/

PLANNING:

WHOLE BUILD…OR PART BUILD / RENOVATE

Traditional / Exclusive / Tight Focus

•Security

•Health for health

•Health in a single place.

•Short term future planning

http://creativitycentral.squarespace.com/creativity-central/2009/6/14/thinking-outside-the-box-what-box.html

CONSTRAINTS & OPPORTUNITIES

TO THINKING

PATHOGENIC AND SALUTGENIC

> Both approaches should underpin and inform

prison planning and design.

> Pathogenic:

• Why and what factors cause disease

• Find medical treatments

> Salutgenic

• Identify wellness factors that maintain and

promote health.

Dilani, 2008

Contemporary / Inclusive / ‘Big Picture’

• All Service delivery and flow

• Health for all – inmates + multi-agency staff

• Long term vision

• Strengthen Self-efficacy, improve outcomes,

reduce costs / impact

• Medications, scripts

• Flow / Access / Location

• Sensory control

• Care delivery

PLANNING:

WHOLE BUILD…OR PART BUILD / RENOVATE

Physical Environment BIG PICTURE focus

Why?..... STAFF AND PRISONERS

> Cortisol production

> Stress

> Coping responses

> Infection / Disease Control

> Agitation / Aggression

> Environmental control – temperature, noise, light

> Sleep Quality / Day-night cycle

> Relationships / cohesion

> Belonging

> Overwhelmed

= Humans. = $$$$$$$$$$$

PLANNING:

WHOLE BUILD…OR PART BUILD / RENOVATE

SEPERATING / SEGREGATING

> Pros and Cons

• Experiences

• Economies of scale

• Efficiencies

• Exposure

• Expertise

PSYCHO-SOCIALLY SUPPORTIVE

DESIGN

‘Psycho-socially supportive design

stimulates and engages people both

mentally and socially , as well as

supports an individuals’ sense of

coherence.’

Create: • Engagement

• Pride

• Teamwork

• ‘Thinking’ design.

‘Psycho-socially supportive design:

A health promoting approach on prison environments.’

OVERLOOKED?

> Carpet – where, where not.

> Security, safety – ALL Staff

> Exits – how many, how big, routes?

> Furniture – safety, IP&C

> T-loops – especially in any interview areas

> Disabled facilities – proper ones! Enough?

> Pressure relief?

> Showers / Toilets

> Stairs

> Falls / Lifting equipment.

> Dementia / Low literacy support

> Multi-cultural

> Bariatric

> IP&C

> Carers?

> Consistency across Australia……

AUSTRALASIAN HEALTH FACILITY GUIDELINES

http://www.healthfacilityguidelines.com.au/default.aspx

>Standards and principles with regard to a wide range of design

features for healthcare facilities

>May provide a sound base standard for prison facility design.

>Include standards for outpatient or non-acute areas.

>May assist with reducing risk or subsequent modification needs

especially with regard to:

•Prisoner evacuation / movement in health emergencies

•Infection prevention and control management

•Impaired mobility, frail / ageing or increased falls risk

•Clinical waste management / removal

> UK

• Prisons

• Forensic Mental Health – Edenfield, Manchester

> New Zealand

• Models, Philosophies

> Victoria

• Wintringham Specialist Aged Care

• Design and environment awards

• Outstanding philosophy

CONSIDER….

COMMISSION, DESIGN & BUILD TEAMS

> Focus on ALL criteria

> Establish Mission and Vision at the outset

> Team incorporation at all stages:

• Security

• Health

• Infection Prevention and Control experts

• Occupational Therapy experts

> Spend early to save later!

Peace:

It does not mean to be in a place where there is no noise, or trouble, or hard work. It means to be in the midst of those things, and still be calm in your heart. Anonymous

QUESTIONS?