The delivery of mental health services to detainees at the Alexander Maconochie Centre – particularly the 24 per cent who are Aboriginal or Torres Strait Islander – is ineffective, the Auditor-General declared in a March report.

The ACT Government last week agreed to most of the report’s recommendations – 10 fully, eight in principle, and one noted, to be delivered through a different tool – by the end of 2023.

“Better mental health care for people in the AMC means they will have their needs better supported while in the facility, and more likely to continue support once they return to the community,” Emma Davidson, ACT Minister for Justice Health, said.

But Aboriginal advocate Julie Tongs, head of Winnunga Nimmityjah Aboriginal Health and Community Services, which runs an autonomous Health and Wellbeing Clinic in the prison, is concerned some of these measures have been tried before and failed.

“I feel like I’m in a time warp,” Ms Tongs said. “It’s a challenging environment, but why waste money when money’s short on the ground?”

Nor, she said, was Winnunga consulted; decisions were made without them.

“All the buzz about co-design – the decision’s already been made – so how do you co-design around that? What role do we now have to play in that, when we weren’t at the table to discuss any of this?”

Government, she says, must have a discussion or a roundtable to sort this out; she is keen to sit down with stakeholders and work out their processes and expectations.

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Planning

Planning to deliver services is ineffective, the Auditor-General’s report found. Data collection and record keeping practices and systems were poor; the Audit could not determine whether detainees received the same standard of health care as outside the prison. Custodial officers were not trained to manage detainees with mental health conditions.

Canberra Health Services (CHS) will develop a Clinical Services Plan for the delivery of mental health services, in partnership with Winnunga Nimmityjah, the Justice and Community Safety Directorate (JACS), and ACT Health. Among other measures, this plan will explicitly embed culturally responsive services for Aboriginal and Torres Strait Islander peoples.

“There should [already] be a plan in place, and the plan should be reviewed every 12 months,” Ms Tongs said. “Here we are, back to developing a plan!”

A Digital Health Record will go live in November, which the government expects will improve record management.

Currently, Ms Davidson stated, screening processes require the detainee to provide information about their medical history and needs, which can impact the type of care they receive.

“The addition of the Digital Health Record will ensure better record keeping of health needs so that people receive the right care, including appropriate cultural support,” Ms Davidson said.

Ms Tongs is not impressed; Winnunga has had an electronic health system for 15 years, she said.

“I don’t understand – government’s got a lot more resources than the NGO sector, particularly the Aboriginal community-controlled health sector. How can they be 15 years behind us when it comes to an electronic health record?”

Standards of health care, provision of psychological services, and staff training will also be reviewed.

Governance

Governance arrangements did not provide clear management linkages between ACT Corrective Services and Canberra Health Services, which have a shared care arrangement, the Auditor-General found.

Nor was Winnunga effectively incorporated into the governance structure. Although Winnunga was a key stakeholder for delivering mental health services, there was no formal oversight of its MoU or funding agreement. Winnunga no longer attends meetings of its Implementation, Operational and Governance Group, advising they had become unhelpful to Winnunga’s operations in the AMC.

The Auditor-General recommended that ACT Health work with Winnunga to improve oversight of services.

But Ms Tongs insists that Winnunga must be autonomous in the AMC, and has fought to make it independent.

“We don’t want to be integrated – but we do need to know how this is going to work, and whether it’s still going to be how it used to be.”

If Winnunga’s clinicians and Aboriginal support staff are seen as part of the system, she said, “straightaway, that level of trust is diminished, because they see you as part of Corrections or part of Justice Health; they don’t see you as independent.”

Nor, Ms Tongs said, did Winnunga have much of a role when its MoU was developed with ACT Government agencies.

“It is piecemeal; they take it upon themselves to do the budget submissions, and we have no role in that.”

She wants transfer of Aboriginal detainees from JACS to Winnunga to be faster. Currently, they can wait up to six months for normal health care, let alone intensive psychological treatment. Aboriginal detainees, she explains, start from a very low base: historical trauma, colonisation, stolen generation, and loss of identity. Even in the community, Ms Tongs said, a lot of Aboriginal people complain they wait months to see a psychiatrist.

“That’s really concerning, because if we can’t do it on the outside, how do they think they’re going to manage that on the inside? … You can’t have people with serious mental health issues out there, waiting three to six months.”

Canberra Health Services’ forensic mental health services team provides holistic care and treatment for people who are involved with the justice system, including at the AMC, a government spokesperson said. It budgets for 5.5 full-time equivalent (FTE) psychiatrists, 15 FTE psychologists, social workers, or occupational therapists, and 10 FTE nurses.

Screening for mental health issues

CHS could not ensure that Aboriginal and Torres Strait Islander detainees were effectively screened for mental health issues at admission, because an Indigenous health officer was not involved in the process, the Auditor-General found. (Non-Indigenous detainees were effectively screened.)

The delivery of mental health services to non-Indigenous detainees under psychiatric or suicide and self-harm ratings was effective, but could be improved for Indigenous detainees by including input from an Indigenous service provider.

The government said a new suicide assessment tool for custodial settings, Connecting with People (CwP) SAFETool, will better screen people at risk of suicide or self-harm, and ensure they receive the appropriate care for their needs. Custodial officers will also be trained to identify warning signs for psychiatric and psychological illness.

The Auditor-General recommended that Canberra Health Services assess whether there were enough Aboriginal Liaison Officers to meet the needs of Aboriginal and Torres Strait Islander detainees, and recruit more if necessary.

The government responded that it would explore employing an Aboriginal and Torres Strait Islander mental health worker. Currently, an Aboriginal Liaison Officer (or a representative from Winnunga Nimmityjah) must be present at inductions and assessments, while Indigenous detainees meet an Aboriginal and Torres Strait Islander peer support detainee within the first 24 hours, and receive a cultural induction and assessment from the Aboriginal and Torres Strait Islander services team within their first week.

But Ms Tongs does not believe Aboriginal liaison officers are a good idea in a correction facility where the staff and detainees don’t trust each other.

“It’s been tried before, 10, 15 years ago, and it hasn’t worked,” she said. “Why duplicate services, and why employ people when they know they’re not going to have the trust of the detainees?”

Detainees with less severe mental health conditions could not receive adequate treatment because there were not enough psychologists in the AMC, the Auditor-General found. The government responded that JACS and CHS would work to address gaps.

“It’s a big call [for the government] to say that they’re going to work with everybody out there with a mental health issue,” Ms Tongs said. “If detainees didn’t go in with a mental health issue, they certainly would acquire one while they’re in there.”

Ms Tongs is concerned that some Aboriginal detainees do not get the services they need. Last year, for instance, one detainee, Keira Brown, said she was denied an Aboriginal Health Assessment; she has taken JACS to court for breaching her human rights.

“How many times do we hear of Aboriginal people dying in custody because of their diabetes, or some other chronic disease?” Ms Tongs said. “These are preventable deaths. Those health checks are one way of picking up what’s going on. Aboriginal people at a very young age have very complex health issues.”

Planning the release of detainees with mental health conditions could also be improved, the Auditor-General recommended. CHS will develop release planning guidance material for all detainees with mental health care plans, including consultation with both ACT Corrective Services and Winnunga Nimmityjah.

“Better discharge planning will establish clear pathways between the different organisations and directorates working within the AMC, so that when someone leaves AMC, their mental health care continues as they reintegrate with the community,” Ms Davidson said.

The Justice Health Strategy, to be delivered by year’s end, will improve health services across the entire justice system (including courts and community correction orders), and provide appropriate support to all levels of need, the government said.

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