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Incarceration even more cruel to the neurodivergent

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For those with mental disorders, imprisonment can be even more harrowing (Image via Rawpixel)

While imprisonment is a barbaric form of punishment, it's far more cruel to those suffering from mental disorders or intellectual impairment, writes Gerry Georgatos.

Prisons and secure mental health hospitals are crammed with people with various cognitive and neurodiverse conditions.

Many are indefinitely detained. All the while, they are not supported. To the Australian nation, these souls are invisible. But to those of us tormented by close witness of the grim reality, the affected are discriminated against, condemned and locked up.

There is no public register for these indefinite detainments. There are likely thousands of Australians trapped indefinitely in harrow.

Their hearts broke, struggling to understand what’s going on, of strange commands, of dense and violent dreams savaging the mind. There’s no expert support in the prisons and inadequate support in “forensic” hospitals which mimic prisons or Dickensian lunatic asylums. In the mad blasphemous squat that is a cell, life’s brief light can be extinguished. Dead on the inside and a pauper’s burial.

Prisons are “ungodly” beasts, hard for the average incarcerated soul to understand and impossible for other types of neurodiverse people who do not understand the world as the majority do.

It is my experience, in general, that people come out of prisons in worse conditions than when they commenced the situational trauma of incarceration.

Be patient with things of this world, it is all too often said, as if to quell rebellion. The wait makes the affected old before their time. We incarcerate like never before, demanding quiet in the darkness. As if it’s their fault they live and breathe. For certain types of neurodiversity, prison is a perpetual torment.

There are those among the incarcerated whose emotional and intellectual quotients are childlike-akin, who do not offend by malintent. The intellectually impaired Marlon Noble was an incarcerated soul who, with the incumbent West Australian Attorney-General’s support – John Quigley – was freed on the grounds of his comparatively diminished intellectuality.

I remind of Roseanne Fulton, who in 2013 crashed a stolen car and was charged. Born with foetal alcohol syndrome, Roseanne was ruled unfit to plead. But Roseanne remained incarcerated unsentenced in Kalgoorlie for a couple of years till extraordinary efforts, including by me, were tapped into to relocate Rosemary to Alice Springs to a psychosocial facility.

For every Marlon and every Roseanne, thousands of intellectually impaired souls are incarcerated across this continent’s barbarous prisons. We know of the many intellectually impaired children incarcerated at Banksia Hill. Prison is no place for intellectually impaired individuals, nor individuals with chronically acute disordered thinking, with ailments such as schizophrenia and with psychoses.

Australia’s prisons are a long way behind the Northern European efforts. In the Netherlands, Marlon and Roseanne would not have been incarcerated. They would have been supported by specialist treatments.

Australia can begin with the foundational reforms — the introduction of Medicare and the National Disability Insurance Scheme (NDIS) into prisons.

Health inequalities and discriminations in this nation’s 132 prisons are at their rifest. Nearly 43,000 prisoners are denied Medicare. Therefore, Medicare is not universal as is touted. Before continuing further, I argue no legislative reforms are needed to pass both federal houses of Parliament. The solution is as simple as only requiring the Federal Health Minister to issue an exemption to the exclusion of the gaoled from Medicare. Concomitant reform to legislation can be pursued.

I remind that Medicare is denied to prisoners, old and young — to children as young as ten. Oftentimes filled with tears, unseen weeping, unmasked sorrow withheld till the perishing.

In addition, the incarcerated in effect are denied access to the Pharmaceutical Benefits Scheme (PBS) and denied access to the NDIS, with disastrous impacts.

It is established and self-evident that nearly all of Australia’s prisoners are people living in the lowest quintile of income. Additionally, they also comprise the quintile of the weakest primary and secondary health.

The Australian Labor Party argues Medicare is universal and at times has included in their national policy platforms a promise to end the health discrimination of the incarcerated. They are yet to do so.

The situational trauma of incarceration should never accentuate and accumulate further trauma. Health equality advocates argue prisoners should in the least be availed of the same level of healthcare as everyone else. I am reminded by Kahlil Gibran; the body is the harp of the soul.

My daughter, Connie Georgatos, coordinated a campaign in recent years to call for access to Medicare for the incarcerated. Connie argues the incarcerated would be validated, and this goes to the heart and soul of mental well-being. They matter, as opposed to being made to feel they do not.

She argues they also come in with a high rate of unaddressed ailments and poor health, and prisons should be, at the least, transformational. There should be an onus on “catch-up” health, addressing physical ailments, improving their overall health, and addressing psychosocial issues and their psychological well-being. Validations cognitively widen individuals to shared understandings and values, and they will be less likely to re-offend.

We speak with a level of authority. Following two suicides, both of First Nations prisoners, in Acacia Prison, aged 19 and 30, and soon thereafter another First Nations death in Acacia, the prison management was ordered into finding deliverers in the reducing of suicidality among the prison’s more than 500 First Nations prisoners.

In October 2020, Megan Krakouer, Connie and I took on the job for nine months, to June 25, 2021, full-time, alongside a one-day-a-week effort by a colleague who is a psychologist. We worked with more than 400 incarcerated souls during the nine months. We also did not turn away non-First Nations brothers.

The last quarter of 2020 recorded the lowest number of self-harms. We made an immediate difference all over the prison. The last quarter also recorded the lowest ever actual self-harms — three. The preceding quarter had recorded 17.

I recount prisoners who complained for months and years of pain and because those who were meant to heed did not. They were not referred but given paracetamol. Their cancers spread.

Half a century has passed where Medicare (Medibank in its first iteration) has in fact not been universal throughout Australia.

Medicare is a health funding stream to be accessed by every Australian, to ensure rapid access to vital services. Poor healthcare in prisons results in poorer physical and mental health long-term.

State and territory governments were made responsible for the provision of healthcare in prisons. But equivalencies of healthcare between prisons and society in general just do not exist.

The Commonwealth Health Insurance Act (1973) includes a clause to prevent “double-dipping” of medical services. It assumed states and territories would fund equivalent access to health services and build internal health systems in prisons. They do not.

The Federal Government has an immutable opportunity to strive for its “no one left behind” claim.

More than half a million living Australians – one in 50 – have been to prison. Poor health marginalises people into unemployment and underemployment.

More than 150,000 living First Nations people – one in six – have been to prison.

There is no worse discrimination than health inequality. Many readers will find it hard to believe health rights such as Medicare and the PBS are denied to Australia’s 43,000 incarcerated adults and to nearly 1,000 incarcerated children. There has been a long silence about this life-threatening inequality. When will we speak of this cruel unfairness and call for a love of one another?

Some of our restorative works and transformational projects in adult and children’s prisons allowed us to witness the effects of health inequalities and the impacts of no Medicare. Seemingly, there is an endlessness of horror stories of untreated infections that led to amputations, and worse — death.

With the cognitive criminal age of responsibility still at ten years old, gaoled primary school-aged children are denied Medicare.

We also believe every prison should have a general practice physician on site, who with Medicare can bulk bill. Prisoners have a higher prevalence rate of comorbidities than the general population, higher rates of disabilities and high rates of acute mental health conditions — and First Nations prisoners have even higher rates.

Bulk-billing onsite physicians can craft primary health care plans for the affected. They can identify types of neurodiversity, the intellectually impaired, and craft mental health care plans and/or advocate for their transfer to specialist facilities outside the carceral estate.

Prisoners are nearly three times as likely to have acute mental health conditions compared to the rest of Australians and up to 15 times as likely to have a psychotic disorder. First Nations prisoners once again are hostage to higher rates.

With First Nations individuals making up nearly 30 per cent of the national prisoner population, as well as having a higher susceptibility to health issues, healthcare catchups in prison are a missed opportunity. Do not get me wrong, I am a prisons abolitionist. Incarceration is cruel and barbarous and there are kinder and gentler ways but while prisons remain, they must ensure healthcare equality.

All it will take to make Medicare universal is moral political will. The Federal Health Minister has the power to immediately extend Medicare to prisoners. Simple amendments to the relevant subsection of the Health Insurance Act, passed through Parliament, can guarantee universality.

I urge everyone to reflect on the trembling that is prison life and of undivided caring. Let us not wage war on one another and move us from shadows to the light, rise beyond chains, bars and wires, prejudices and demonisation, and turn our eyes to each other. Let not the unfairness of the world harness us. Let not the good luck and bad luck we are born into divide us.

I urge the Departments of Justice and of Corrective Services – its people within – to interrupt their silences and prayers, to speak out and publicly and contribute to collective consciousness universalisms and advocate on behalf of hearts and souls they have been vested with their care.

More than half of individuals released re-offend within two years, the majority during the first year. They are also up to ten times more likely to die of suicide and unnatural deaths in the first year of release as compared to their time locked up in blasphemous dungeons.

The Dutch have done away with the carceral estate to bastions of restoration, transformation, specialist support, love and nurture. The Netherlanders recognised a significant proportion of people corralled in prisons were people with mental illnesses, psychiatric disorders and psychosocial disabilities.

I have often argued a history of psychosis should not mean a long prison sentence. It should mean addressing the psychosis. Is there any greater legacy than turning a life around?

Adequately resourced community care programs with endless specialist support in the Netherlands have seen people with mental illnesses, who would have been damagingly incarcerated, instead treated, with genuine wraparound support and authentic safety nets crafted. Not only is this the salvation of an individual but also the prevention of crime.

Society is kindest when it supports vulnerable people and treats people with severe personality disorders, dissociative disorders, addictions and trauma. Society is cruel when it imprisons the sick. Let us remind ourselves, any human being can become sick or mentally unwell.

We need checks and balances to ensure no Kafkaesque impunity locks up in unsupported prison settings the cognitively challenged, where they are devastated. The neurodiverse must not be neglected and demonised in prisons. To argue we treat everyone the same is to discriminate and torment.

We need public registers, monitoring systems to ensure forensic hospitals do not regurgitate the lunatic asylums of centuries past where people were warehoused for life.

Indefinite detention, where often no plea has been entered, where no conviction has been secured, or where a sentence has been completed but they remain gaoled because of unaddressed psychiatric, psychological and psychosocial conditions is an abomination.

With great ardour, during the last decade, I have assisted to secure the release of individuals whose neurodiversity was disregarded, who had psychosocial needs, who needed specialist support. From Darwin Correctional Centre, Kalgoorlie’s Goldfields Prison, Acacia Prison, Brisbane Women’s Correctional, and from Banksia Hill and Don Dale and Cleveland juvenile detention centres. For each person I assisted in the binary of release and support, there are hundreds indefinitely locked away and unsupported.

Gerry Georgatos is a suicide prevention and poverty researcher with an experiential focus on social justice.

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