Inspector of Custodial Services Inspector of Custodial Services Health services in NSW correctional facilities Produced by Inspector of Custodial Services Level 3, 50 Phillip Street Sydney NSW 2000 P: 02 8061 9387 W: www.custodialinspector.justice.nsw.gov.au ISSN: 2207 0389 March 2021 © State of New South Wales through the Inspector of Custodial Services March 2021. This work may be freely reproduced for personal, educational and government purposes. Permission must be received from the department for all other uses. This document has been prepared by the Inspector of Custodial Services for general information purposes. While every care has been taken in relation to its accuracy, no warranty is given or implied. Further, recipients should obtain their own independent advice before making any decisions that rely on this information. For extended copyright permissions or to request the report in an alternative format such as Braille, audiotape, and large print contact [email protected] (March 2021) Contents Foreword .................................................................................................................................. 6 Acknowledgements ............................................................................................................................... 8 Glossary of terms and acronyms ........................................................................................................ 9 Executive summary ..............................................................................................................................11 Recommendations .............................................................................................................................. 18 Chapter 1. Introduction ...................................................................................................................... 22 1.1 The Inspector of Custodial Services ............................................................................... 22 1.2 Background to the inspection .......................................................................................... 22 1.3 Terminology ....................................................................................................................... 23 1.4 Methodology ..................................................................................................................... 24 1.4.1 Limitations ............................................................................................................... 25 1.5 Overview of the custodial facilities we inspected ......................................................... 26 1.5.1 Secure Annex, Prince of Wales Hospital, Randwick ............................................... 26 1.5.2 Tamworth Correctional Centre ................................................................................ 27 1.5.3 Junee Correctional Centre ...................................................................................... 28 1.5.4 Shortland Correctional Centre ................................................................................ 29 1.5.5 Cessnock Correctional Centre ................................................................................ 29 1.5.6 John Morony Correctional Centre, Windsor .......................................................... 31 Chapter 2. The NSW Context ............................................................................................................. 32 2.1 Standard of health care services .................................................................................... 32 2.2 Responsibility for health care services ........................................................................... 32 2.3 Health status and needs of NSW inmates ...................................................................... 34 2.3.1 General population .................................................................................................. 34 2.3.2 Dental ..................................................................................................................... 35 2.3.3 Chronic health ........................................................................................................ 36 2.3.4 Women ................................................................................................................... 36 2.3.5 Aboriginal inmates .................................................................................................. 38 2.3.6 Aged inmates .......................................................................................................... 40 2.3.7 Inmates with disability .............................................................................................41 2.3.8 Inmates with complex comorbidities ..................................................................... 42 2.4 Delivery of Health Services ............................................................................................... 43 2.4.1 Models of Service Delivery ..................................................................................... 44 2.4.2 The ‘public-public’ model ...................................................................................... 46 Inspector of Custodial Services Health services in NSW correctional facilities Page 3 2.4.3 The ‘private-private’ model ......................................................................................47 2.4.4 The ‘public contracted’ model ................................................................................ 48 2.5 Demand for health services ............................................................................................. 49 2.6 Complaints about health services .................................................................................. 53 Chapter 3. Health services available to inmates .............................................................................. 57 3.1 Primary care ....................................................................................................................... 57 3.1.1 Shared care model .................................................................................................. 59 3.2 Mental health .................................................................................................................... 60 3.2.1 Servicing the general population ............................................................................ 60 3.2.2 Inmates at risk of self-harm ..................................................................................... 61 3.2.3 Specialised mental health facilities ........................................................................ 63 3.3 Population health ................................................................................................................. 69 3.3.1 Harm minimisation .................................................................................................. 71 3.3.2 Health promotion ................................................................................................... 73 3.4 Alcohol and other drugs .................................................................................................. 74 3.4.1 Opioid substitution therapy ......................................................................................74 3.5 Aboriginal health ............................................................................................................... 78 3.5.1 Aboriginal Health Services currently provided in NSW correctional centres ......... 80 3.5.2 The Aboriginal workforce ........................................................................................ 82 3.5.3 Embedding cultural safety ..................................................................................... 84 3.5.4 Connection to culture ............................................................................................. 84 3.6 Medication ......................................................................................................................... 86 3.7 Oral health ......................................................................................................................... 89 3.7.1 Provision of dentures ............................................................................................. 93 3.7.2 Oral Health service practices at Junee ................................................................... 94 3.8 Allied health ........................................................................................................................ 94 3.8.1 Physiotherapy .......................................................................................................... 94 3.8.2 Medical Imaging ...................................................................................................... 94 3.8.3 Podiatry ................................................................................................................... 95 3.8.4 Optometry ............................................................................................................... 95 3.9 Chronic and complex health ........................................................................................... 96 3.10 Environmental health and hygiene .................................................................................. 98 3.11 Secondary and specialist health services ...................................................................... 99 3.12 Tertiary care ......................................................................................................................