Millions of Australians now have a much deeper understanding of how isolation and loss of freedom can undermine our mental health after spending many months in lockdown to fight COVID-19.
But while life for most of us returns to normal, for the more than 40,000 people detained in Australian prisons, many of whom suffer from pre-existing mental illness, COVID-19 lockdown restrictions remain in place. And we still do not know if we are doing enough to protect their mental health.
Dense housing, overcrowding, poor sanitation and ventilation, and poor access to (and quality of) health care mean that prison environments are a perfect environment for transmitting infectious diseases. Many people in prison are also among the most medically vulnerable people in our society.
But the same restrictions designed to protect people in prison also bring new hardships.
WHAT’S IT HAPPENING IN PRISON LOCKDOWN?
Listening to those detained in immigration
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To counteract the high risk of COVID-19 infection in these environments, strict prevention measures have been in place in Australian prisons since the beginning of the pandemic. For example, restrictions that prevent family and loved ones from visiting in person intensify the isolation of people in prison during an unusually turbulent time.
Many social, educational, and employment programs that engage inmates in meaningful activities and reduce their risk of reinstatement have also been suspended.
Limited space and reduced staff in prison facilities means that people in prisons spend more time confined in their cells. And people who are in custody are often subjected to routine quarantine upon entry into prison, transfer or after other possible exposure incidents.
In Australia, these measures have reduced COVID-19 infections in prisons and detention centers, but at the same time they have had a detrimental effect on the mental health of remand prisoners and pose a lasting risk to their mental health.
According to data from the Australian Institute of Health and Welfare, 40 per cent of people in Australian prisons in 2018 had a pre-existing mental illness and 25 per cent had a history of self-harm. More than a third of deaths in Australian prisons in 2020-21 were self-inflicted.
Prisons are also communities
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These vulnerabilities have exacerbated the impact of COVID-19 lockdowns on persons in custody.
Throughout the pandemic, prison locks have been compared to solitary confinement, where people spend up to 24 hours a day locked up in cells. Parallels drawn by remand prisoners between their experiences of medical isolation and solitary confinement – whether perceived or in practice – can exacerbate trauma for incarcerated individuals at risk of psychological harm and raise human rights concerns.
Aboriginal and Torres Strait Islander – almost 13 times more likely to be in adult prison and 18 times more likely to be in juvenile detention – expressed concern about the possibility of contracting COVID-19 behind bars and about limited access to appropriate health care. Similar fears have been expressed by those detained in Australian immigration prisons.
What can we do to protect them?
There must be a delicate balance between controlling infectious diseases and protecting mental health. There are things that we can and must do to maintain the broader social, emotional and mental health of people in custody.
Our most recent global review of guidelines for dealing with the COVID-19 pandemic in prisons and detention centers identified a number of recommendations for the protection of mental health:
- Provide early release to persons who do not pose a risk to society, who are medically vulnerable, and / or who are awaiting sentencing, in order to reduce the pressure on overcrowded prison systems and protect people from unnecessary psychological harm
- Ensure that access to fresh air does not fall below one hour per day in accordance with international human rights standards
We leave people released from prison vulnerable
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- Make sure that the conditions of medical isolation differ from the conditions of punitive solitary confinement
- Make sure people in medical isolation have meaningful human contact every day
- Increase free access to virtual communications, including email, phone and video conferencing to stay connected with your loved ones from the outside
- Improve mental health support for all persons in custody, including online counseling and psychological services, especially when in medical isolation
- Replace suspended social, educational, work programs and other activities with virtual alternatives
- Improve access to culturally appropriate support for Aboriginal and Torres Strait Islander and other First Nations people in custody
- Provide remand prisoners with regular, timely and transparent information on COVID-19, including implemented measures, their reasons and available support
Are we doing enough to protect the mental health of remand prisoners?
The short answer is that it is impossible to say because so far we lack sufficiently detailed, publicly available information on implemented COVID-19 responses and the associated mental health outcomes.
What is clear, however, is that better information sharing is needed to learn for the future.
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In Australia, most prisons and other detention centers are administered by states and territories, which provide different levels of information on COVID-19 responses.
For example, correctional departments in New South Wales and Victoria, the most COVID-affected jurisdictions, provide broad information on what is being done to support the mental health of people in custody.
According to their websites, people in custody have increased access to video and phone calls and some extra support during routine 10-14 day quarantine and medical isolation.
In Victoria, quarantined persons have some degree of access to telephone and video calls, books, television, and printed training instructions. Aboriginal liaison officers and specialized psychiatric services regularly check in with people in isolation, but it is not specified how often this happens or whether this involves personal contact.
In NSW, legislative changes were made for the early release of low-risk and vulnerable convicted persons in custody. But at the time of writing, no one has been released under this scheme.
Until now, the mental health impact of COVID-19 and associated responses on remand prisoners is still hidden.
To give prisoners a sporting chance
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What more can we do?
We need to improve the timely publication of information on implemented measures, how they were implemented, how long they will remain in place, and aggregated health data for people in Australian prisons. This information is important both for maximizing the effectiveness of COVID-19 responses and for protecting the mental health and human rights of persons in custody now and in future health crises.
We also need to hear directly from people in custody about their experiences with COVID-19 and related lockdowns. We need to know, from their perspective, what interventions were useful, what they found inappropriate, and how to make things better in the future.
Increased collaboration between the legal, health and research sectors to use this data for evaluation, research and ongoing policy development would facilitate effective decision-making.
Finally, the UN Optional Protocol to the Convention against Torture (OPCAT) provides a mechanism for monitoring and protecting the health and human rights of remand prisoners. But despite an official commitment to OPCAT dating back to 2009, Australia recently missed its latest deadline to implement the protocol.
This raises several unanswered questions, including whether – and when – an overall national framework will be developed for those states and territories tasked with implementing COVID-19 responses. More than ever, mechanisms like these are crucial to protecting the mental health and human rights of people in custody.
While the wider societal impact of COVID-19 lockdowns has been highlighted, the impact on people in Australia’s prisons and detention centers remains in the shadows. We need to shed light on that.
The co-authors of this research include Professor Stuart Kinner, Associate Professor Rohan Borschmann, Dr. Lucas Calais-Ferreira and Dr. Jesse Young from the University of Melbourne and the Murdoch Children’s Research Institute; and Associate Professor James Foulds of the University of Otago.
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