Deaths in custody: ‘Every Aboriginal family has a story’

Anastasia Tsirtsakis

15/04/2021 4:36:39 PM

It’s been 30 years since the royal commission first tabled its recommendations and GPs are calling for more action.

Man standing in front of Aboriginal flag.
On average, one Aboriginal life is lost in custody every three weeks.

A detective visited the parents of a young Aboriginal man; a warrant had been issued for their son’s arrest.
‘We’re going to get your son; he’s going to be locked up,’ the detective told them.
‘But if you get him to come around now, I can guarantee you that the arrest will be a non-eventful process. He won’t be harmed; we’ll put him into custody, he’ll serve his time and then he can get on with his life.’  
The request went against their instincts, but the parents agreed. When their son arrived, however, the promise fell through.
‘They grabbed him, ruffed him up and smashed him into the fence, causing a head injury,’ Professor Peter O’Mara, a Wiradjuri man and Chair of RACGP Aboriginal and Torres Strait Islander Health, told newsGP.
‘That young man then went into the system. Approximately one week later, he died.’
This is just one of 474 Aboriginal and Torres Strait Islander deaths that have occurred in custody – five alone since the beginning of March – over the course of 30 years since the royal commission’s report was first released on 15 April 1991.
That is, on average, one Aboriginal life lost in custody every three weeks.
The report put forward 339 recommendations, and according to a 2018 Deloitte review, 64% have been implemented, 30% partially, and 6% remain untouched – stats Professor O’Mara describes as ‘disappointing’.
‘We’ve about halved the rates of death in the system, but there are more people being incarcerated, as well, so that’s also a problem,’ he said.
A key finding of the royal commission was that while Aboriginal and Torres Strait Islander people do not die at a greater rate than non-Aboriginal people in custody, the rate at which Aboriginal people come into custody compared with the general community’ is ‘overwhelmingly different’. 
And yet, since 1991, incarceration rates of Aboriginal people have more than doubled from 14% to 29%, despite crime rates having dropped.
Associate Professor Penny Abbott, Chair of RACGP Specific Interests Custodial Health, says not nearly enough progress has been made.
‘Every Aboriginal death in custody is a tragedy with far reaching impact and this should be one of our highest priorities in Australia,’ she told newsGP.
‘The ongoing experience of disadvantage, systemic racism and poor health contribute to this, and requires long term investment, commitment, and partnership with Aboriginal and Torres Strait Islander communities.’
Professor O’Mara agrees. He says a multi-pronged approach is needed, starting by addressing inequity.
‘If you look at the very onset of where it all starts, Aboriginal people are more likely to in fact be arrested rather than be given a warning for the same offences as non-Indigenous people,’ he said.
‘Once that occurs, Aboriginal people are more likely to receive a custodial sentence than other options available to the courts for the same kind of crimes. And, of course, when custodial sentences are enforced, they’re usually a lot longer.’
The overrepresentation of Aboriginal and Torres Strait Islander people in prisons starts from as young as 10. One crucial step, Professor O’Mara says, is to raise the age of criminal responsibility, a campaign supported by the RACGP.
‘What we know from evidence is that there’s a period of development in the brain that’s still going on in young kids, and so if you institutionalise them in those timeframes then you’re setting them up for a life of institutionalisation,’ he said.
Dr Tim Senior, who contributed to the RACGP’s Standards for health services in Australian prisons, believes prison has become a means of ‘managing’ people, when what they truly need is health and social supports.
‘Over half of the deaths have been in people on remand, and Aboriginal people are much more likely to be denied bail,’ he told newsGP.
‘While the circumstances of many of the deaths are different, there are themes that come through, and one of these is people receiving timely healthcare when they need it in custody.’
Associate Professor Abbott says while there are many well-known solutions to addressing deaths in custody, financial support for their implementation is lacking.
‘For example, community-based justice reinvestment programs need support and expansion,’ she said.
‘There should be improved access to culturally targeted reintegration programs for Aboriginal and Torres Strait Islander people before and after leaving prison.
‘Increased court diversion programs will also make an enormous difference, including for those people with substance use disorders, intellectual disability and mental health conditions who should not be in prison.’

Professor Peter O’Mara says there is clear evidence that employing good quality cultural training can have a positive impact.
Meanwhile, she says GPs can also play a role in helping to break a cycle of repeated incarcerations among their patients by ensuring they are getting the healthcare they need.
‘Managing substance use disorders and mental health problems effectively when people are in the community prevents deaths and incarcerations,’ she said.
‘Linking patients with community supports and following through on healthcare commenced in prison will also help, [as] people with health problems of any type are more likely to return to prison.’
Dr Senior agrees, and says it is vital that clinicians are aware of any biases they may be harbouring.
‘All health practitioners need to make sure they are not making assumptions about someone’s condition based on the fact that they are Indigenous in prison,’ he said.
‘And all health practitioners need to advocate for systems that allow good healthcare for people while in prison.’
To help address these biases and ensure better understanding of the issues at play, Professor O’Mara says there is clear evidence, from the education sector right through to child protection services, that good quality cultural training can have dramatically positive effects on outcomes.
‘In areas where there are high rates of suspension of Aboriginal children, the teachers and the staff have very little cultural training,’ he said.
‘But when you analyse those areas where there are low rates of suspension of Aboriginal children, then you can see that the teachers and staff have had cultural training, so they understand the issues.
‘That also applies in areas of child removal through the services. So that’s something that we need to consider all the way through for policing, for the judicial system, and for the detention systems as well.
‘If you do it in a culturally appropriate manner and do it well, you can change the course of their trajectory for the rest of their life.’
Dr Senior says making sure the voices of Aboriginal and Torres Strait Islander people are embedded into policy development is a crucial way of ensuring deaths in custody stop happening.
‘The Uluru statement from the heart, including a constitutionally enshrined Voice to Parliament, is a way of formally ensuring this happens,’ he said.
Though 474 Aboriginal deaths have occurred in custody over the past 30 years, the number of lives impacted are countless, from families to communities, and society at large.
‘It’s hard to put it into words; it’s absolutely devastating,’ Professor O’Mara said. ‘Every Aboriginal family has a story, unfortunately.
‘We’ve got to stop this nonsense. Stop targeting Aboriginal people and our kids.
‘People have to be accountable.’
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