Post-custodial health: Helping to navigate a smooth transition

Morgan Liotta

12/04/2019 11:14:55 AM

What role can GPs play in assisting people recently released from prison integrate back into the community?

Prison fence
Maintaining continuity of care between prison and the community once a person ends their sentence can be vital in ongoing health outcomes.

Dr Penny Abbott, a GP with a special interest in custodial healthcare, believes the process starts with the care people receive once they are released from prison, followed by an adequate transitional system to the outside community.
‘People need to have good quality healthcare while they are in prison, so there is actually a useful package of care for GPs to take over,’ she told newsGP.
That package of care incorporates equipping GPs with the knowledge and skills to manage patients who are or have recently been in prison, and supporting those GPs to do so through a skilled and confident workforce in the community – which Dr Abbott cites as a ‘blueprint for success’.
There has been a focus on providing healthcare to people while they are in prison and resources to assist GPs, but Dr Abbott believes just as much importance lies in the provision of high-quality healthcare following release – and primary care is the frontline of this effort.
‘The primary people who manage and come into contact with people who leave prison are GPs,’ Dr Abbott said. ‘And that’s just a great window of opportunity to help them reintegrate.’
Dr Abbot recognises the importance of a whole-of-team approach. She also believes GPs can benefit from taking advantage of community supports such as drug and alcohol services and psychologists, particularly in light of the fact substance misuse and mental health issues are often reoccurring themes for people who have been in prison.
‘If someone has health problems that aren’t really properly addressed or followed up, they’re more likely to end up back in prison, and also more likely to have public health problems in the community, so the interface is really important,’ she said
‘A person’s problem may be their use of benzodiazepines, opioids or prescription opioids, and there’s a tendency for people to come out of prison and that may be what they start to seek again. This relapse and cry for help can happen quite quickly ... [and] a large part of the GP’s role is to support the [newly-released] patient’s wellbeing and prevent relapse of drugs.
‘[The GP should] have quite a holistic view and skills and confidence in mental health and managing addiction, or at least an interest in knowing how they can help that person be linked up.’
Dr Abbott sees the time directly after release as a key opportunity for GPs to help break the cycle of substance misuse by not prescribing inappropriate medication and putting management plans in place.
‘In those early visits, GPs can do a mental health care plan by identifying that that person may benefit from [for example] a psychologist,’ she said.
‘Those first meetings are important, but this is not a quick fix. This is a commitment to engage over the long term with the patient who may have complex social, mental and physical health needs, and to be aware of how difficult it can be to settle back to life outside of prison.’

Penny-Abbott-Article.jpgDr Penny Abbott believes being aware of patients’ vulnerability following release from prison can help them to not feel stigmatised.
According to Dr Abbott, transition at the end of a prison term that involves programs to help people effectively connect with the community, as well as maintaining continuity of care between prison and the community, are key approaches.
‘People leaving prison often have had quite a lot of healthcare in prison, which can then become siloed with information not being passed on [to the relevant healthcare provider] when people leave,’ she said.
‘We need health systems that work for people leaving prison. It’s about rehabilitation, but it’s also about reintegration, and they can be moving into a health system which doesn’t support their needs and the access is quite fragmented.’
Dr Abbott has found that part of the solution to avoiding fragmented care is to provide healthcare providers with more education and overshadow any associated stigma.
‘A lot of medical students and young doctors are a bit fearful of caring for this group,’ she said.
‘It can be seen as one of these groups [of patients] that can be a bit overwhelming ... so providing more opportunity for medical students and general practice registrars to have experience with people in prison may be a good start.
‘Also, some people often don’t disclose that they’ve been in prison because they are expecting they might get different treatment – so there may be a stigma attached to it.’
Dr Abbott is hopeful that one way to reduce this type of stigma would be through GP health assessment item numbers for people leaving prison. The Medicare Benefits Schedule (MBS) Review Taskforce currently has this recommendation open for consultation.
‘A health assessment item like this could be a good driver, both from a GP perspective of being able to fund the work that they do with complex patients, but also from a patient perspective to know that they can actually tell their GP that they’ve left prison and need a full health assessment,’ Dr Abbot said.
‘The bottom line is that people who are leaving prison are just like every other person; they just want to get something done and they often have high needs and are in a state of transition.
‘It’s really about taking the time to engage with that patient as you would with any other patient, and recognising that leaving prison is a real point of vulnerability.’
The RACGP’s Custodial health in Australia: Tips for providing healthcare to people in prison includes a section on post-custodial support for patients to connect with the community.

continuity of care custodial health mental health prisons substance abuse

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anon   17/04/2019 9:11:18 AM

There is a risk of heroin overdose because of lack of tolerance. How can this be managed?

Elizabeth Hindmarsh   17/04/2019 9:55:08 AM

This is an important issue - it will be covered as part of an ALM on the Wednesday 23rd October before GP19 - Caring for vulnerable patients in general practice.
This is part of working for access and equity in the Australian health system.

Kelly W   19/04/2019 7:42:31 AM

Fantastic work & great article! Dr Abbott’s continuing work shines much needed light on one of the most vulnerable groups in our community. GPs can make a real difference.