GPs advocate for central role in youth justice

Youth justice must be considered a health issue, with young people at risk of incarceration or experiencing incarceration allowed access to high-quality care from a GP and primary healthcare team.
 
That is according to a new RACGP submission, calling for sweeping changes to Australia’s youth incarceration system.
 
Its advocacy includes raising the age of criminal responsibility to 14, therapeutic models of custody, and improved services for children with neurodevelopmental disorders.
 
Last month, a Parliamentary Committee was tasked with investigating Australia’s youth justice and incarceration system, including the outcomes of and impacts on young people.
 
Specifically, it will examine the over-incarceration of Aboriginal and Torres Strait Islander children, the degree of compliance and non-compliance by prisons and detention centres, as well as the rights of the child, freedom from torture and civil rights.

In the RACGP’s submission, the college strongly supports decarcerating young people, calling for a health-first approach to supporting young people who are at risk of incarceration.
 
‘Many young people at risk of incarceration experience significant health issues, including in physical, psychological and behavioural health, and so need holistic healthcare and wrap around support,’ it said.
 
‘Adversities such as social disadvantage, traumatic experiences, substance use, and mental illness are common precursors to incarceration of young people.
 
‘A disproportionate level of punishment has been demonstrated against Aboriginal and Torres Strait Islander young people due to the impacts of racism in health and justice systems and there has been a failure to recognise or support the complex health and social needs of Aboriginal and Torres Strait Islander young people.’
 
Dr Karen Nicholls, Chair of RACGP Aboriginal and Torres Strait Islander Health, told newsGP the topic remains a health issue because childrens’ brains are still developing all through adolescence.
 
‘It’s hard enough for adults, so therefore expecting children to be able to navigate it is not a realistic expectation,’ she said.
 
‘Incarceration impacts the opportunities for things like early diagnosis, early intervention, and management and support, which are more appropriate.
 
‘Appropriate treatment for medical conditions does not involve detention or incarceration.’
 
On an average day in 2022–23, 4542 children were under youth justice supervision, with 57% of those being Aboriginal and Torres Strait Islander children.
 
Around 85% of children released from supervised detention were returned to sentenced supervision within 12 months.
 
Earlier this year, the ‘Help way earlier!’ report from the National Children’s Commissioner revealed that ‘basic service systems of health, education and social services are fragmented, uncoordinated and not fit-for purpose’.
 
It laid bare the system’s current failings, saying those who need the most help are unable to access it and that the underlying causes are not being addressed.
 
The report made 24 recommendations, including the establishment of a National Taskforce for reform of Australia’s child justice systems and a 10-year cross-portfolio National Roadmap for reform.
 
In its submission, the RACGP called on State and Federal Governments to implement all 24 of these recommendations ‘as a matter of priority’.
 
It is calling for the age of criminal responsibility to be raised to 14 years old across all jurisdictions, for the states and territories to implement alternative, therapeutic models of custody for young people.
 
But the calls come just days after the Northern Territory’s new Government passed laws lowering the age of criminal responsibility to 10 years old – a decision which has gone on to cause significant backlash across Australia.
 
On Monday, it also announced an ‘emergency response’ which will see young people relocated from the Alice Springs Youth Detention Centre to Darwin, a 1500-kilometre journey which would further isolate them from their families and Country.
 
The submission also said Health Ministries across Australia must provide and be accountable for healthcare services in youth justice, rather than the current model of Ministries of Justice or Human Services being responsible.
 
It also wants to see the Federal Health and Aged Care Minister facilitate the leadership of the Aboriginal Community-Controlled Health sector in the policy, design, and delivery of health services for Aboriginal and Torres Strait Islander peoples in custodial settings.
 
‘Connection to culture is highly protective for wellbeing, and programs imposed from outside Aboriginal and Torres Strait Islander communities are highly likely to fail, and result in a sense of hopelessness for all concerned,’ it said.
 
Dr Nicholls said it is ‘upsetting’ to hear of any child who is incarcerated when there is an alternative that might be more appropriate.
 
‘Anything that strengthens the cultural determinants of health leads to positive health outcomes for Aboriginal and Torres Strait Islander communities, and they’re going to be specific for the local context,’ she said.
 
‘We need to bear in mind that it’s not going to be one program that will be suited to the whole of Australia, we have a lot of diversity, and there’s a lot of strength in that diversity, and lots to celebrate in that diversity.
 
‘They are the things that keep us well and they are the things that should be prioritised and embedded into health programs.’
 
The RACGP also wants greater support for children with neurodevelopmental disorders before they become involved in the justice system, and attention deficit hyperactivity disorder (ADHD) and fetal alcohol spectrum disorder (FASD) services linked to primary care to ensure early diagnosis and management.
 
According to the submission, training must be given to youth justice staff to recognise and respond to behaviours associated with ADHD and other neurodevelopmental disorders, and evidence-based interventions for managing ADHD within youth detention facilities.
 
‘Many incarcerated youth struggle with impulse control issues related to neurodevelopmental disorders, which can contribute to their involvement in criminal behaviour and subsequent incarceration,’ the RACGP submission said.
 
‘From a healthcare perspective, there is often inadequate access to specialist mental health services, including assessment and treatment, within youth justice facilities.’
 
Dr Nicholls said GPs play an important role in helping these vulnerable young people, including diagnosing and identifying children who may have neurodevelopmental disorders such as ADHD, FASD and autism spectrum disorder.
 
‘Seeking appropriate diagnosis and treatment is extremely important, not just in terms of the potential for reducing interaction with the justice system, but also for the children’s ability to engage in education and future employment,’ she said.
 
‘Setting up children for the best start is really important, and GPs being aware that there is a relationship between health and justice.
 
‘The health of populations who are finding themselves in incarceration is poorer than the health of people who are not, so being aware of that and then advocating for what is appropriate in terms of the developmental stage of a child.’
 
The submission said greater support is needed for children once they leave custodial settings, labelling it a ‘particularly vulnerable period’
 
‘Isolated initiatives will not adequately support their transition, with additional need for mental health, alcohol and drug, and disability services,’ it said.
 
‘Support services are often under-resourced, fragmented and do not meet the needs of Aboriginal and Torres Strait Islander people in custody.
 
‘There is a critical role for ACCHOs, GPs and community health providers in the transitional period to ensure successful community reintegration, however they must be appropriately resourced and supported to understand the particular challenges faced by this cohort of patients.’
 
The Committee is set to hand down its findings on 28 February 2025.
 
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