The Future Of

Prisons | Dr Stuart Kinner

Episode Summary

“People are sent to prison as punishment, not for punishment.” The appalling treatment of children at Banksia Hill Youth Detention Centre urges us to rethink how we treat some of society’s most vulnerable people.

Episode Notes

“People are sent to prison as punishment, not for punishment.” The appalling treatment of children at Banksia Hill Youth Detention Centre urges us to rethink how we treat some of society’s most vulnerable people. 

People who have spent time in prison are generally more disadvantaged, with higher health care needs than the wider Australian population, but their quality of life is often not considered to be public health or human rights issues. 

In this episode, Sarah is joined by Dr Stuart Kinner, a Professor in Curtin’s School of Population Health. They discuss Australia’s current treatment of justice-involved people, and changes that need to be made to multiple systems to improve structural inequalities that exist for people who are involved throughout the prison cycle. 

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Dr Stuart Kinner is a Professor in Curtin’s School of Population Health. He leads a program of multi-disciplinary research on the health of marginalised and justice-involved people. His work is distinguished by methodological rigour, ethical research practice and meaningful research translation. 

He is experienced in longitudinal studies, multi-sectoral data linkage, randomised controlled trials, program evaluation, policy analysis, systematic review, and meta-analysis. He has produced more than 250 publications (192 peer reviewed) and attracted more than $28 million in research and consulting funds, mostly from nationally competitive schemes. 

Dr Kinner is Chair of Australia’s_National Youth Justice Health Advisory Group and_ the WHO’s Health in Prisons Programme Technical Expert Group. He also serves on the Steering Committee for the_Worldwide Prison Health Research and Engagement Network.

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Transcript

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Behind the scenes

Host: Sarah Taillier
Content creator: Zoe Taylor

First Nations Acknowledgement

Curtin University acknowledges the traditional owners of the land on which Curtin Perth is located, the Whadjuk people of the Nyungar Nation, and on Curtin Kalgoorlie, the Wongutha people of the North-Eastern Goldfields; and the First Nations peoples on all Curtin locations.

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Curtin University supports academic freedom of speech. The views expressed in The Future Of podcast may not reflect those of Curtin University.

Episode Transcription

Sarah Taillier:

(00:00) This is The Future Of where experts share their vision of the future and how their work is helping shape it for the better.

(00:10) I'm Sarah Taillier. People involved in the justice system are some of the most vulnerable in society. Research shows that people who spend time in prison experience high rates of homelessness, mental health disorders, illicit drug use and chronic disease compared to the general population. In this episode, I was joined by Dr. Stuart Kinner, professor of health equity at Curtin University and Chair of Australia's National Youth Justice Health Advisory Group. Stuart and I talked about some of the reasons behind the health outcomes for people who have spent time in prison and explored possible changes to Australia's justice systems. If you'd like to find out more about this research, you can visit the links provided in the show notes. Stuart, if you are going to give Australia's prison system a health check out of 10, right now, how would the nation rank?

Stuart Kinner:

(01:04) Very hard to reduce this very messy, complex system to a number. It certainly wouldn't be 10, but it wouldn't be zero either. And it varies a lot around the country. I think in terms of the money we spend on the system, we're certainly spending a lot. Lots of other countries don't have the resources that we do have, so that's a plus. Whether we're spending it well is a separate question and there are certainly ways in which we're spending it very poorly. One way in which we're not spending enough money, which we can come to a little later, is that the Commonwealth government is trying to stay right out of this issue. We are a federation, and other countries have this challenge where prisons and youth detention are exclusively the remit of states and territories. But this is clearly an international issue. So I would give the Commonwealth Government a very low score.

Sarah Taillier:

(01:58) And we are going to come to that in terms of who is responsible for what and who should be responsible. But when we are looking at WA, WA's Juvenile Detention Centre, Banksia Hill, has obviously been making headlines recently about its treatment of detainees. There was that black and white CCTV footage of a boy being handcuffed, pushed to the ground and folded up, that really brutal restraint technique by several guards. In response the state government has held a summit. What are your thoughts on the state's response so far?

Stuart Kinner:

(02:29) I'm very disappointed. I mean, firstly, those things should never have happened in the first place. We're in the 21st century and we... Of course, the youth justice system has to deal with some young people with very significant behavioural issues. And of course there are safety issues both for staff and for the young people themselves. But there are many places in which these issues are managed a whole lot better and it's not managing better with better restraint techniques, it's managing better through not escalating situations for young people in the first place.

(02:59) So first a big cross for the way the system is being managed. In terms of the summit, obviously I wasn't there. Disappointing that only a very small number of people were there, but full credit to those people, particularly Fiona Stanley and Daniel Morrison from Wungening, who have very clearly expressed their disappointment at that meeting. It doesn't sound like anything meaningful is changing. I did hear Mark McGowan talk about extra money going into the system, but the question again is where is that money going? What's it going to do? Where's the evidence and who's being consulted?

Sarah Taillier:

(03:35) So let's look at that question for a moment. How do you think the government of various levels should be responding?

Stuart Kinner:

(03:43) So this is a whole government problem. This is not a criminal justice problem or issue. So both in the youth justice system and in prisons, the people who we see in those systems are society's most vulnerable, most marginalised, most traumatised. And that's not to try to excuse antisocial behaviour. That doesn't make theft, assault, things like that okay. But it is to say that the reasons that people have got there have a lot to do with their own personal life circumstances. Therefore, meaningfully and sustainably changing things for those people is not something that's going to happen by locking people up. It's going to happen by giving people meaningful employment, or income, or activities, safe, stable, humane accommodation, pro-social supports, addressing underlying disability, mental health issues, and so on and so forth. So those are clearly not things that are going to happen by locking people up. It's a whole government responsibility.

Sarah Taillier:

(04:42) When these issues kind of really come to the surface like they have at Banksia Hill, you hear a lot, initially... Well, we heard a lot, initially, politicians saying it, prisons aren't meant to be comfortable places, it's meant to be punishment, and we hear a lot about the behavioural issues. What are your thoughts on that response and that mentality?

Stuart Kinner:

(05:02) They're just wrong. I mean, categorically wrong. Prisons are not places where we punish people. The punishment is deprivation of liberty, or to put it another way, people are sent to prison as punishment, not for punishment. So if the punishment is deprivation of liberty, which under the international human rights instruments that we've signed up to, that's what it is, it begs the question, now that we have somebody deprived of their liberty, what do we do? Do we make things worse or do we make things better? And unfortunately, footage like we've seen recently at Banksia Hill suggests that we're making things worse rather than better.

Sarah Taillier:

(05:35) This is, again, going to be a very broad question, Stuart, but I'd love to hear from you. How do rights of people in prisons in Australia compare to some other parts of the world?

Stuart Kinner:

(05:46) Obviously everybody in the world has the same human rights. The question is how well we're upholding those rights. And it's really disappointing that in the Australian setting, despite the fact that, for example, we've ratified the conventional rights of the child, which provides for every young person to have the highest attainable standard of health. We're clearly seeing that, for example, not happening in Banksia Hill in both youth detention and in prisons. In Western Australia and around the country, despite the fact that we've committed to providing equivalent healthcare to people in prisons, the federal government has seen fit to exclude people in prisons and youth detention from our federal health insurance system. That's Medicare and PBS (Pharmaceutical Benefits Scheme). So we're not doing well. People are not having their human rights met in prison settings around the country.

Sarah Taillier:

(06:36) So what are the impacts of that, of not having access to Medicare?

Stuart Kinner:

(06:39) Well, there are many and varied. So let me give you a few specific examples. First of all, we know that the prevalence of mental health problems in prisons is extraordinarily high. One estimate is that around 80% of people experience a diagnosable mental health problem in any 12-month period in prisons. And the prevalence is higher in youth detention. So there's an international review that showed, for example, that the prevalence of psychosis is 10 times higher among children in youth detention than in the community. So despite that, there is no meaningful investment in mental health services in prisons or youth detention in most places around the country. That's a national disgrace. It's absurd and it's regressive. And I did see Mark McGowan on TV recently claiming that there were terrific mental health services. And to that, I would say show us the data, show us the proof of that, show us the evidence. And in the absence of that, I'm not willing to believe an assertion of somebody in that position.

Sarah Taillier:

(07:42) You've mentioned that people in prisons are excluded from accessing Medicare. Why is that?

Stuart Kinner:

(07:49 ) So it's an unfortunate consequence of Section 19-2 of our Federal Health Insurance Act . So that's a piece of legislation that was... So Medibank as it was originally called, was developed in 1968 in Australia. And the idea was to provide a mechanism for paying for healthcare for anybody who couldn't afford it. 1972, it was renamed Medicare and the Whitlam government quote, "trimmed the fat". And one of the things they did at that time, because it was seen as likely to be very expensive as it is, they introduced a clause in the Act called Section 19-2. And in a nutshell, that clause prevents double-dipping. It says if somebody else is paying for someone's healthcare, then the Commonwealth Government funds don't apply. So because of this view that state and territory governments lock people up and provide healthcare in prisons, therefore they're providing healthcare, therefore Medicare and PBS subsidies don't apply.

(09:33) That's the prevailing view. So I'm not a lawyer, but my understanding is that firstly, that's incorrect because the Act doesn't say Medicare subsidies never apply. The Act is much more specific. It says, if a particular service, for example, an occasion of mental health care is being provided by the states and funded by the state, then Medicare doesn't apply. So what we know now, getting back to this notion of what gets counted gets done, is that there are very important elements of comprehensive, appropriate equivalent healthcare that are not available in prisons or youth detention such that those Medicare subsidies arguably should apply. Nobody's been brave enough to actually test that, but we know that there are some significant consequences of this exclusion. We know for example, that mental health services in prisons are woefully underfunded.

(28:18) A few years ago we did a national benchmarking exercise and we showed that in all states and territories except for ACT, which is very small and except from Victoria, which uniquely decided to hide its data. We know that mental health services and prisons are woefully underfunded. And Medicare as you know, provides funding for mental health services for every Australian, unless you're incarcerated, where the prevalence of mental health problems is two to three times higher. That doesn't make sense. We know, for example, I had a conversation with Dana Slape, who's Australia's first Indigenous dermatologist, and she provides healthcare for people in New South Wales prisons and as a dermatologist and for a number of other specialties as well, need to access these very expensive medications called biologics that are used to treat autoimmune conditions. Those medications are extraordinarily expensive, but they're subsidised on the PBS in Australia. So if you or I were to get them, it costs us $38. In prison, it might cost you $40,000.

(10:33) So that's another specific example of why we need this to change. The good news is it's easy to change. All we need is a federal health minister with the courage to exercise their authority under Section 19-2 of the Act to grant an exemption to this exclusion. Now that has been done before in multiple instances, in cases of demonstrable inequity. So in my view, the only reason this hasn't happened so far is because we don't have a health minister who has yet shown the political courage to do what's right because of the fear that the community will not like it.

Sarah Taillier:

(11:12) What are your hopes in that space?

Stuart Kinner:

(11:14) My hopes are that the new, the relatively new federal government will move towards that. And I'm cautiously optimistic that there is some interest within the Labor government in supporting reform in this area. That reform will probably be specific to particular services, which is probably sensible and appropriate. Things like mental health services, things like expensive biologic medications on the PBS, things like indigenous health checks to support particularly indigenous people transitioning from custody into the community. So I'm cautiously optimistic as it happens, it'll be before this comes out. But next week in Sydney, I'm joining Damien Linnane, who's an amazing Indigenous man who's been incarcerated New South Wales and is now doing a law PhD at University of Newcastle. We're holding a national round table to talk about exactly what we need to do and exactly how we're going to get there. So I think the momentum for change in this area is growing and at some point I think our political leaders will have to listen to community sentiment and do what's right.

Sarah Taillier:

(12:23) You've written about the need for all levels of government to establish measurable national standards for treatment and healthcare in youth detention and a system of routine monitoring of these standards. You've just touched on it there. Well, you've actually written what gets counted gets done. Why is that so important?

Stuart Kinner:

(12:42) Because what doesn't get counted gets ignored. I mean, this is not a popular area and I think that certainly I'm in the fortunate position of having been working in this space for 24 years now. So I know it well. I have an understanding that I'm privileged to have. I speak with friends and colleagues who have no background in this area, and I think that that's a litmus test for how the general community sees these issues, which is, "Well, if these people have committed a crime, they should just be locked away. What are we doing here?" But these are vulnerable, marginalised members of the community and it serves us all to meet their needs and to improve their health and wellbeing.

Sarah Taillier:

(13:25) How do you begin to really humanise that conversation around people in prisons?

Stuart Kinner:

(13:29) They are people, they're members of our communities. So I think there's this misapprehension that we're talking about some separate group of people. These are people in prisons. And the language that's used both by the systems and by governments perpetuates that by talking about, for example, 'young offenders.' Young people who've committed an offence, not young offenders. When do these young people become young people? So if we have a system that on the one hand says we're focused on rehabilitation and integration of marginalised young people into the community and on the other hand talked about young offenders and put 14-year-olds in an adult prison, that seems a little incompatible to me.

Sarah Taillier:

(14:06) We're just going to pause for a quick break. We'll be back right after this ad.

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Sarah Taillier:

(14:48) And we're back. I'm with Dr Stuart Kinner, who leads a program of multidisciplinary research on the health of marginalised and justice involved people at Curtin University.

Sarah Taillier:

(14:59) The Australian Institute of Health and Welfare states that many people often arrive at prison with health problems like you've mentioned, some are considered to be geriatric by the age of 50. What does that say about health equality in Australia?

Stuart Kinner:

(15:16) So I mentioned before that people in prison are not separate from people in the community. So they're part of our community. And so the people we see entering prisons, in prisons, and leaving prisons are just the subset of our communities who are particularly unwell and marginalised. So what it says is that this is not a new thing, that we have profound health inequalities in Australia. One symptom, one manifestation of that extreme inequality is this growing incarceration rate. Now I'm not saying that people committing crimes is exclusively because of inequalities, but the evidence is abundantly clear that it is an important driver of incarceration rates, which in turn drive further inequity and further incarceration. So it's a vicious cycle. And unless we change things in Australia, we're just going to go down the road that America went down for decades and it's just going to get worse and worse.

Sarah Taillier:

(16:97) Question without notice, but how does the size of Australia's prison populations compare to other places like the US for example?

Stuart Kinner:

(16:15) Our incarceration rate, if you look at the global picture is pretty much in the middle. It's about average. But it's increasing at a rate that's faster than many countries around the world. So we're currently going rapidly in the wrong direction in terms of our incarceration rate. Obviously the number of people in prison in Australia is a lot smaller than in other countries like the US as you've noted. At any given point in time, there's about 2 million people in prison or jail in the US but because of the rapid churn, there's 11 million people who churn through that system in the US each year. And again, you've noted before that the number of people in prisons in Australia on any given day is about 43,000. That is not the number we need to be thinking about. That's the number in prison today. How many people go through prisons in Australia a year?

Finally, after about 10 years of advocacy, the Australian government now estimates that number it probably around 65,000 people who churn through prisons each year in Australia. What's also important, and this is a response with no notice, is that the characteristics of those people are a bit different to what we see. So if you look at the cross-sectional profile of people in prison in Australia, as you've noted about a third of them identify as indigenous, as Aboriginals, or Torres Strait Islander. If you look at the people churning through prisons each year, they're more likely to be indigenous, young and female. So if we look at that cross-sectional number and think, well, that's the people who go to prison, we're underestimating the extent to which we're incarcerating, particularly young Indigenous women.

Sarah Taillier:

(17:51) What can be done?

Stuart Kinner:

(17:53) Prevention. Prevention is obviously first and foremost and there's primary, secondary and tertiary prevention. Primary prevention is addressing the profound health inequalities that we have in society, and that's to the extent that incarceration is a symptom of those profound health inequalities. And it is. So we don't need to go into the details of what that looks like. Secondary prevention is getting people who are at risk, people who are, for example, disengaging from school, young people in the child protection system, which is really a funnel into youth justice, investing meaningfully in those systems which are profoundly underfunded because even though it looks like a cost, when you look at the cost savings, given that we spend hundreds of thousands of dollars for every child we lock up every year, it's almost certainly going to be a significant cost saving.

(18:40 ) And then tertiary prevention is for people who are at the point of contact with the criminal justice system, investing more in evidence-based diversion away from that system. Critically important because we know that incarceration is criminogenic. What that means is that when you lock someone up, it makes them more likely to get locked up again. It doesn't make sense. Imagine if our hospitals, which were another expensive taxpayer-funded institution, were such that every time we sent someone to hospital, they got sicker. We'd think we need to change something there. And that's exactly what happens with our correctional institutions.

Sarah Taillier:

(19:15) On that, you recently published a research paper that found people who seek help for mental health or substance use problems are more likely to end up back in prison. Can you talk me through those findings?

Stuart Kinner:

(19:27) Sure. Just to unpack that. So a lot of the work that my group has done, the Justice Health Group, which is now spanning across Curtin University, Melbourne and Murdoch Children Research Institute, is looking at the health outcomes of people released from prisons and youth detention. And what we found in Australia, and it's consistent with what we see in other countries, is that those health outcomes are often disastrously poor. So what we see is escalation and mental health problems. What we see is rapid relapse to particularly risky patterns of substance use. Remarkably high rates of injury, decompensation of chronic disease for people, for example, not taking medications they need to treat asthma, diabetes, heart disease and so on. Extraordinarily elevated rates of preventable death due to suicide, overdose, violence and other causes. So the picture is really grim. So you would think therefore that engagement with health services is what we need and it is, but it needs to be effective and appropriate engagement with health services.

(20:27) The piece of research that you were talking about there was looking at people, people released from prisons in Queensland about a decade ago, but we don't think things have changed much since, where we found that people who had co-occurring substance use and mental health problems after release from prison, who contacted mental health and drug and alcohol services were in fact more likely to go back to prison, not less likely. Now that's not because those services are causing people to commit crimes, it's because those services don't have the resources or the capacity or the inclination to meaningfully engage with people to address those problems. And we know these issues and we know that these issues are particularly pronounced for the most marginalised and stigmatised members of society. There are issues like mental health, and drug, and alcohol services, not wanting to take on, quote unquote, "forensic clients". These are issues of mental health services that are woefully underfunded, not wanting to take people who have co-occurring substance use issues, woefully underfunded substance use issue treatment areas, not wanting to take on people with mental health problems.

(21:35) So it sounds absurd, but that is the reality of the situation that we're facing. Some other work that we've done led by Dominique De Andrade found something very similar, which is that people released from prison who present frequently to the emergency department (ED) are also more likely to go back to prison. And in fact, the more times they go to the ED, the more likely they are to go back to prison. Now again, that's not because emergency physicians are causing people to commit crime. That very expensive acute healthcare that we are paying for is a symptom of our failure to support people as they're released from prison to reintegrate back into the community. So by failing to invest in that throughcare, firstly people released from prison are having poor outcomes that's impacting not just them, but their families and their communities.

(22:22) Secondly, it's costing us the taxpayer an extraordinary amount of money to transport them regularly by ambulance to the emergency department and into hospital to provide tertiary care for health problems that we could have addressed better earlier. And then thirdly, these people are much more likely to go back to prison, which is a terrible outcome again for that individual and for their family and for society and for us as the taxpayer, given that we're spending close now to $6 billion a year and are locking up our people around the country.

Sarah Taillier:

(22:55) Are there any effective support services that you've come across after people leave prison?

Stuart Kinner:

(23:02) Yes. Yeah, there are definitely things that we could do better. So we did a randomised trial again in Queensland a number of years ago called the Passports trial, where we provided very low cost, what you would call case management. So we did something that doesn't actually happen, which is to assess people's needs before they get out of prison. And then we directed people to services in the community that existed to address those needs. That extremely low cost intervention that was just limited to the first four weeks after release from prison. It was four phone calls and a booklet, increased contact with primary care and mental health services for at least six months after release from prison. Now that's not what we need. That's the very low end of what we need. There are some terrific examples. For example, a colleague in the US, Emily Wang, who runs the Safe Centre at Yale University, has co-developed a thing called the Transitions Clinics.

(23:57) And a model of that sort would be terrific here in Australia. So Transitions Clinics are clinics that are designed to support people released from prison. And what they are is they're embedded in existing community health services and involve two people. One is a primary care physician, a GP who has experience working in prison settings. So they know what the issues are. They understand what people coming out of prison need and how to engage. And they're paired up with a peer navigator, somebody who has lived experience of incarceration, who's trained up and paid at an appropriate real wage to function as a peer support and a navigator through the various systems people released from prison need to go through. There are versions of that happening around the world. There's these community transitions teams in BC, in Canada doing very similar things.

(24:51) We're just woefully underinvesting in these in Australia. And the core reason for that, in my view, is this absurdly individualistic narrative where we know that the things that drive people into prison are complex and multifactorial. We know that poverty, discrimination, intergenerational trauma, racism, learning disabilities, mental health problems, substance dependence, et cetera, et cetera, are all powerful structural drivers of incarceration. And yet the narrative when people end up in the criminal justice system is, 'You have to just change your thinking in your behaviour.' And one consequence of that irrational narrative is that when people get out of prison, it's what's up to you. Just stay on the straight and narrow.

Sarah Taillier:

(25:36) At this point, what support services are actually available when people walk out the door?

Stuart Kinner:

(50:41) We don't know. Not enough. And they're different all around the country. They're probably different by prison around the country. There are some examples of probably quite good practice. One again in Queensland, because I know that area quite well. The Richmond Fellowship provides support for people with serious mental health problems. Now that's typically people with a psychotic disorder and they provide that kind of wraparound support where they engage the people before they get out of prison and continue for months after they get out of prison. That's only for people with serious and persistent mental illness, which is the small minority of people with mental illness getting in and out of prison.

(26:19) So things of that sort need to happen at scale. The fact that we don't know what's available is a problem in itself. As we were saying before, what gets counted gets done. There is no coherent collection of information around through care support for people getting out of prisons in Australia. And to be honest, I think they're probably pretty thin in the ground. There are some likely good examples of practice in New South Wales as well for supporting people with drug and alcohol issues. But these supports need to be available for everyone.

Sarah Taillier:

(26:51) In some Scandinavian countries, they have open prisons where, for example, inmates can leave the prison to go to work and earn a wage. What could countries learn from each other when it comes to making changes to their justice systems?

Stuart Kinner:

(27:05) A great deal. I mean, people often point to Scandinavian countries an example of good practice. And I think a fair rebuttal to that from people working in the system, but we are not Scandinavia. It's a very different place. There's cultural homogeneity, there's a lot of resources, there's a different culture, but it is something to aspire to. We shouldn't also just throw the baby out with the bath water and say, well they're different to us. Let's just keep doing the dysfunctional things that we've been doing. We can learn a great deal about what we shouldn't do and what we can do. So the US for example, is a terrific example about how mass incarceration drives inequalities and structural racism. Let's not do that anymore. Some of the Scandinavian countries, Norway is a terrific example, are a great illustration of how we can support reintegration of people into the community.

(27:53) And so as you've alluded to, the mainstream view, not just within the system but within society in Norway, is that prisons are a place for rehabilitation. So we don't send people there to punish them so they come out worse. We put them there so that we can fix whatever was going wrong in their lives that led to them committing whatever crime they've been convicted of. So that basic ethos is something we need to move towards. That requires political leadership. And I think a key problem is that our political leaders are very fearful of that. They're fearful of losing votes by saying, let's be smart about crime rather than being tough on crime. But there is evidence, in the US for example, incarceration rate in a number of states is now decreasing because there's widespread support for taking a different approach. So we can change, we must change. It just takes some political courage and leadership.

Sarah Taillier:

(28:55) What are your hopes for the future of prisons and for justice involved people in Australia?

Stuart Kinner:

(29:03) Well, fewer of them. So I think prevention is key. So to take a slight digression to explain this to you, my group a couple of years ago led the health component of this thing called the UN Global Study on Children Deprived of Liberty. So our job was to look at the health of children who are deprived to liberty and the impacts of depriving them with the liberty on their health. And so what we said is that... We did a global review of all of the evidence in all settings, in all languages as far back as the evidence went. So it took a little while. And the key conclusions were that in all settings, including youth detention, children deprived to liberty have a terrible health, health writ large. We're not just talking about whether they've got a disease, we're talking about mental health, we're talking about social health and wellbeing.

(29:51) So what do we do about that? Firstly, we want to prevent these children ending up in detention. That's where we want to go. But if that's all we do, for example, raise the age is a good example. There is a move to raise the minimum age criminal responsibility from 10 to 14. Terrific idea, 100% in support of that. But if that's all we do, we'll continue to fail these children because they still have significant unmet health and social needs. So prevention must be coupled with alternative ways of addressing their unmet needs because unfortunately, incarceration, detention, particularly in wealthy countries like Australia, is an unfortunate regrettable opportunity to improve people's health. It's often the first time that people are diagnosed with mental health issues, with chronic disease, issues with disabilities. So for example, the work in Banksia Hill led by the Telethon Kids Institute showing this extraordinarily high rate of cognitive impairment among children in detention.

(30:52) So we need a mechanism for identifying those needs, but locking people up is not the best or the cheapest way to do that. So prevention coupled with alternative mechanisms to invest in supporting the health and wellbeing of marginalised people. Nevertheless, these systems will continue to exist. Much as we may aspire to it, we're not going to get rid of prisons in the near future. So while they continue to exist, firstly politically, we need leadership to have them construed as places in which people, not offenders. People receive support and rehabilitation that benefits us all.

(31:30) Secondly, we need routine independent scrutiny of those settings to make sure that they're providing appropriate equivalent care. And thirdly, we need to invest much more than we currently do in supporting people when they come out the other side of these systems. Because what we typically see is that no matter how well we do in custody, things often just rapidly unravel once people return to the community. And the net effect of incarceration is probably health depleting, as well as criminogenic.

Sarah Taillier:

(31:59) Stuart, you have degrees in psychology and forensic psychology. What led you to become a researcher in this space?

Stuart Kinner:

(32:08) I did my PhD in forensic psychology and I was looking at people with a psychopathic personality. And so I spent about a year and a half walking around maximum security prisons, interviewing and assessing people to find the most scary and dangerous people that I could find. And in the process of doing that, I found that for every particularly risky person walking past, tens, hundreds of vulnerable, disadvantaged young men in the case of my PhD, and I started to think I was on the wrong track. And so I kind of defected really from psychology to public health and really changed my lens on this area. And I started to understand that prisons and youth detention centres are just settings where we temporarily hold disadvantaged, marginalised, unwell people. And so to me that just seemed irrational and a missed opportunity.

(33:08) I think my personal background that brings me to this is a strong sort of social justice lens. And my dad was a police officer in Northern Ireland at the height of the Troubles over there and very much at his time in the police, his view was that if you treat people with respect and in an equitable fashion, that's what you're going to get back. If you treat people like animals, people behave like animals, is the way he would put it. And so I have a strong belief that you yield back from society what you put into it. And if we treat people with respect and equity, that's what we're going to get in return.

Sarah Taillier:

(33:43) And if there is one thing you could change about our prison system today, what would it be?

Stuart Kinner:

(33:480) Less of it. Look, unfortunately we need to spend money first before we can save money. And that's a common problem of course. First of all, we need to professionalise... There's a number of things, I'm sorry, I'm going to give you a few things.

Sarah Taillier:

(34:01) That's fine. I'll allow it.

Stuart Kinner:

(34:03) We need to professionalise custodial officers. They have a very difficult job to do. Many of them are woefully undertrained and undersupported, and unfortunately they don't have the skills or the support to provide the genuinely rehabilitative functions that they can and should be providing. That's step one. Then we need to try to work many of them out of a job by reducing our incarceration rates. And that's about changing many things. It's about changing the way our courts work. It's about changing the way our police work and enabling police officers to divert particularly young people away from criminal justice sanctions to other ways of supporting them. And then if we go upstream from there, we need to start changing all of the inequities that drive people into contact with the police in the first place. But if we had to change one thing today in the criminal justice system, it would be for Mark Butler to exercise his authority under Section 19-2 of the Federal Health Insurance Act and stop excluding our most marginalised Australians from our supposedly universal healthcare.

Sarah Taillier:

(35:05) Well done for distilling that down. And thank you so much for coming in today, Stuart, and helping to really humanise a really important conversation and outline a path forward.

Stuart Kinner:

(35:16) My pleasure.

Sarah Taillier:

(35:17) You've been listening to The Future Of, a podcast powered by Curtin University. As always, if you've enjoyed this episode, please share it and don't forget to subscribe to The Future Of on your favourite podcast app. Bye for now.