Welcome and Introduction

Behind Bars: Nursing People in Prisons

Nurses who work in prisons require highly specialised skills to meet the vast array of professional challenges that exist. This session sets the scene by looking at some of the key professional issues most pertinent to nurses working or considering working in prisons. It includes:

• What international, national, local and professional standards and principles exist for the provision of healthcare in prisons?
• What are prisoners’ rights?
• How does a nurse-led model of care work in prisons?
• What are the core nursing responsibilities when working in prisons?
• What are the core attributes needed to be a correctional nurse?
• Is privatisation of prisons really risky business?

Hepatitis C: Meeting the Challenge in Corrections

Due to the nature of prisons, it is easy for infectious diseases to spread from one prisoner to another, and, in some cases, to cause an outbreak. This session will discuss infection control in corrections generally and look at a recent report on prisoner health that found that 1 in 5 prisoners treated in NSW and Victoria have hepatitis C. Discuss:

• What are the updates on the incidence and current guidelines for treatment of hepatitis C in Australian prisons?
• What is the evidence for prison-based needle and syringe programs and are the alternatives for reducing transmission effective?
• What health promotion techniques are most conducive to risk reduction?
• How can we address attitudes and values associated with hepatitis C?
• Is there a difference between infection control in healthcare settings compared to the correctional setting?
• Do inmates have a higher chance of contracting infectious diseases than non-prison populations?
• What safeguards are in place in the event of an outbreak of an infectious disease?

Primary Mental Health in Prisons

The potential for people with no pre-existing mental health issues to then experience a change in their mental health may occur upon arrival at a correctional facility. Why is this the case and how can nurses effectively respond to this challenge and improve the mental health outcomes for this vulnerable group of people? This session looks at:

• Why there such a potential for mental health to become unstable
• Managing behaviour defined as ‘mad or bad’ - issues for health staff
• Identifying vulnerable prisoners who are at risk of developing a mental illness
• Early response strategies to signs of mental distress and illness
• Managing the mental health caseload in prisons

Beware: The Dangers of Benzodiazepines

Benzodiazepines are commonly prescribed in Australia, including in prison populations. Alarmingly, they are also the most common drugs associated with multi-drug overdose deaths. Meaning that, while they do not often cause deaths, they commonly contribute. This session includes:

• How do benzodiazepines act on the brain?
• What makes them addictive?
• What is the safest use of benzodiazepines?
• What are the dangers of mixing benzodiazepines with other CNS depressants, such as alcohol?
• What is the drug of choice amongst prisoners?
• Are there any tips for first aid response in a drug overdose in prisons?

Care of Incarcerated Aboriginal and Torres Strait Islanders

Aboriginal and Torres Strait Islanders are disproportionately represented in Victorian prison populations. These numbers have gotten higher in recent years, showing that there is a need to change the narrative. The Change the Record campaign aims to close the gap in imprisonment rates by 2040. This session will discuss:

• What are the key principles of the Change the Record campaign?
• Why are incarceration rates high for First Nations People?
• What is intergenerational trauma and how is it related to First Nations' incarceration rates?
• What are the risks of incarceration for Aboriginal and Torres Strait Islander children?
• Is there a way that healthcare professionals can help reduce incarceration and reoffending rates of Aboriginal and Torres Strait Islander populations?

Seeing Things Differently: Nonviolent Communication in Prison

Prisons are thought of as places where violence is the answer, but there are programs that aim to make this belief a thing of the past. This session will discuss a course based on an approach developed in the US. It includes:

• What are the concepts involved in nonviolent communication?
• How can nonviolent communication programs benefit both prisoners and those who have been released from prison?
• Whose role is it to manage violent behaviour - correctional or healthcare staff?

Pregnancy and Parenting in Prison

At any point, it is likely that a small proportion of women may be pregnant while in prison. As well, for some women, they may only learn that they are pregnant upon arrival at a correctional facility. Improving the prenatal care of these women and their babies may considerably improve outcomes during these high-risk pregnancies. As well, the postpartum and parenting support provided to these women is crucial. This unique session discusses the range of considerations from pregnancy to the postpartum and parenting stages. It includes:

• What predisposes these women to have high-risk pregnancies and how can these complex needs be best managed?
• Postpartum care - What are the physical and mental health considerations?
• Mother-infant attachment - is this possible if separation occurs shortly after birth?
• Contact visits, nurseries and parenting services - what’s possible and what occurs?
• Risks and rainbows - what are the pitfalls and benefits of having children on site with incarcerated women?

Blurring Boundaries: The Risks of Over and Under Involvement when Providing Healthcare in Prisons

Developing and maintaining a therapeutic relationship with patients is an important component of healthcare practice and one that is regulated through professional codes of conduct, ethics and professional standards for practice. Any breach of these could lead to an investigation into the health practitioners’ practice. This session will explore the potential harm to patients where professional boundaries are not maintained by exploring:

• What is meant by professional boundaries
• Common breaches of boundaries
• The impact of the media on attitudes, values and beliefs regarding prisoners
• The risks of under and over-involvement when providing care
• The regulatory response to health practitioners who breach professional boundaries

Care of Transgender Inmates

Transgender persons often suffer from social stigmatisation and discrimination, but this may be amplified in a prison setting. This session will discuss a very specific inmate population. It includes:

• Are there a lot of transgender inmates in Australian prisons?
• What are the potential issues in housing transgender inmates in prison?
• What are the special needs of transgender prisoners?
• What are the systemic problems relating to transgender inmates?
• How are the specific health and privacy needs of transgender inmates addressed?

Thinking Outside the Bars: Advocating for Imprisoned Patients in End-of-Life Decision-Making

All competent adults have a right to decide in advance what medical treatment they would refuse if they lost the capacity to make decisions in the future. This is also an important human right for those dying in prison. Members of the healthcare team have an important advocacy role in protecting, promoting and defending the social justice and welfare concerns of prisoners who are patients - particularly with end-of-life care. This session looks at issues associated with end-of-life decisions and palliative care options for incarcerated patients, including:

• What is advocacy
• Barriers to advocacy in prison settings
• What constitutes a valid advance care directive
• Can a prisoner appoint a substitute decision-maker
• Prisoner, health provider and prisoner family relationships
• Medical parole
• Security risks with acute transfers
• The choice to die behind the wall vs the wish to die beyond it
• The rights of a prisoner who is dying

Confidentiality and Privacy: The Rights of Health Professionals and Prisoners

Confidentiality and privacy are fundamental rights of patients and employees in the healthcare system. Providing healthcare to patients in prisons can pose some challenges to this right due to the priority focus on the security of prisoners. Healthcare staff also have a right to privacy. Shared information between correctional staff and healthcare staff may be necessary - but what are the limits: This session will identify:

• What constitutes ‘a confidence’
• Limits to confidentiality in prison systems
• The ‘need to know’ offending and medical histories
• Protecting personal staff information
• Maintaining objectivity in high profile media cases
• Should a report be made to AHPRA when a prisoner is also a registered health professional?

Leaving Prison and Moving On: Impressions from the Inside

Prison systems used to be akin to revolving doors - released inmates commit crimes and are sent back into the prison system. Current prison systems are now realising the importance of rehabilitation in reducing recidivism rates. This session is about how one prison's youth unit relied on the belief that young offenders can be rehabilitated and will discuss:

• What is the youth unit model?
• In what way is the youth unit model different from other prison models?
• What can healthcare workers do to help reintegrate former prisoners into society when they leave prison?