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Secretly suicidal: Why prisoners need access to Medicare

Content warning: the following article contains references to suicide.


The sympathy in the mental health nurse’s eyes was genuine. ‘I’m sorry Damien’, she said, ‘but the only thing we can do for your mental health is give you the phone number of a service to call once you’re released. There’s no funding for therapy for general inmates in prison. My job is just to assess the mental health of inmates, not to treat it.’

Two months into a 10-month prison sentence, I was placed in solitary confinement after having a nervous breakdown. I’d originally made a fruitless attempt to keep my breakdown to myself, because I’d been told what would happen if Corrective Services found out I was having mental health issues.

One of the first friends I made in prison, like many of the inmates, was suicidal. ‘The best advice I can give you if you’re struggling with your mental health’, he told me, ‘is to do everything you can to keep it from the officers. If they find out how depressed I am, they’ll follow the Corrective Services handbook for dealing with that. Which means they’ll put me on suicide watch until they’re convinced I’m not going to make them fill out a heap of forms by killing myself. Then they’ll take my single cell away from me, and put me back in a two-man cell, so that another inmate can do their job for them.’

The theory is if you try to kill yourself in a two-man cell, your cell-mate will alert the officers. In reality, probably half the problems in prison could be resolved if everyone had their own cell, and wasn’t fighting over space. Remember what it was like being confined to your house during COVID lockdown? Now imagine instead of being stuck in your house, you’re locked in a room that’s smaller than your laundry, with a complete stranger. There’s no internet, no phone, and when one of you needs to take a shit, there’s also no privacy.

The extent of my breakdown meant I could only make the most perfunctory efforts to pretend things were normal. The correctional officers, some of whom were genuinely concerned, quickly noticed. Once I’d come to their attention, and against the advice I’d been given, I decided to be honest about how bad my mental health was. It was a desperate cry for help, but what I effectively got was punishment. Before I knew what was happening, I was locked in a cell under 24-hour surveillance. The irony wasn’t wasted on me even at the time. The way prisons treat severe depression is by depriving you of exercise, sunlight, and the ability to contact your friends or phone your family. This is not a recent development. In 1999, the process was condemned as an ‘unacceptable practice’, with an Auditor General concluding ‘it is difficult to imagine why any prisoner would voluntarily alert staff to their intention to attempt suicide or inflict self-harm, if the final outcome was for the prisoner to be placed in an observation cell.’


'Historically, the general public has been unsympathetic towards the rights of prisoners. It comes as no surprise that the issue has to date been given little priority from politicians, as there are few votes to be gained from fixing the issue.'


Of course, it didn’t take me long to realise the only purpose of the observation cell was to protect Corrective Services from bad statistics. Historically, the Productivity Commission measured the effectiveness of Australian prisons primarily on reduction in escapes and deaths in custody, rather than improvements in mental health, human rights, or any form of rehabilitation. While offence-related programs and education initiatives are used as a measure of efficiency today, alongside a decrease in ‘apparent unnatural deaths’ including suicide, there is no mention of mental health improvements in their most recent report on effectiveness. It appears that as long as inmates don’t act on their depression and kill themselves until after their release, it’s a win for the correctional centre.

But correctional centres are only working with the cards they’ve been dealt. The real issue is that prisoners do not have access to Medicare, which means there’s next to no funding for psychologists or therapy in prison. Prisoners, the people who arguably need therapy more than anyone else, don’t have access to it.

How is this counter-intuitive situation possible? While correctional centres in Australia are a state and territory issue, Medicare is a federal one, and prisoners, including children in juvenile detention, have never had access to it. Section 19(2) of the Health Insurance Act 1973 stipulates that Medicare isn’t available when health services are being provided by a government entity. Originally designed to lower the cost of Medicare, this provision was made on the basis that incarcerated people would be provided equivalent services through alternate funding. Chronic underfunding of health services, however, means that in reality treatment is often too expensive to be delivered without Medicare, resulting in prisoners missing out on both physical and mental health services. In one case, an incarcerated man took a year to be diagnosed with bowel cancer, because he was unable to be examined by doctors.

Not only does there appear to be no reason aside from Section 19(2) as to why prisoners are denied Medicare, it has been argued that prohibiting them from accessing the level of healthcare available to the general public may mean Australia is violating its obligations under international human rights law. Furthermore, both the Australian Medical Association and the Public Health Association of Australia have called for the end of the Medicare exclusion from prisons. So why does it remain in place?

Legislation makes it clear that states and territories are responsible for prisoners, meaning legal action against them will not fix the problem, which instead lies with federal legislation. Historically, the general public has been unsympathetic towards the rights of prisoners. It comes as no surprise that the issue has to date been given little priority from politicians, as there are few votes to be gained from fixing the issue. Until such time as it is, however, I’m afraid many prisoners are going to keep their mental health issues to themselves, hoping to make it until the end of their sentence so they can finally access the support they desperately need to rehabilitate and reintegrate into society.

You can sign a petition to get Medicare access to children in juvenile detention here.


If you or someone you know is struggling with feelings of depression or suicidal ideation, call Lifeline on 13 11 14. 




Damien Linnane is a recipient of the CIFAL PhD Scholarship and is currently undertaking research at the University of Newcastle.

Main image: 19-year-old inmate James looks out of the window of a Young Offenders Institution attached to Norwich Prison. (Peter Macdiarmid/Getty Images)

Topic tags: Damien Linnane, Prison, Medicare, Mental Health



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