The lack of NDIS and disability support in prisons

By Damien Linnane PhD candidate, University of Newcastle

When addressing issues with the National Disability Insurance Scheme (NDIS) we must not overlook incarcerated people in Australia, who are more likely than the general population to have a disability. Approximately 29% of people in prison report having a disability, compared to 22% of Australians in the general community.​​ Mental health issues are particularly overrepresented in prison, with 40% of prisoners reporting being formally diagnosed with a mental health disorder.​​ The actual proportion is estimated to be significantly higher due to undiagnosed conditions.

Despite the higher instances of people with disabilities in custody and the greater need for disability support, the NDIS has actually been curtailed in prison. Rule 7.25 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 limits the amount of support the NDIS can provide in prisons, such as expressly prohibiting day-to-day care and support needs. As a result, it is rare for incarcerated people to be able to continue accessing existing NDIS funding, and typically only transitional support services are available.​​ It is also “exceedingly difficult” to apply for NDIS funding and be assessed for support needs while in prison.​ Not only is there no equivalent of NDIS in prisons, there is significantly less healthcare and support available than in the general community.

The lack of healthcare in custody

Most prisoners come from extremely disadvantaged backgrounds,​​ and many have had little to no health care before entering custody. Prisoners also underutilise health services both before and after release,​ often because health is seen as a lower priority than issues like housing and employment.​ Prisons are recognised as having great potential to detect and treat healthcare issues, though this potential is not utilised.​ Incarcerated people cannot access certain healthcare services in prison at all, and experience significantly longer wait times for the health services they can access when compared to the general community.

They have no choice of when they can access medical services,11 and experience a restricted choice of health care providers,12 despite the settled legal position that prisoners retain all civil rights not expressly taken away as a necessary requirement of imprisonment.13

While some State correctional websites claim that prisoners do receive equivalent healthcare, these self-serving assertions, which provide no sources as supporting evidence, do not withstand much scrutiny. For example, the Victorian Corrections webpage on prisoner healthcare states that the “quality and standard of health care provided to prisoners is the same as that provided in the community through the public health system”. However, the 2022 Inquest into the death in custody of Victorian prisoner Veronica Nelson heard considerable testimony from healthcare professionals working in prisons about the lack of adequate care,14 with Coroner Simon McGregor making adverse findings about the overall quality of healthcare in the State’s prisons.15 Further, a 2018 report from the Victorian Ombudsman found many issues in relation to the healthcare available to people with disabilities in custody. In a case the Ombudsman noted was not isolated, these issues led to a woman with severe mental health issues being locked in solitary confinement for over 18 months as there was no adequate place in the Victorian prison system to provide the treatment she would have received outside custody. The woman had experienced extreme and prolonged difficulty accessing NDIS funding while incarcerated.16

There is little to no mental health treatment available in prisons.17 As a result, the typical response to a prisoner disclosing severe mental health issues is to place the individual in solitary confinement on protective grounds.18 Solitary confinement is typically referred to by the euphemisms ‘segregation’ or ‘separate confinement’ in Australia, despite the practice meeting the international definition of solitary confinement.19 Solitary confinement significantly deteriorates mental health conditions, physical health conditions, and rehabilitation prospects.20 In the absence of more appropriate supports, prisons often have no choice but to subject people at risk of suicide or self harm to this dehabilitating treatment, as they have a duty of care to prevent immediate harm.21 This process, however, has limited success. Suicide and a lack of support are major causes of death in custody among people

The inability to access disability services in prisons

While the lack of NDIS access in prison is concerning in its own right, it should be noted that prisoners have little to no recourse to improve their access to healthcare and disability support in custody. Incarcerated people technically have the right to apply for permission to be transported to an external medical practitioner. However, not only is this subject to strict approval, prisoners must bear the entire cost themselves, including paying for transport and escort to appointments by correctional officers.

This can costs in excess of $1,000 per trip, not including the fees set by the medical practitioners themselves. The extremely limited employment available for incarcerated people within prisons, such as food preparation and woodwork, can usually only be completed by those who are able-bodied, meaning people who would otherwise be eligible for NDS outside prison are unlikely to obtain work in custody. For those that can, the rate of pay in prison for full-time work is usually no more than $50 a week, meaning it is not possible for prisoners to earn enough money in custody to pay for ongoing external healthcare and support.

The benefits of effective support for incarcerated people with disabilities

People with disabilities who do not receive adequate support are at a higher risk of reoffending. Research proves that poor mental health is a strong predictor of recidivism, and there is also convincing evidence that improving the physical health of people in prison reduces their rates of recidivism. The Productivity Commission recognises improved health care in prison as a factor in reducing recidivism and saving on the costs of reincarceration.

While, superficially, the cost of health and support services may be considered expensive, it is far cheaper than reincarceration, which in Australia is $144,480 per prisoner each year. Improving health and support in prisons would also assist with several of the goals listed in the National Agreement on Closing the Gap. Further, as untreated conditions worsen in prison, providing support only after people are released places additional strain on public

Conclusion

Incarcerated people clearly have a higher need for NDSupport, though are denied access to this service when they arguably need it the most. Removing the restrictions on NDSSupport access in prisons will improve health outcomes and reduce deaths in custody. It will also save taxpayers on the cost of reincarceration due to reductions in recidivism, and the increased cost of providing support only after health and well-being has significantly deteriorated in custody.

health care services and funding. For example, people released from prison access primary care at two to three times the rate of age-and sex- matched people in the general population, and incur health care costs that are 2.1-fold higher.31

31 Kathryn Snow et al, ‘Impact of Dual Diagnosis on Healthcare and Criminal Justice Costs After Release from Queensland Prisons: A Prospective Cohort Study’ (2022) 28(3) Australian Journal of Primary Health 264, 265.