Holistic Conceptualizations of Health by Incarcerated Aboriginal Women in New South Wales, Australia.

While there has been extensive research on the health and social and emotional well-being (SEWB) of Aboriginal women in prison, there are few qualitative studies where incarcerated Aboriginal women have been directly asked about their health, SEWB, and health care experiences. Using an Indigenous research methodology and SEWB framework, this article presents the findings of 43 interviews with incarcerated Aboriginal women in New South Wales, Australia. Drawing on the interviews, we found that Aboriginal women have holistic conceptualizations of their health and SEWB that intersect with the SEWB of family and community. Women experience clusters of health problems that intersect with intergenerational trauma, perpetuated and compounded by ongoing colonial trauma including removal of children. Women are pro-active about their health but encounter numerous challenges in accessing appropriate health care. These rarely explored perspectives can inform a reframing of health and social support needs of incarcerated Aboriginal women establishing pathways for healing.

Reframing spaces by building relationships: community collaborative participatory action research with Aboriginal mothers in prison.

Aboriginal women are vastly over-represented in the Australian prison system. Their recidivism rates are high. Aboriginal women in contact with the criminal justice system also have higher rates of mental health disorders and are likely to have been a victim of violence. The majority of these women are mothers. Their increasing incarceration therefore has serious implications for the health and social and emotional wellbeing of their Aboriginal children, families and communities. Illustrating and exploring this situation requires an Indigenous informed conceptual framework utilising a decolonising research methodology inclusive of enduring community and stakeholder dialogue and consultation. Respectful and ethical praxis are central to this approach. We will describe how this methodology has been applied within a current National Health and Medical Research Council (NHMRC) research project in NSW, Australia. The NHMRC guidelines for research with Aboriginal and Torres Strait Islanders peoples have supported our process and will be highlighted in illustrating our research experience.

Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program.

INTRODUCTION: The rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described. METHODS AND ANALYSIS: Population-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the 'time-to' health-related outcomes after adjusting for potential confounders. ETHICS AND DISSEMINATION: Ethical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Ethics Committee, the Corrective Services NSW Ethics Committee and the University of Technology Sydney Human Research Ethics Committee.

Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing.

OBJECTIVE: To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison. METHODS: Cross-sectional survey, including a Short Form Health Survey (SF-12) and Kessler Psychological Distress Scale (5-item version) administered to Aboriginal women who self-identified as mothers. RESULTS: Seventy-seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty-three per cent (n=59) of mothers in NSW were in prison for drug-related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty-eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF-12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1). CONCLUSIONS: Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health: Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.

Systematic review of qualitative evaluations of reentry programs addressing problematic drug use and mental health disorders amongst people transitioning from prison to communities.

BACKGROUND: The paper presents a systematic review and metasynthesis of findings from qualitative evaluations of community reentry programs. The programs sought to engage recently released adult prison inmates with either problematic drug use or a mental health disorder. METHODS: Seven biomedical and social science databases, Cinahl, Pubmed, Scopus, Proquest, Medline, Sociological abstracts and Web of Science and publisher database Taylor and Francis were searched in 2016 resulting in 2373 potential papers. Abstract reviews left 140 papers of which 8 were included after detailed review. Major themes and subthemes were identified through grounded theory inductive analysis of results from the eight papers. Of the final eight papers the majority (6) were from the United States. In total, the papers covered 405 interviews and included 121 (30%) females and 284 (70%) males. RESULTS: Findings suggest that the interpersonal skills of case workers; access to social support and housing; and continuity of case worker relationships throughout the pre-release and post-release period are key social and structural factors in program success. CONCLUSION: Evaluation of community reentry programs requires qualitative data to contextualize statistical findings and identify social and structural factors that impact on reducing incarceration and improving participant health. These aspects of program efficacy have implications for reentry program development and staff training and broader social and health policy and services.

Anorexia nervosa: the diagnosis. A postmodern ethics contribution to the bioethics debate on involuntary treatment for anorexia nervosa.

This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter "AN: the diagnosis") several ethical issues are revealed. Firstly, "AN: the diagnosis" influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, "AN: the diagnosis" impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, "AN: the diagnosis" can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. "AN: the diagnosis" can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.