Lidia Thorpe (Victoria, Independent) Share this | Hansard source

I rise today to speak about the health crisis this country continues to impose on First Peoples of this country. The so-called gap in health, in housing, in justice, grows with every preventable death, every child removed, every prison sentence, every community left without basic health care or housing. They call it a gap. We call it what it is: a system of racial segregation. Our people are being killed through the destruction of country and culture, systemic neglect, targeted state violence, racist institutions and mass incarceration at the highest rates in the world, not by accident but by a system designed to assimilate or exterminate us. This is racial segregation, it is apartheid, and it is a slow and sophisticated genocide.

Health care in prisons isn't just a service or a hospital or a policy area; it is a human right that continues to be selectively denied to our people. People who should have been cared for by family in safe, secure housing or in a doctor's waiting room or in a hospital are sent to prison. There they often die alone in prison cells, without proper medical care, and too often their deaths are labelled 'from natural causes'. Let me be very clear: there is nothing natural about dying in a prison cell from a treatable illness. There is nothing natural about a child taking their own life while on remand. There is nothing natural about shackling a woman while she's giving birth or shackling a palliative-care patient. This is outrageous. There is nothing normal or natural about losing your hearing from an untreated infection or having your fingers amputated because your pain is not taken seriously until it's too late. These are real stories, real people. There is nothing natural about a man hitting his head against a wall to try and get relief from excruciating dental pain caused by an infected tooth left untreated for weeks. These are not natural injuries or deaths; this is systemic neglect at the hands of a state, including police officers and prison guards, who do not see our people as worthy of being looked after.

Those of us who have been around long enough have heard, time and time again, stories and reports about racism that festers in every police department and in every prison. Health care in this country is not equal. It is not safe. If you're black, disabled, criminalised or all of the above, you're far more likely to be denied the care you need to survive. This is how racism harms and kills. The brutal reality is that this country continues to deny incarcerated people their right to health care. As First Peoples, we are the most incarcerated people on the planet, which means we are the ones dying from this neglect, abuse and torture, all of which are very well documented. Behind closed doors, where international observers are denied entry, adults and children are being physically and sexually abused by the state. They are being shackled and spit-hooded. They are denied food and water, as punishment, and monitored on screens 24/7, with the lights on. If someone says they are depressed, the response of the prison is solitary confinement—for their so-called safety, in cells that still have hanging points.

The Royal Commission into Aboriginal Deaths in Custody included a number of recommendations on health care. One of these recommendations was to remove all hanging points from prisons. This was 30 years ago, and it still hasn't been acted on. The Guardian Australia recently revealed at least 57 people died by suicide, using known hanging points, over the past two decades, despite numerous warnings from coroners over that time. What message does that send to families? What message does that send to young people who are in the crisis? When someone in custody reaches out for help, they should not be punished for it and they should not be placed in solitary confinement. They should be met with care, support and connection. Instead, we are seeing suicide risk treated as a threat, and that only makes things worse.

We've had report after report from coroners, ombudsmen and royal commissions all saying the same thing: the prison system is not safe for people in custody, racism is rife, proper health care is extremely rare, mental health support is inadequate, chronic illnesses go untreated and deteriorate, medication is delayed or denied and antipsychotic medications are used as silent handcuffs to sedate and placate people, contributing to a number of side effects and chronic diseases. And people are dying as a result. Our community controlled organisations are doing their best to reach people inside, but they are underfunded, overstretched and forced to operate in hostile environments that continue to criminalise and punish our people for being unwell. Ministers and governments are quick to promote our services to cover up their failures and to showcase them as evidence of progress while routinely making community controlled organisations work harder.

The government has acknowledged some of these failures, in the National review of First Nations healthcare in prisons. That review was a long time coming. It made one thing very clear: the system needs to be transformed. The review calls for a range of measures, but we have not seen any action on this yet. I commend Minister Butler for showing more interest in this area than other previous health ministers did, but the truth is that we have not seen any change. It's all talk, no action. And we can't afford to wait any longer, because people are literally dying—children are dying.

I want to talk about medication in prisons. People in prison are still being excluded from the Pharmaceutical Benefits Scheme, the PBS, and that means they don't have access to the medicine they need, including basic things like insulin for diabetics. We know blackfellas, in particular, have high rates of diabetes—they can't access insulin in the prison system. It's like you just want us to die. There's no access to antipsychotic medications and there's no access to HIV treatment. People inside should have access to the same standard of health care as people on the outside, but we are failing to meet that standard in this country.

We've seen reports of prisons substituting medications with cheaper, less-effective options. We've seen delays that have caused seizures, infections and permanent disabilities. We've seen people denied treatment because it's too expensive or not available on site, and the vast majority of these people are Aboriginal and Torres Strait Islander people. This is not only dangerous; it's a violation of people's rights. It is one of the strongest and most effective levers the federal health minister has at his disposal. I've spoken to the health minister about fixing this a number of times. There is a range of solutions available, and I've provided those as well. One of my amendments to this bill also provides solutions. But people are still waiting. While we wait, people are dying.

It is time for the government, if they are genuine, to get on with it. Pull the states and territories into line. Use the Medicare scheme to implement the recommendations of last year's view that you paid for; establish nationally consistent standards; improve access to essential medicines, disability supports, drug and alcohol support, sexual and reproductive health care and post-relief care; remove all hanging points in custodial settings as a matter of urgency; address the widespread neglect of mental health and disability in youth and adult prison populations; and ensure First Peoples have access to community controlled, culturally safe models of care before, during and after incarceration. I foreshadow moving the second reading amendment as circulated, which outlines some of these priorities.

This is just the start. I also want to touch on health care for our elders, the ones who carry our stories, our lore and our culture. For our elders in custody—yep, they're there too—the situation is terrible. Prisons are not equipped to care for ageing people, to support complex needs, to treat cancers or for dying with dignity. There must be full and independent oversight and accountability for healthcare services in prisons. This is something that requires national coordination and leadership. Crucially, any work to transform custodial health systems should be designed, led and governed by First Peoples, including through adequate resourcing of Aboriginal community controlled health organisations. Health care is also where some of our strongest resistance has come from and where the community controlled movements come from—from our old people who fought against the system that saw them as less than human and who established our own services on our own terms.

To the families that reach out on a daily basis: I hear you, I see you and I stand with you. To our young people: your lives do matter, your future does matter and your health does matter. To our elders: thank you for your strength, your knowledge and your endurance. Let us honour them not just with words but with justice because until our people are safe in hospitals, in homes and in prisons none of us should be comfortable with the status quo.