With the COVID-19 pandemic now in its third year, we have experienced many variants and witnessed several outbreaks occurring in high density areas. A particular population that has proved challenging during these ‘unprecedented’ times are those individuals who are incarcerated. An outbreak of COVID-19 in correctional facilities has the potential to impact not only those incarcerated but also the health professionals employed in the sector and the surrounding communities. Several digital technology options have been utilised across Australian correctional facilities to maintain the well being of prisoners in response to the sudden cessation of several activities.
While the Australian crime rate fell during 2020-2021, the imprisonment rate and number of prisoners increased by 5%, equating to 214 prisoners per 100,000 adult population and 42,970 prisoners1. Each day new detainees, including those who are homeless, arrive in facilities that could potentially be bringing the COVID-19 virus with them2. Australian and United States prisons have the additional threat to racial minorities and First Nations people who are significantly over-represented in these facilities3. In addition to prisoners, over 33,000 people are employed in the 115 custodial correctional facilities across Australia, with a daily movement of staff in and out to cover the three shifts a day4-5. This flow of people creates risk for the staff and the communities in which they live5, and the increased risk to both prisoners and staff led several countries to release or decarcerate as many people as possible in preparation for the increased burden of disease6.
Despite a median age of 35.6 years1, people entering correctional facilities are amongst the most vulnerable in society, and that vulnerability is exacerbated during incarceration by restricted movement, confined spaces, and limited healthcare7. Compared to the general population, prisoners have higher levels of mental health disorders, risky alcohol consumption, tobacco smoking, illicit drug use, chronic disease, and communicable and infectious diseases8. Half of all incarcerated persons generally have at least one chronic disease, and many are over the age of 60 years2,7. Highly transmissible viral infections such as measles and mumps spread rapidly in prisons9, and the 2009 H1N1 influenza pandemic highlighted the challenges of highly transmissible novel respiratory pathogens in congregate settings7.
The number of women in prison has also increased worldwide in the last decade, accounting for nearly eight per cent of the Australian prisoners1. With a 77% increase of women in Australian prisons, Indigenous women comprise the most growth – more alarming; Indigenous women make up 2% of Australia’s population, yet 34% of them are incarcerated10. Additionally, just over half of female prisoners have at least one dependent child and they are often the primary carer for their children, and the ensuing separation often contributes to mental health problems11. Women entering incarceration may also be pregnant, resulting in miscarriage, termination of pregnancy, giving birth, and children living in custody, and require the services of both midwives and women’s health nurses11.
Social distancing measures were introduced in Australia in mid-March 2020, however it has been challenging in correctional facilities given residents live in close overcrowded confinement (at times in double- or triple-occupancy cells), share toilets and showers with limited hygiene products, and usually sit shoulder-to-shoulder in dining rooms for meals2,12. Poor ventilation is also common9, and it is difficult to carry out established infection prevention protocols such as repeated disinfection and decontamination of all surfaces in correctional facilities9. Many correctional facilities do not allow basic cleaning or sanitation products that contain alcohol13.
Correctional facilities have been using isolation through solitary confinement as a punitive measure for decades, and its impact on mental health has been well documented6. It has now been implemented for health protection rather than punishment, and this may be incorrectly interpreted. Social distancing mandates resulted in the sudden suspension or limiting of nonessential movement – visitation by community members and legal representatives, facility transfers, and time outside of cells for incarcerated people6-7. Additionally, work, education, fitness, and religious activities were also stopped or reduced, and often not substituted with social distant activities6. These restrictions have led to increased mental health morbidity (including anger, depression, psychosis, self-harm, and suicide), a perception of being in solitary confinement, stress and anxiety over the risk to themselves of contracting the virus, and concern about their family members and significant others contracting and dying from the virus prior to their release6,14. Interestingly, visitation reduction has also led to a decline in drug availability within correctional facilities and an increase in demand for opioid substitution medication to assist withdrawal symptoms6.
All correctional facilities have established processes for preventing and managing the spread of coronavirus in custody, including the use of QR codes, rapid antigen testing, and proof of vaccination status for staff, service providers, visitors, and contractors; screening questions, temperature checking, and wearing of personal protective equipment for all individuals entering a facility; and physical distancing measures and increased hygiene standards14. Correctional facilities have turned to a variety of technological options in the provision of individual and communal socially distant activities15. An example is how each state and territory have replaced in-person visitation15 (Refer to Table 1).
Table 1 Australian state and territory approach to correctional facility prisoner visitation
|ACT||Virtual visits using Zoom software, with each detainee allowed one video visit per week|
|NSW||600 tablet computers rolled out to facilitate video calls|
|NT||Increased phone access and other communication platforms|
|Qld||Introduced prisoner email service, where incoming emails are printed off and handed to prisoners. Prisoners in isolation were provided with Bluetooth headsets to enable them to make and receive calls|
|SA||Video visits using Zoom software|
|Tas||Increased phone access, and 50 iPADs obtained for Skype and other virtual visits|
|Vic||Video calls trialled, as well as prisoner email service, where incoming emails are printed off and handed to prisoners within 48 hours upon receipt of email|
|WA||e-visits and Skype kiosks established|
While correctional facilities have welcomed the use of information and communications technology for security and to support staff in their activities, there has been a much more protracted acceptance for use by prisoners16. Prior to the pandemic, very few Australian correctional facilities had allowed prisoners to use email, and internet access was prohibited in most high-security prisons worldwide until the 2010s16. Videoconferencing technology has been used in selected Australian prisons for over a decade to facilitate legal proceedings, family visitation, and medical consultations, with implementation being most prevalent in New South Wales facilities16. Kiosks and tablets have been used in some facilities to allow prisoners to retrieve information about their sentence, generate prison canteen purchases and requests, manage and transfer prison earnings and gratuities in prison accounts, and engage in educational activities16. Despite these pockets of innovation, allowing prisoners to access more sophisticated and interactive technology is problematic for correctional facilities, whose primary driver is security. Enabling them to reach the outside world through technology can lead to further criminal activity through exploiting access16.
A counter-argument to restricting access to technology is providing access but implementing mechanisms to manage the security risks16. Risk factors before incarceration have resulted in prisoners often finding themselves being both digitally and learning excluded, and this ‘digital divide’ between prisoners and the wider community continues to widen during incarceration, exacerbating their social inclusion on release from prison16-18. Unfamiliarity with iPADs, tablet computers, and Bluetooth headsets requires large-scale training programs to upskill users in basic functionality, however may improve the prisoner’s use of time whilst serving their sentence and their post-release employment opportunities and access to education16.
The United States House of Representatives has recently requested an examination of the feasibility of artificial intelligence (AI) to monitor and analyse telephone calls between prisoners and outside callers19. Current AI technology can automatically transcribe the phone call conversations, analyse patterns of communication, and highlight certain words or phrases that have been pre-programmed into the system19. While AI is a labour-saving innovation, there will need to be careful consideration of its use for this purpose, given the inherent challenges and possible outcomes – potential for errors, misunderstandings, and racial bias; limited existing data for the software to compare conversations; difficulty understanding some communication forms more than others; the existence of over 30 major dialects spoken by Americans; and the fact that AI consistently misinterprets African American English dialect on a statistically significant level compared to other dialects19.
It will undoubtedly be interesting to see how much information and communications technology remains in the correctional system for prisoners once the pandemic has subsided and we return to living without significant restrictions.
Dr Jen Bichel-Findlay FAIDH CHIA, April 2022