Implementation of a Needle and Syringe Program at the Alexander Maconochie Centre (pdf)
The Public Health Association of Australia (PHAA) was engaged by the ACT Government in May 2011 to investigate and report on models for the implementation of an NSP in the AMC. The project also entailed an assessment of barriers to implementation and broad consultations with key stakeholders. The emphasis of the project has been on seeking to develop a model that ensures optimal health and safety outcomes for everyone impacted upon by a custodial sentence. This includes not only the person being detained in custody but all prison staff and the broader community. This report outlines outcomes and recommendations from the project and proposes a way to meet this challenge.
The terms of reference for the work are as follows:
1. Investigate models for the delivery of needle and syringe programs in custodial settings, including existing programs in other jurisdictions, their applicability to the AMC and evidence for the effectiveness of different models.
2. Consider the views of staff at the AMC, and relevant stakeholders to better understand their knowledge, beliefs and perceptions about needle and syringe programs in custodial settings and in the context of the AMC in particular.
3. Identify barriers and enablers for the implementation of a trial needle and syringe program at the AMC. Where barriers are identified, provide advice on specific strategies to overcome these.
4. Consider and advise on the potential impact of a trial needle and syringe program on services for prisoners post-release.
5. Provide analysis on the feasibility and likelihood of successfully implementing a trial needle and syringe program at the AMC.
6. If appropriate, provide recommendations on implementing a preferred model of a trial NSP at the AMC.
Recommendations
Recommendation 1: Requirement Under Law
The ACT Corrections Management Act 2007 be amended to require the establishment of an NSP at the AMC.
Recommendation 2: Rules, Procedures and Protocols
A clear set of rules, procedures and protocols be established through an appropriate process guided by the ACT Corrections Management Act.
Recommendation 3: Implementation through a Flexible Contingency Process
Adopt a contingency process for the implementation of appropriate model/s for a needle and syringe program at the AMC. If the initially preferred model does not meet the needs of stakeholders the procedure should be to move to the next preference. The order should be as follows:
Preferred Initial Model: NSP Model 3 (Contained NSP)
– Model 3B: Contained NSP operated by external agency (within Health Centre)
Should an external provider fail to deliver the necessary outcomes, Model 3 could alternatively be operated by ACT Health.
– Model 3A: Contained NSP operated by ACT Health/Nursing Staff (within Health Centre)
Contingency Step 1: NSP Model 2 (Equipment provision from Health Centre)
– Model 2B: NSP operated by an external agency
Should an external provider fail to deliver the necessary outcomes, Model 2 could alternatively be operated by ACT Health.
– Model 2A: NSP operated by ACT Health/Nursing Staff
Contingency Step 2: NSP Model 1 (Vending Style Machines)
– Model 1: ‘One for one’ Exchange Vending Style Machines
Recommendation 4 Aboriginal Health Worker
Recruitment of a dedicated Aboriginal Health Worker position in an NSP and related service provision would be worthy of consideration.
Recommendation 5 Secure Syringe Disposal Bins
The installation of secure syringe disposal bins would further reduce the potential for accidental needle-stick injury and be worthy of consideration even without the implementation of an NSP.
Recommendation 6 Retractable Syringe Technology
Future developments in retractable syringe technology will need to be considered as part of the ongoing development of an NSP in custodial settings.
Recommendation 7: Civil and Criminal Liability
Legislative amendments be considered to protect all staff from potential civil and criminal liability.