Citizens’ juries were conducted in six Australian prisons to learn from incarcerated people about what they view as the most important issues for prison health care and research.
Problems and Purpose
The Nelson Mandela Rules, or UN Standard Minimum Rules for the Treatment of Prisoners, posit that people in prison should receive the same health care and treatment as the general population. This, the researchers argue, includes research participation on health issues that impact people in prison, particularly because it has been shown that they have some of the poorest health outcomes. [1]
Background History and Context
The study was conducted in 2019 when there were 43,000 people full-time in Australian prisons. Broken down, this is made up of 8% women and 92% men, and an over-representation of First Nations people. [2]
Organizing, Supporting, and Funding Entities
The study was funded by the Australian National Health and Medical Research Council.
Participant Recruitment and Selection
50 people took part in the six citizens’ juries, with jury sizes ranging from seven to 11 participants. [3]
Expression of interest forms were distributed in the prisons by prison staff for people to elect to take part. This was available to all incarcerated people and asked for demographic information including how long they have been incarcerated for. Depending on how many expressions of interest there were, participants were selected to take part in the citizens’ jury to ensure there was diversity. Reimbursements for participants were offered, but only one prison accepted this. [4]
Six prisons were involved; one men’s and one women’s prison in Queensland, and two men’s and two women’s prisons in New South Wales. These prisons were elected based on recommendations from a research reference group. These prisons were also chosen as they allowed for representation of both urban and regional locations, “security levels”, gender and representative numbers of First Nations people to reflect numbers in the prison system. The research team attempted to hold separate citizens juries for First Nations and non-Indigenous people, to provide more space to hear from First Nations people as they are both over-represented in the Australian prison system and face health disadvantages. However, due to logistical and security matters, this only happened in two of the six citizens’ juries. [5]
Methods and Tools Used
A citizens’ jury method was chosen because it aligns with the James Lind Alliance (JLA) Priority Setting Partnership approach, which outlines ways to engage people who are often not involved in health research. [6]
What Went On: Process, Interaction, and Participation
The citizens’ juries were about 7-8 hours long and split into two sessions during one day. The morning session involved participants defining key priorities and the afternoon session involved discussion on the ethical issues that arise when doing research with incarcerated people. 3-4 hours were allocated for deliberation amongst participants to decide on five research priorities. Deliberations had to fit within prison schedules, and no prison staff attended the citizens juries. Research staff were available to answer any further questions, and they took notes as deliberations were taking place. [7]
Participants were given videos of expert presentations about three topics as decided by a research reference group: “defining health and health research,” “research into the health of people in prison,” and “changes in health as people enter and leave prison.” Experts who recorded these videos were asked to keep it to 10 minutes and speak in an accessible way and draw on reputable sources. There was also a PowerPoint presentation detailing prison health priorities as determined by “prison health service directors” from a prior deliberative study. [8]
Influence, Outcomes, and Effects
Five research priorities were identified from the six citizens' juries, with mental health as the top priority. There were, however, differences amongst the juries about what areas of mental health need greater focus. Other priority areas (before they were distilled to five) were alcohol and other drug support, harm prevention, syringe programs, infectious diseases, and health education. [9]
After the citizens’ jury, participants were sent a report of the day to ensure it correctly represented the group. They also received a survey to evaluate the day and process. One prison did not allow the report and survey to go to participants due to security concerns. The survey results from those who did respond showed that participants felt they did not have enough time to deliberate. [10]
Analysis and Lessons Learned
This initiative showed the ability for deliberative approaches to include incarcerated populations in addressing issues that impact them. It is a way to combat the idea of “civil death” that happens when citizens’ ability to participate in public life is diminished. There are challenges to doing so, such as obtaining access and permission to engage with prison populations. [11]
There are concerns that participants were deliberately chosen by prison staff to present a certain impression, but this was refuted by the prisoners themselves, saying they would not have agreed to take part if they did not want to. [12]
See Also
References
[1] Simpson, P. L., Guthrie, J., Jones, J., & Butler, T. (2021) Identifying research priorities to improve the health of incarcerated populations: results of citizens’ juries in Australian prisons. Health Policy. 6(100), 771-779, https://doi.org/10.1016/S2468-2667(21)00050-5
[2] Ibid., p. 772
[3] Ibid., p. 774
[4] Ibid., p. 773
[5] Ibid.
[6] Ibid., p. 772
[7] Ibid., p. 773
[8] Ibid.
[9] Ibid., p. 774-775
[10] Ibid.
[11] Ibid., p. 776-777
[12] Ibid., p. 777
