Fetal Alcohol Spectrum Disorder: Are we doing enough for people in prison?

Author: Christopher Reid

Aotearoa, we need to talk about our drinking culture, which permeates almost every aspect of society. Despite alcohol-related harm being well understood and documented, those with the power to make a difference ignore some options that could reduce the negative impacts on our communities.One often overlooked negative impact is Fetal Alcohol Spectrum Disorder (FASD), a lifelong neuro disability caused by exposure to alcohol in utero, leading to brain damage that affects behaviour, learning, and social-emotional functioning.

FASD is an invisible condition, not intentional, and people with FASD can struggle with judgment, self-regulation, and adapting to others. With the right support though, people with FASD can thrive.

The lack of leadership in alcohol-related harm by successive governments unfairly affects many, including people with FASD, who face life-long challenges and are at risk of increased harm through no fault of their own.

People with FASD are more likely to become involved with the criminal justice system and end up in prison. Compounding the inequities facing people with FASD, Māori are more likely to have FASD and more likely to be imprisoned. This inequity occurs because of factors arising from impacts of colonisation, structural racism, resource theft, and poverty, in addition to social issues caused by a lack of culturally-appropriate services to support access to adequate housing, healthcare, and education.

The actual prevalence of FASD in our population is not well understood due to a lack of research. So we look to similar countries to determine the likely prevalence in Aotearoa. Studies in Canada, the United States, and Australia are useful comparisons because they too have coloniser-settler histories and their Indigenous populations are over-represented in prisons.

Looking at the above, the number of people with FASD in the general population is around 2–5 per cent. However, the rate for people who offend ranges from 17.5 per cent (Canada) to 36 per cent (Australia). Even a conservative estimate of 17.5 per cent for Aotearoa still equates to over 1,800 cases in our prisons based on recently published figures. How do we meet the needs of such a large group of incarcerated people?

What exactly are their needs? And why bother? They're in prison because they've been bad, aren't they?

To understand the challenges facing people with FASD, we first need to figure out how to identify them. Diagnostic guidelines have been developed in Aotearoa, to support clinicians and professionals working in the assessment and diagnosis of FASD in a health context. It is critical that health professionals are informed of these guidelines and are supported to apply them effectively. Without this, people with FASD risk missing out on the support they need and, due to the nature of their condition, may even face unjust outcomes such as imprisonment.

A widely known example of such an injustice is Teina Pora, wrongfully convicted of rape and murder for a crime he didn’t commit. Keeping people in prison costs money—not to mention paying compensation if found innocent. Such costs run into the millions and far outweigh the cost of assessing one person for FASD, which could prevent such miscarriages of justice.

Regarding supporting people in prison, these are managed by Ara Poutama Aotearoa, the Department of Corrections. Nothing in either of those names references punishment or refusal of treatment based on people in custody being "bad". Those with FASD have a right to treatment like any patient in the community would. With prisons being over 50% Māori they are also an environment ripe for kaupapa Māori-informed interventions.

In better news; initiatives in the youth space have resulted in improved awareness and support for our rangatahi. Specialist courts put the person at the centre of the process, seeking referrals for conditions like FASD so individuals can be assessed. Their disability is then considered during the justice process. Furthermore, some health practitioners and judges have undergone training, which increases awareness of the likely prevalence and impacts of FASD.

Even so, an FASD diagnosis remains challenging due to the lack of people available to do the necessary neuropsychological assessment.

Once diagnosed or otherwise referred, groups such as the FASD Centre Aotearoa and FASD-CAN provide advocacy and support.

The lack of evidence-based information about FASD in adult prisons is troubling. Further research is needed, with increased funding to properly diagnose and support people with FASD, taking into account the high proportion of Māori in prisons and including culturally-safe interventions.

Bilbliography

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