Prescribing Ideology

Picture the scene: A teenager presents with a serious skin complaint. He’s had it for a while, it’s sore and, given how it looks, most people won’t go near him. The doctor, tutting through the appointment, ends up prescribing him heart disease medication and sends him on his way.

The doctor knows that the meds are not going to work. Pharmaceutical trials have shown that these heart drugs are ineffective for his skin condition, and can have multiple side-effects.

Sure enough, a few months later, the teen re-arrives at the surgery. He’s more agitated than before. His skin is hard to look at, even for the doctor. He’s suffering from extreme palpitations, depression, he says he feels angry all the time. Against orders, the boy has taken the decision to come off the medication.

The doctor examines the teen thoroughly. Being the family doctor, she knows that the teen’s mother had this skin complaint, about eight years ago, although it cleared up with topical cream and dietary changes. She decides on further medical interventions.

She prescribes a new set of meds – this time a cancer treatment. She knows these drugs will make his existing complaints far worse, and he’ll undoubtedly suffer a range of excruciating side-effects. He might even die. If he survives, he’ll have internal and external scarring. The original complaint, and the side-effects, will pass down to any potential offspring.

She increases the regulated dose. She knows it goes against all the evidence, and that the international health standards committee will strongly object, but his unsightly face fills her with disgust. And, besides, there’s a pharmaceutical industry push on this medication, and ‘cancer care’ is even a DHB performance indicator nowadays, so it’ll be good for surgery business. As she passes the prescription over, she wonders how long it will be before she sees him again.

This is what the NZ health system would look like if it operated according to National Party’s new youth justice policy.

The new policy heralds treatments that will, by all national and international evidence, invariably make things a whole lot worse.

The most obvious is ‘boot camps’. A similar NZ scheme was adopted in the 1980s. ‘Corrective Training’ (CT) focused on regimented control, work and education. Trainees emerged with toned bodies and hard minds. In 1983, 71% were reconvicted within a year of release and, by 1988, CT reconviction rates stood at 92%. Wow! The government tried again with Military-Style Activity Camps (MAC). In 2013, after following 57 MAC participants, the MSD noted that 48 (84%) had reoffended within 12 months (although their offending had decreased in seriousness and regularity). In 2015, the Minister of Social Development saw that children had been escalated up the sentencing tariff scale to access the camps.

Or what about increasing the use of adult prisons for children aged 14 or over? In 2009, NZ Corrections’ research found that 71% of those aged under 20 were re-imprisoned within five years. Teen offenders who had previously spent time in prison were more likely to become persistent offenders. Stigma and labelling have sustaining negative effects. Some of the reasons why the UN Committee on the Rights of the Child discourages imprisonment for those under 18 is that prison is developmentally damaging, it introduces children and young people to more serious offenders, and reduces rehabilitation opportunities.

Other proposed powers – removing restorative justice; putting more children in adult court; increasing punishments for children who run away; requiring guardians to be ‘conviction free for 10 years’; stopping warnings for bail breaches; removing potential early release from youth justice facilities; and increasing sentence lengths – will mean that more young offenders will inevitably fail.

For some, these strategies are enticing: no more excuses! But, as NZ’s newest Ministry would surely attest, they overlook that busy young offenders are our most vulnerable children.

There is a deep, sustaining ‘pipeline’ from our state care system into court systems and prisons – about 80% of young prisoners have had contact with state care. Most prolific young offenders have histories of sexual and physical victimization. Maori youngsters endure layers of structural, institutional and socio-cultural discrimination, which propel them through the justice system. Our social systems have failed them. The vast majority live in situations of poverty, unemployment, homelessness, precarious housing. They have mental health difficulties. They are poorly educated. They use substances to have fun and forget.

Proposed new policy dismisses all of this. It ignore the causes, the conditions. It treats children like adults. It controls children for who they are. It punishes children for failing to respond to treatments, or for trying to keep themselves well. It disciplines guardians for not being well for long enough. It prescribes the wrong treatments. And we will all pay the price: more crime, more victimization, more institutionalized bodies, more criminal justice spending, and on and on.

Young offenders can be downright difficult, challenging, annoying, hurtful. But this ideological youth justice document is the equivalent of the doctor who knowingly prescribes harmful medications for emotional satisfaction or business success. We wouldn’t run our health system like this, so why do we allow it for criminal justice?

Dr Elizabeth Stanley is a Reader in Criminology at Victoria University of Wellington.

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