Foetal Alcohol Spectrum Disorder Screening at Bimberi
Madam Speaker, I am pleased to move this motion today and to address this very important topic.
One of the key strategies in the ‘Blueprint for Youth Justice in the ACT’ is quote, ‘providing intensive individualised support to children and young people’, including ‘recognising individual circumstances and responding appropriately’. This strategy acknowledges that kids who come into contact with the youth justice system or who are at risk of coming into contact with youth justice all have unique needs and equally unique risk profiles. As a result, effective responses will be carefully tailored to each child or young person’s particular circumstances.
And this, Madam Speaker, requires that a young person’s unique needs are known. Unfortunately, some risk factors are frequently unknown. One of these is foetal alcohol spectrum disorder or FASD. This disorder ‘is characterised by severe, pervasive neurodevelopmental impairment due to prenatal alcohol exposure’. In the health community, it is also ‘well-recognised that FASD is underdiagnosed’.
Research that was published in the British Medical Journal only three months ago highlights this problem. Researchers recently assessed 99 children and young people in Western Australia’s Banksia Hill Detention Centre. Like our Bimberi, Banskia Hill is the only detention centre in WA.
The published findings are staggering: 36 per cent of the detainees who were assessed were diagnosed with FASD. Out of these 36 children and young people, only two had been previously diagnosed. This means, Madam Speaker, that out of 99 kids screened in Western Australia’s youth detention system, more than one-third of them had a serious disorder that had not previously been identified.
I suspect this problem is not limited to Western Australia. The National Health and Medical Research Council recommend against drinking alcohol when pregnant, planning for pregnancy or breastfeeding because evidence clearly shows that no amount of alcohol during pregnancy is safe.
Nevertheless, alcohol consumption during pregnancy is common behaviour in Australia. In many cases, this consumption occurs unintentionally during the first few weeks of an unplanned pregnancy; however, the latest National Drug Strategy Household Survey conducted by the Australian Institute of Health and Welfare found that one-quarter of women reported having consumed alcohol after becoming aware that they were pregnant.
It is known that when an expectant mother drinks, the alcohol passes easily through the placenta within a couple of hours, giving the foetus a blood alcohol concentration that nearly matches the mother’s. Amniotic fluid retains alcohol, which prolongs alcohol exposure for the foetus, which has minimal ability to metabolise it. Alcohol has potent effects on foetal brain development, with the result being some form of FASD.
The latest national action plan for FASD notes that the extent of the disorder within Australia is not known owing to a lack of data collection. For example, our hospitals here in the ACT have not consistently recorded alcohol use during pregnancy, which complicates diagnosis in our local community. Regardless, a very conservative estimate is that 500,000 Australians may suffer from some form of FASD.
FASD manifests primarily as behavioural problems and learning difficulties, and people who suffer from FASD make up a vulnerable part of our population, particularly where undiagnosed and unmanaged. Research has shown that children and youth with FASD are at a much higher risk of not completing their education, of falling into lower socioeconomic groups, of self-medicating with drugs and alcohol, and of suffering from anxiety or depression.
Furthermore, the Australian Medical Association has stated, and I quote, ‘the symptoms and behaviours relating to FASD increase the likelihood that impacted individuals will come into contact with the criminal justice system (particularly those that are undiagnosed)’.
And because FASD is not easily identifiable, Madam Speaker, it frequently remains undiagnosed. People with FASD often do not realise they have broken the law and often do not comply with court orders, which can lead to imprisonment. A Chief Justice of Western Australia has observed that, and I quote again, ‘FASD is an increasing problem in our courts. It is one of those conditions that are almost certainly chronically underdiagnosed … it is a condition that is inherently likely to put them in conflict with the justice system’.
Madam Speaker, statistics reveal that juveniles with FASD are 19 times more likely to be incarcerated, and are also far more likely to be recidivist. Sixty per cent of people with FASD over the age of 12 have criminal histories. Research has also shown that prisoners with FASD are prone to exploitation and higher rates of victimisation, as well as repeating the behaviour of their perpetrators to others in the community following their release from prison.
A national inquiry into FASD was held in 2012 and found a need for diagnostic tools and services, as well as capacity to provide them. Consequently, in 2016 a national diagnostic and screening tool for FASD was published. It is now available nationwide in the hopes of learning more about the prevalence of FASD in Australia and enhancing the necessary lifelong service provision by educating health professionals to better equip them with the necessary tools to assess, diagnose and manage FASD. It was this diagnostic and screening tool that was used in the Banksia Hill Detention Centre study.
The Children and Young People Act already requires that each young detainee admitted to Bimberi Youth Justice Centre be assessed within 24 hours to identify any immediate physical or mental health needs or risks and that any such needs or risks be addressed. I understand that the Bimberi Mental Health Service is a cross-disciplinary team comprising a psychologist, an occupational therapist and a psychiatrist. This is a good start but does not go far enough. Considering the established links between FASD and contact with the youth justice system, it is essential that young detainees also be screened for foetal alcohol spectrum disorder.
Management of FASD is most effective when diagnosed as early as possible. Our young people at Bimberi are particularly vulnerable and belong to a population that is at high risk of suffering from undiagnosed FASD. A positive diagnosis will help explain certain behaviours and capabilities, which can then be followed up with a plan to manage a detainee’s condition and, in turn, help him or her to live a better life.
Madam Speaker, today I ask this Assembly to call on the ACT Government to do four things. First, to assess and screen our young people in Bimberi for FASD, in full accordance with the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder, and then to use results of such screening to help develop truly individualised case management plans.
In doing so, the ACT will become a world leader in this area. According to the recent report in the British Medical Journal, the Banksia Hill study was the first of its kind in Australia. Other studies have all been completed in Canada, where the prevalence of FASD in youth detention centres ranged from 11 per cent to 23 per cent. I have no way of knowing if similar numbers of young people in Bimberi will be found to have FASD, but the only way to find out is to assess them.
Second, I call upon the government to practice robust collection and sharing of data relating to the FASD assessments and screening for our young people at Bimberi. As I mentioned earlier, we simply do not have enough data available to us yet, and this is another opportunity to lead the way in collecting and sharing this information.
Third, I call upon the ACT Government to work with nationally recognised and accredited organisations to make sure that best practice is reflected at each stage of the process and in all aspects of the work undertaken. After all, as the ‘Blueprint for Youth Justice’ states, individualised support needs to be based on evidence and best practice.
Lastly, Madam Speaker, I wish to move the amendment circulated in my name. An important part of fully meeting the needs of young detainees found to have FASD is to guarantee that the youth workers and other staff who daily care for these kids have the appropriate training as well. Some might suggest that this point goes without saying, but I feel the importance of making it clear by means of this amendment.
Madam Speaker, we have the resources: we have a national diagnostic and screening tool for FASD. We have evidence showing the lifelong impact of FASD on young people, especially when left undiagnosed, and the strong presence of affected young people in youth detention or in other contact with the youth justice system. I have spoken in this chamber before on youth recidivism. This is one significant action we can take to seek to reduce youth recidivism.
We have existing services that can be trained and equipped to assess, diagnose and provide ongoing care and management of FASD for our young people in Bimberi. We have recommended screening tools such as AUDIT-C that our local hospitals can start using consistently to keep better records for alcohol use during pregnancy. We have what we need; we just need to do it.
FASD is a lifelong disability that is 100 percent preventable yet common enough to pose a significant burden to our society when left undiagnosed. Today I urge this Assembly to call upon the government to look after our young people in Bimberi. Every person, including a person with FASD, has the right to health, education and employment, quality of life and happiness, and for the sake and safety of our entire community, let us find out what our young people in detention really need and then make sure that they get it.
Madam Speaker, I commend this motion to the Assembly.