**4. Carcerality**

There is a growing interdisciplinary literature on studies of the process of incarceration itself, on carceral spaces and places, and their consequences for those incarcerated [32]. Such spaces are increasingly seen to include not only places of formal imprisonment but various institutional spaces that may have 'secure' facilities and associated features [e.g. 33, 34]. These may be both formalised and informal (e.g. informal and formal refugee camps) and cover the control and 'management' of various groups in the population e.g. secure youth facilities, mental health facilities, disability care facilities, orphanages and so on. In other words, there is a growing understanding of the similarities between the types of carceral spaces societies produce and the systemic problems that can occur in them.

One of the issues associated with such spaces is that, historically at least, some have been the sites of abusive practices including, for example, Parramatta Girls Home in New South Wales, Australia where young, often Aboriginal, girls were subject to significant physical, psychological and sexual abuses over many decades [see 35, 36]. These types of institutions and their practices effectively manufacture places of abuse and ill-health. And this is far from unique, as many inquiries into patient safety, child abuse and other domains have shown across various jurisdictions [e.g. 37, 38]

This nexus of institutional, carceral spaces has clearly produced a variety of negative outcomes for many of those incarcerated including both physical and mental health consequences as illustrated throughout this chapter. Such outcomes can be long-term, even lifelong, in their impacts making such sites the producers of ill-health for those detained within them. In the criminological literature these forms of often sustained abuses of the rights of individuals have even been characterised as the consequences of harmful societies [39]. This emphasis suggests that our societies have the capacity to generate systemic institutional harms that, ultimately, must reflect back on that society. In effect, the abuses enacted, and tolerated, in carceral spaces reflect the 'true' values of our societies because they represent enacted values in contrast to espoused values [e.g. 40].

To address these types of societal and systemic drivers of abuse in these sorts of bounded carceral environments, we need to consider the voices of those harmed and not simply the official responses or inevitable list of formal recommendations that often result. In other words, we need to disrupt the conventional discourses that present such spaces/places and the abuses that occur within them as exceptions to some general benevolent rule. As various writers have commented, including feminist theorists, this process of exceptionalising often widespread, even repetitive, systemic abuses, adds an additional harm to those injured in them [see 41]. Their experiential truths are often either minimised or dismissed in systemic responses and thus there is a diminution of the harms perpetrated on people who are often amongst the most vulnerable in our societies.

This approach has an additional benefit for both theory and research because it extends the scope of inquiry beyond the individual carceral site and seeks to identify

#### *Patient Safety and People Who Are Incarcerated DOI: http://dx.doi.org/10.5772/intechopen.108942*

and unpack patterns of health-related harms and their connection to the environments, or places, within which they occur. We would further suggest that there is an issue of *generativity* to be examined here in that some institutions can acquire such reputations but not all do, or at least not to the same degree. If the pattern is not uniform, then clearly some mix of institutional governance and perhaps individual factors combine to enable carceral environments that produce these types of harmful outcomes. This in turn can assist us in developing a body of theory to examine past, present and potentially future scenarios where such problems have emerged and might yet emerge. Potentially, at least, if such understanding can be used to influence policy, practices and professional values then future harms may be averted.

We can look for and potentially predict the consequential outcomes for human health and wellbeing in carceral environments that have the capacity for, or may have even already produced, harms to vulnerable people in them (we note this may include staff too). And we can seek to understand these factors better by looking for similarities and differences across multiple carceral domains – prisons, youth detention, mental health, aged care and so on. By disrupting the systemic distinctions between these often quite similar environments, we can better theorise why such things emerge in this first place and why they persist. In addition, because some causes are obvious to a degree, we can readily identify the repetition of factors that lead to harms.

The current reporting on deaths at the New York Riker's Island facility illustrates how contemporary these issues are and yet how sustained they can be across time to the serious detriment of those incarcerated within them. Examining such facilities on a case-by-case basis runs the serious risk of making each one seems unique when clearly a variety of overt and covert factors are in play.
