Co-designing custodial health: Building a shared framework
Professor Kerry Arabena
Managing Director
Why co-design mattered
Prisons are some of the most dehumanising environments we have. For Aboriginal and Torres Strait Islander people, time inside adds another layer to historical trauma, disconnection from Country, and systemic exclusion. Health services in custody have usually been about compliance, containment, or short-term treatment, not about social and emotional wellbeing.
Indigenous businesses are starting to change that. They bring cultural authority into the room, hold credibility with communities, and know how to bridge the gap between institutions and Aboriginal voices. Karabena’s role was to help co-design a framework for custodial health that put Aboriginal culture at the centre as a driver of healing, identity, and systemic reform.
Starting with lived experience
We ran a series of workshops to shape what became a theory of change for an Aboriginal Community Controlled Correctional Health Service (ACCCHS). The mix of people in the room mattered: corrections officers, VACCHO and VAHS representatives, justice health staff, policymakers, and Aboriginal men who had lived inside.
The workshops began with lived experience. Men spoke about what had helped them survive in custody, and what had made things worse. Staff described the constant challenge of balancing safety, security, and wellbeing. Community organisations shared which cultural practices could actually be sustained inside.
For one corrections officer, it was the first time he had “heard men talk about their health as something tied to family and culture, not just medical care.” For him, it shifted how he thought about his role. For Aboriginal men, the workshops created an unusual space where lived knowledge was treated as central to planning. One participant described it as “a chance to put back some of what gets stripped away when you go inside.”
Our job was to knit those perspectives together and make sure Aboriginal voices sat on equal footing with institutional expertise.
Building blocks for change
The shared framework laid out the building blocks:
Aboriginal Health Workers and Elders embedded in prisons
Trauma-informed, culturally safe programs across units
Peer mentors recognised and supported
Corrections staff trained in cultural safety
Stronger links with Aboriginal community organisations
What change looks like
Participants mapped how these inputs could lead to change:
Short term: More trust, greater engagement in programs, fewer incidents
Medium term: Calmer units, stronger cultural identity, fewer self-harm incidents
Long term: Better reintegration, reduced reoffending, safer prisons
The framework rested on a few key assumptions: that group dynamics shape behaviour more than individual choice, that positive practices can spread just as quickly as negative ones, that Aboriginal Community Control restores identity and belonging, and that remand and sentenced populations need connected but tailored approaches.
The roadmap turned into something practical: a platform ACCOs could use in advocacy and corrections staff could use to talk across institutions.
Holding the space
Karabena’s role was to make the conditions for this work possible. We centred cultural authority, designed spaces where people could listen across divides, and ensured ACCOs had feedback loops to keep the work community-led. Lived experience was treated as evidence, not anecdote. Structured reflection tested whether cultural programs could genuinely shift norms and whether staff training could lower resistance.
We also developed frameworks and indicators communities could pick up, argue over, reshape, and make their own. The theory of change was written up for VACCHO, ready to be used by ACCOs in advocacy, and to be taken up by corrections and justice health staff as a reference point for multi-institutional conversations. What started as workshops turned into a tool for ongoing engagement and reform.
From compliance to genuine reform
Co-designing a custodial health framework showed that reform doesn’t have to come only from policy directives. It can be built from lived experience, cultural authority, and staff knowledge. What came out of the process was a platform Aboriginal organisations could own and corrections staff could use to push reform beyond compliance.