5.3 Medical Care Community health providers who provided medical care to individuals following their release from hotel APODs invariably emphasised the complexity of medical issues that were observed in former detainees. In particular, they emphasised the increasing severity of mental illness that was being observed, and that they had noted a substantial deterioration in the overall mental health of those released in 2022 as compared to those who had been released earlier in 2021. Particular concerns were raised about the transition period following release from detention and the need to ensure continuity of medical care. Those providing medical care to former detainees following their release from hotel APODs expressed frustration at individuals being released with inadequate supplies of ongoing medications, clinical handover being lacking, difficulties in obtaining patient notes from IHMS, and incomplete patient information being received. This reflected concerns that were also raised with respect to continuity of care being lacking when people are transferred between forms of detention, namely when they are transferred from prison into the immigration detention network. IHMS staff described being given only limited notice of upcoming releases from hotel APODs, which they accepted led to practical constraints in terms of ensuring an effective handover. They described the circumstances as ‘very challenging’ and acknowledged that there had been occasions where there had not been time to provide a full consultation to detainees about their ongoing care needs prior to release or where individuals had been released without their medical records. They indicated that while they tried to ensure that detainees were transitioned effectively into 56 appropriate medical care outside of detention, the reality was that the role of IHMS staff formally ceased upon a detainee being released. Community health providers described needing to organise urgent doctor appointments to obtain prescriptions for regular medications, with particular concern being expressed in relation to people released on opioids but without adequate supplies, leading to the risk of withdrawal. They also gave examples of difficulties obtaining full medical records from IHMS, and a lack of clinical handover resulting in missed follow-up appointments and care. At least two individuals who had been diagnosed with cancer, were said to have been released without any medical documentation relating to this diagnosis and no information about their next scheduled medical appointments. Examples were also given of cases of individuals being advised that specialist medical treatment that had been authorised but not provided while an individual was in detention, would no longer be funded following release. One specific issue that was raised by multiple stakeholders was delays in individuals being able to obtain Medicare cards following their release, which in turn led to delays in being able to access medical appointments and medications. The Commission was informed that an individual could only apply for a Medicare card once they were released from a hotel APOD, and that some individuals had experienced delays of several months before a card had been issued. The Commission has concluded that the transition from IHMS to external medical care providers outside of detention could be more effectively managed, and that this is essential to avoid negative health outcomes for individuals. One way