9.3 Mental health and prisons
- 9.3.1 Are people with mental health issues being inappropriately put into prisons?
- 9.3.2 Adequacy of treatment of prisoners with mental health issues
- 9.3.3 Training of prison officers
- 9.3.4 Post-release planning and service provision
Female prisoners have a very high prevalence of mental illness in comparison with the general population. Almost two thirds of women reviewed in prison in the Queensland Women Prisoners' Health Surveyreported having received treatment or assessment by a psychiatrist or a doctor for an emotional or mental problem. By contrast, mental disorders affect 5.8% of the total Australian population. Depression, anxiety and substance dependence were the most common conditions reported by the survey.
Women prisoners have a much higher incidence of mental health problems, previous counselling or treatment and psychiatric admissions than male prisoners.
Mental health problems contribute to women's offending and imprisonment can be extremely damaging both to the women, their children and other family members.
The treatment of prisoners with mental health issues has attracted a great deal of discussion in recent times on two levels.
9.3.1 Are people with mental health issues being inappropriately put into prisons?
The first issue is the appropriateness of the prison system for people with mental health issues. The argument is that:
- a number of these prisoners, who would previously have been placed in mental health institutions, are now being incarcerated in prisons; and
- the deinstitutionalisation of people from mental health institutions, without providing the necessary or sufficient supports to help them live safely within the community, has led to their being reinstitutionalised in prisons.
It is clear from the health surveys conducted with prisoners that they have a greater level of mental health issues than the general population. This is particularly the case for female prisoners. Some people have their mental illness diagnosed, for the first time, while they are in custody, although most have had dealings with mental health services prior to their imprisonment. It is also apparent that there is a critical shortage of both in-patient and community-based mental health services in Queensland.
Whether the increase in the numbers of people being imprisoned with mental health issues is related to a decrease in services, or inadequacies in these services does appear to be a critical issue that requires further research. Recent press reports seem to support the view that, on some occasions, judges believe they have to place mentally ill people into prison for their own safety because there are no other options available.
There is no dispute that improved and integrated services for mental illness and substance abuse, as well as assistance in areas such as housing, social and disability support, would reduce the likelihood of people with mental illness coming into contact with the criminal justice system.
Prison officers in New South Wales have argued that a far greater number of prisoners with mental health problems should be being diverted from the prison system. Queensland has a well developed set of processes for determining criminal responsibility and fitness for trial through the Criminal Code and the Mental Health Court under the Mental Health Act 2000. Now it also has a network of clinical forensic mental health workers at service locations throughout the state.
Even with these recent initiatives, the ADCQ believes that people with a mental illness are poorly dealt with at all stages of the criminal justice system, and that efforts to improve their situation have been piecemeal and fragmented. This is an issue that needs to be properly addressed by the entire justice system to ensure that systemic discrimination does not continue to occur for persons with mental health issues. The adequacy of the training and delivery of services by police, lawyers, court and judicial officers on how to recognise a person may be experiencing mental health problems, and being aware of the options for diversion from the justice system, are of critical importance. The same applies to the level of legal services that are available for persons with mental health issues. Inadequate or no legal representation can lead to the incarceration of persons in circumstances when imprisonment is not the appropriate sentencing option.
While the justice and health systems must play important roles, the DCS has a major responsibility to ensure that there are adequate community corrections programs and options available to sentencing authorities to divert offenders with mental illness.
9.3.2 Adequacy of treatment of prisoners with mental health issues
The second issue is the adequacy of appropriate services in prisons for prisoners with mental health issues. Providing effective best practice mental health services to a prisoner from the time of incarceration to the time of their discharge from the supervision of the correctional system, is the responsibility of the Queensland Government and all its relevant departments. The National Standards for Mental Health Services in Australia 'emphasise the need for multidisciplinary teams within one mental health service to ensure an integrated approach to in-patient care, crisis intervention, case management and rehabilitation, disability support, health promotion, developmental programs and functions.' A draft report dated October 2004 entitled Report on the Improving the Provision of Prison Mental Health Services Across Queensland Project  stated that the service delivered to Queensland prisoners with mental health issues was substantially below best practice. The draft report identified a number of issues about the level of service including:
- Debate between Queensland Government departments as to who had responsibility to address the multiple issues for prisoners with mental health issues, particularly for prisoners on remand or incarcerated for short periods. This included the poor links into housing, services, support and reintegration into the community.
- Resources were primarily aimed at prisoners with major mental health disorders, and primarily consist of pharmacological treatment. Resources were not directed to prisoners who were not suffering from a mental health disorder that was not at a crisis stage. Therapy was not generally available or provided to prisoners with mental health disorders with the present level of resources.
- Due to the shortage of, or reluctance to admit prisoners to, in-patient beds within District Mental Health Services, inmates were being held in DU, CSU or in the care of other inmates for extended periods of time because they were acutely unwell and in-patient beds were not available. 'Current practices do not reflect the equivalence of treatment that underpins the principles of Forensic Mental Health in Queensland or nationally and may be in breach of human rights.'
- Access to drug treatment and rehabilitation programs was not generally available in prisons, however limited methadone and buprenorphine maintenance programs were in place at some sites.
- There were currently no mental health services available for people suffering personality disorders in Queensland correctional centres.
- Crisis counselling was available to prisoners to prevent suicide or self-harm but ongoing therapy or counselling to address the causes were not usually available.
- There were no customised programs for people with mental illness or programs and services specific to the needs of people with intellectual disability.
- The prison environment was harsh and can be unsafe for those with an intellectual disability or a mental illness, that 'intimidation is not uncommon and physical and sexual assault do occur.'
The draft report concludes that there is significant room for improvement in the provision of prison mental health services, and has made a range of recommendations that could be implemented without further funding. The draft report also identified that there are program gaps for which no government department is taking responsibility for the provision or funding of critical services. The draft report has made a number of recommendations to improve the mental health services to prisoners which the ADCQ endorses and supports. The draft report raises serious concerns that are consistent with matters that have come to the attention of the ADCQ. The ADCQ urges the government to act on those recommendations to ensure that the current level of inadequacy of mental health services provided to prisoners in Queensland does not continue.
In December 2005 the DCS advised the ADCQ that it made two major submissions to the 2005 Queensland Health Systems Review (known as the Forster Inquiry)  resulting in recommendations that:
- A review of current funding arrangements for mental health should occur with a view to improving mental health services for people in correctional and custodial settings.(7.16)
- Health care in correctional institutions be resourced adequately and Queensland Health and the DCS seek agreement on the best future delivery options (7.18)
The DCS states it is currently working with Queensland Health to implement the transfer of health care responsibility to Queensland Health. It states that as part of this process:
'an appropriate resourcing model is being identified which will include the provision of psychiatrists, allied health workers, tele-based psychiatric services for remote locations and greater through care with the use of non-government organisations.'
The DCS envisages'that this will improve the standard of care to prisoners with mental illness.'
The inadequacy of the existing prison mental health services in Queensland prisons was highlighted in the six month imprisonment of Cornelia Rau as an immigration detainee in the BWCC.
Findings of the Palmer Inquiry
(Findings of the Palmer Inquiry into the immigration detention of Cornelia Rau in relation to the BWCC)
The Palmer Inquiry is highly critical of the level of effectiveness and speed of the systems and clinical pathways in the BWCC in identifying and dealing with a prisoner or detainee with a major personality disorder or major mental illness. The Inquiry considered:
'it might be necessary, in the light of experience, to radically reorganise existing relationships, training and clinical pathways for the delivery of services in the Queensland mental health system. In particular, the Inquiry has in mind the need to advance preliminary observations of possible mental illness more speedily towards action for assessment and to look for practical ways in which clinical pathways will better ensure the continuity of care.' 
The ADCQ does not believe that failures of the prison mental health services and systems to provide the appropriate care are unique to the Cornelia Rau case. The case illustrates some of the problems with the provision of mental health services in Queensland prisons. Her detention in the DU on four occasions may also be an illustration of the inappropriate treatment of a person displaying symptoms of being mentally unwell. Prison staff with low-level training and skills in dealing with people with mental illness, often fail to recognise manifestations of mental disorder and respond with restraint or disciplinary action. 
Assessment and treatment of women prisoners
The ADCQ is of the view that procedures for detecting and treating mental illness in prisons for female prisoners are inadequate, and psychiatric services in female prisons do not adequately address the extent of need. This is particularly the case for female prisoners who have a high incidence of mental health issues compared to the general population and to male prisoners.
It is apparent that female prisoners experiencing mental health problems, but who have not been diagnosed with an acute psychiatric illness, rarely receive the level of treatment or rehabilitation they need. Those rehabilitation programs that are offered, do not adequately deal with female prisoners who also have a cognitive incapacity.
Female prisoners and Sisters Inside Inc have identified insufficient emphasis on counselling and therapeutic approaches to treatment of mental illness within the prison system. Given the background of trauma, abuse and deprivation experienced by many female prisoners, therapy could be a vital element of their treatment.
Further, women prisoners with personality disorders (DCS staff advised a significant proportion of female prisoners suffered from this condition) receive no assistance except for pharmacological interventions.
Given the large number of female prisoners with personality disorders and the difficulty and costliness of traditional treatments for this illness, the ADCQ recommends that DCS identify alternative and cost-effective ways of treating personality disorders.
It would appear that female prisoners with illnesses other than personality disorders, but who are perceived to be manipulative or thought to have a personality disorder, are not always being afforded the mental health assessment and treatment that is needed.
It is also clear that the forensic unit at John Oxley, Wolston Park, is overcrowded and not generally available for women prisoners with serious mental illness who may benefit from its services. There is a shortage of mental health beds in the Queensland health system generally for security patients. Because of the inadequate capacity or the reluctance of relevant authorities to admit and treat acutely ill patients, it appears that, on more than a few occasions, women prisoners with acute mental illness may be being inappropriately detained and receiving inadequate treatment in either the CSU, DU or health units of the women's prisons. Prison staff are not trained to deal with acute mental illness, and the prison environment is not an appropriate setting to treat women with serious mental health issues.
9.3.3 Training of prison officers
The ADCQ understands that in the nine week initial training for new corrective services officers, they briefly touch on mental health issues. There is no primary component about mental health in their training and no routine maintenance or further development of corrective officers on mental health issues. It has been reported:
'that staff in correctional centres express concern that behavioural problems, which would be recognised as manifestations of mental disorders by health professionals, are seen as recalcitrance by some corrective service officers, who respond with restraint and/or disciplinary action.' 
It is important that custodial staff are trained to recognise and respond appropriately to mental illness so that human rights abuses do not occur through misjudgement, ignorance or prejudice.
9.3.4 Post-release planning and service provision
For female prisoners with mental health issues who are released directly from prison into the community, without parole, there appears to be a lack of post-release planning, rehabilitation programs, and referral to community-based social services. Further, there does not appear to be any well developed mechanism to adequately follow up female prisoners with mental illness after release.
168. B A Hockings et al, See note 46, 43.
169. DCS, See note 36, 17.
170. 'Despairing judge jails serial railway-station menace' Courier Mail (Brisbane) 28 July 2005.
171. The NSW based Probation and Community Corrections Officers Association has recently made submissions about the value of community-based sentencing options for offenders with mental illness. 'Parole Officers want mentally ill prisoners released from jail' Australian (Sydney) 1 August 2005.
172. Pilot projects such as the Disability Law Project funded by Legal Aid in the Advocacy and Support Centre at Toowoomba (where a criminal lawyer has been employed specifically to represent people with mental illness and intellectual disability), need to be permanently resourced and expanded.
173. A. Chauvin, Draft Report on the Improving the Provision of Prison Mental Health Services Across Queensland Project, Community Forensic Mental Health Service, Brisbane , October 2004,p5 (unpublished report). The ADCQ has been advised by DCS that this draft report has not been released and there are no plans for its release.
175. Ibid 7.
176. Ibid, 29. An ex-prisoner spoken to by the ADCQ stated she was held initially in the DU for two weeks and then in the CSU in excess of six months whilst on remand.
177. Ibid, 13.
178. Ibid, 91.
179. Queensland Health Systems Review Final Report, (Forster Inquiry) September 2005.
180. DCS, Submission to Women in Prison Review (14 December 2005) 10.
181. Inquiry into the circumstances of the Immigration Detention of Cornelia Rau (Palmer Inquiry) (July 2005).
182. Ibid 129.
183. ADA s 11.
184. This was found to be the situation with Cornelia Rau in the Palmer Inquiry. See note 181 at 147.
185. A.Chauvin, See note 173, 7.