Mental Health and the prison system: a policy concern

Mental health care is a significant policy challenge facing our prison systems in Australia. According to the Australian Institute of Health and Welfare, 1 in 3 people entering prison have a diagnosed mental illness; almost 2.5 times the rate of the general population. There is growing concern that people with an untreated mental illness are more likely to be imprisoned due to a lack of community-based care. There is also concern about the lack of quality of mental health care in prisons, and its implications for those making the transition back into the community. In this article, Stephen Hall, Leader Mission and Service, Baptistcare WA, outlines the need for better mental health services for the prison population. While the focus is on Western Australia, the issues raised here will resonate nationally, and internationally.  

This article originally appeared on Stephen Hall's professional blog. 

We need better mental health services in our prisons.

While diversionary courts for people suffering from mental illness have been established, there has been no progress in the provision of mental health services for the WA prison population.  We just don’t seem to care that we have moved treatment of serious mental illness into prisons. Instead of providing treatment and care, we are content as a society to spend more imprisoning people with a serious mental illness, and restricting prisoners’ access to treatment.

Just because a person is in prison, their access to adequate mental health services and support should not be denied.  These services may also prepare prisoners for life outside of prison after release.

Mental health care and/or psychiatric treatment should be at an equivalent level to that available to the general public.

Four years ago, in a report into health services in the WA prison system, it was noted that:

"The mental health care available in WA prisons is inadequate or unsuitable.  The United Nations Minimum Standard Rules for the Treatment of Prisoners (1990) is an international standard of prisoner treatment; these requirements reflect the fact that imprisonment is the loss of freedom, not a punishment of maltreatment or poor health."

Mental health services in Western Australia’s prisons do not meet the United Nations Minimum Standard Rules for the Treatment of Prisoners. Many imprisoned offenders have addictions and mental health issues that remain un-addressed. Prisoners facing these issues are denied appropriate support while incarcerated and do not receive continuity of care upon release, increasing the chance of recidivism.

Speaking at the WA Rural and Remote Health Conference in Northam last September, Chief Justice Wayne Martin said that people in society with a mental illness who should be diverted to treatment were instead being committed to prisons. Martin said:  “There are real limits on what the criminal justice system can and should do in relation to people who are mentally unwell or intellectually disabled.”

A key WA Government policy document in the planning and delivery of Mental Health has made the following points:

• Around 74% of people in prisons have some form of mental health problem, many undiagnosed
• There are currently insufficient mental health services available for prisoners
• There are too many prisoners who have been deemed incapable of pleading who remain imprisoned.

The report adds:

“Experience from other parts of Australia and internationally demonstrates that a comprehensive and linked response to people with mental health problems and/or mental illness involved in the criminal justice system is required...There are no clear entry criteria for patients, no clear clinical protocols for patient assessment or management for either mental health or addictions and no established competencies for the staff of the program. Previous clinical assessment and treatment pathways for addiction services need to be urgently reviewed and updated. There does not seem to be a consistent approach to patients with addictions or mental illness across the Service.”

While prisoners may be screened for mental illnesses upon arrival, we also need regular screening that identifies those who develop mental illness while incarcerated. Prison has a disturbing culture that is marked by intimidation and violence. Living in this environment promotes the development of mental illness; this increases the likelihood of a difficult reintegration and possible recidivism when released from custody.

The care of those who are mentally ill weighs heavily on a prison system that lacks both the resources and expertise to deal with the responsibility.  There is ultimately a price to pay for this.  People with mental illness should be treated in a humane, least-restraining environment. We’re collectively spending millions of dollars every year imprisoning people, rather than supporting them in the healthcare system — where they belong. Not only do they deserve a health care response, they would receive treatment and care at a fraction of the cost of what it costs to incarcerate someone.

Today, sadly, Western Australia is failing its citizens in providing the minimum standard of care that all of our citizens deserve.

Posted by Pauline McLoughlin