Human Rights and Prisons - Rethinking Crime and Punishment

Applications for the compulsory assessment or treatment of prisoners, or their
hospital detention, must meet the requirements of the Mental Health
(Compulsory Assessment and Treatment) Act 1992. The Mental Health Act
1992 notes that it is an offence for a person concerned with the care,
oversight and control of mentally disordered people to neglect or ill-treat them.
Responsibility for mental health provisions are split between the Department
of Corrections (for primary care) and District Health Boards (for specialist care
through Regional Forensic Services). The Ministry of Health guides strategic
direction.
Issues
Recently, good-practice initiatives have included the opening of a 13-bed „At
Risk Unit‟ at Hawkes Bay Prison in 2008. This Unit is staffed by on-site
registered nurses with mental health training as well as a forensic nurse from
Hastings DHB. Prisoners can also access a psychiatrist on a weekly basis.
This Unit, like others, is a useful tool for short-term stays.
In addition, it is clear that certain practices – such as the use of Forensic
Mental Health Services (FMHS) to work with those with serious mental illness
– provide very good service delivery. As Simpson et al (2006) have identified,
these services are costly but offer very good outcomes in terms of lowering
offending rates. Their study, of 105 patients (many of whom had psychotic
disorders and a history of violent offending), demonstrated that at the end of
the study, half were in independent living and half were in employment. Only
five were reimprisoned. This illustrates that committed mental health services
can produce high level outcomes. This is something that is not evidenced in
other forms of care.
Despite these advances, there remain a range of concerns about provision for
those with mental illness within the prisons:
Capacity – Over recent years, forensic services have been operating at
full capacity (and beyond). Still, many prisoners do not receive the
treatment they need in a timely manner and prisoners who require
urgent treatment for mental illness often have to remain in prison and
wait for an available bed. This puts pressure on prison services, that
are already stretched through prisoner numbers, to look after disturbed
individuals (Brinded et al, 2001; Fennell, 2006; Office of the Auditor-
General, 2008; Simpson et al, 2006). The Office of the Auditor-General
(2008) detailed the situation of 59 prisoners on the Auckland prison
waiting list (between July 2006-June 2007). Of the 59 prisoners, 34
waited ten days or less, 10 for 41-80 days, 15 waited longer than 80
days, and 10 prisoners waited more than 100 days for treatment.
Limited funding for Primary or Preventive Care – There are few
services for prisoners with mild to moderate mental health illness.
More basic treatment options, such as counselling or therapeutic
treatment, are not available (Office of the Auditor-General, 2008). The
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