Mental Health Treatment and Services in NZ Prisons are Inadequate

Regardless of a person’s offending, all New Zealand prisoners deserve adequate mental health services as means of rehabilitation. Ideally these services would provide support to prisoners and equip them with the tools they need to cope with prison life. Most importantly, treatment would prepare prisoners for release, enabling adaptation to life outside of prison and reducing our high recidivism rates. 

The available Department of Corrections mental health services in New Zealand prisons are insufficient, falling short of the United Nations Minimum Standard Rule for the Treatment of Prisoners (1990).

Safety while in government custody should be guaranteed. Ensuring prisoners receive suitable treatment would reduce the likelihood of harm to prisoners, whether it be to themselves or others. The nature of imprisonment limits prisoners’ ability to promote and care for their own health. As appropriate medical care is a basic human right, the Department of Corrections has a constitutional responsibility to provide it.

Section 75 of the Corrections Act 2004 states that:

-A prisoner is entitled to receive medical treatment that is reasonably necessary

-The standard of healthcare that is available to prisoners must be reasonably equivalent to the standard of healthcare available to the general public

-In addition to medical treatment, Article 22 also requires psychiatric treatment to be of an equivalent level to that available to the general public

This is in accordance to the United Nations Minimum Standard Rules for the Treatment of Prisoners (1990).  As 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. In 2011, the Ombudsman’s report on mental health services available to prisoners concluded that the Department of Corrections’ standard does not meet the United Nations Minimum Standard Rules for the Treatment of Prisoners. The report also found prison healthcare to be reactive rather than proactive and established that mental healthcare available in New Zealand prisons to be inadequate or unsuitable.

Many offenders are imprisoned recurrently with health issues that remain unaddressed. Issues such as addiction and mental health conditions continue to motivate the same offending behaviour. Prisoners facing these issues are denied appropriate support while incarcerated and do not receive continuity of care upon release, increasing the chance of recidivism.

The prison suicide rate is eleven times higher than that of the general public, which can be attributed to the high number of prisoners suffering from mental health disorders which can go mistreated or undiagnosed.

The 2010 “Health in Justice” report conducted by the National Health Commission found that

-89% of prisoners have suffered from substance abuse sometime in their lives;

-60% of prisoners have a personality disorder;

-54% of women have experienced severe head injury, and 67% for men;

-52% experience anxiety and psychotic mood disorders;

-20% stated they had been thinking a lot about committing suicide.

As the prison population is three times more likely to require mental health services than the general public, expectations that these services are of sufficient quality and easily accessible are warranted. In 2008, the Auditor-General conducted a report into the quality of mental health services provided by the Department of Corrections.

Notable limitations in the service included:

–       Timely access of services to prisoners;

–       In-patient services for women;

–       Services for those with mild to moderate illnesses;

–       Services targeted at prisoners with personality disorders;

–       And service receptiveness to Māori.

The Auditor-General also noted that prisoners are screened for mental illnesses upon arrival; however, frequent screening identifying those who develop mental illness while incarcerated is non-existent. Prison is a distressing social environment unlike what most New Zealanders experience: a culture marked by intimidation, assault and sexual violence. Living in this environment would undoubtedly promote the development of mental illness which would go untreated when released from custody, increasing the likelihood of a difficult and complicated reintegration and possible recidivism.

The Department of Corrections does not provide therapeutic services such as counselling to those with mild to moderate mental health conditions as it retains the view that they have a custodial role, not a therapeutic one, and it is not its responsibility. However, the Department holds a rehabilitative obligation and therapeutic services to resolve mental health issues is an obvious means to assist in this. Prisoners with acute mental illness are transferred to an in-patient service or a hospital. Fifty-eight per cent of prisoners are treated within 40 days, which the Auditor-General stated was of moderate concern. Although those with severe issues eventually received the necessary treatment (this report noted 10 prisoners waiting over 100 days), prisoners with mild to moderate illnesses are left to languish and it seems to receive mental health treatment in prison, you must be intensely ill.

At-risk units exist for those likely to seriously injure themselves or others. Prisoners are housed in isolation cells and constantly observed to prevent self-harm. The maximum stay is intended for up to a week; however, in the Health in Justice (2010) report it was discovered that some people had been kept in them for months. Prisoners in at-risk units are not allowed footwear and are clothed in a single rectangle of fabric with the intention of minimising the ability to commit suicide. The cells are small and bare, consisting of a fixed bed and toilet, sometimes a concrete bed or mattress and a plastic container as a toilet. Light and noise is constant, and access to the outside world is prohibited, leaving them with no fresh air and no human contact.

This limited psychiatric and medical treatment and mishandling of seriously ill prisoners was apparent in the management of Antonie Dixon in his final days. Dixon was held in an at-risk cell in Auckland’s Paremoremo prison before his suicide in February 2009, instead of being transferred to a specialised acute mental health unit. Since his death, it has been found that he was illegally restrained two days beforehand for 31 hours. Leading to this, Dixon had ripped up his gown and attempted to commit suicide to which no notes were taken. As Dixon was committing suicide, officers waited 7 minutes until four were present to open the door to Dixon’s cell and attempt to resuscitate him. These officers were unaware that an exception existed in their manual. Dixon suffered from infections in his hands due to the restraints and dehydration through lack of water and was in a seriously delirious and psychotic mental state. No mental health services were called and Dixon’s Waitemata District Health psychiatrist made the decision not to transfer him to a mental health unit.  In the recently released report on his death, Coroner Gary Evans concluded that Dixon would still be alive had he been transferred to a mental health unit.

The Department of Corrections failed in their duty of care, failing to uphold the standards of the Corrections Act 2004 and the United Nations Minimum Standard Rules for the Treatment of Prisoners (1990). Due to Dixon’s profile and the crimes he committed, it is unlikely Corrections will be held responsible for his death, however changes must be made to prevent harm to future inmates. Being sentenced to prison is a loss of freedom and should not result in physical and mental harm, poor health or death. Current mental health services provided by the Department of Corrections do not guarantee this. As each prisoner costs $91,000 yearly to accommodate, their temporary incarceration should be rehabilitative, ensuring they have the means to reintegrate into society with support to reduce the risk of re-offending.

 

Article by Holly Mortimore (JS Intern) on 29 August 2013 
http://hollymortimore.wordpress.com/