Community Healthcare / Correctional Healthcare / Health & Healthcare

Solving the Mental Health Crisis in Australian Correctional Facilities

PrisonerThe 6th annual Correctional Services Healthcare Summit will be held on the 24th – 25th of August at the Rendezvous Grand
Hotel in Melbourne and will deal with a large range of issues surrounding healthcare in a correctional setting, including prisoner mental health, rehabilitation and models of care.

Jim Coombs is a retired magistrate, former barrister and economist, and will be presenting at the event. Concerned with how mental illness is treated in correctional facilities in his experience as a magistrate and from an economic point of view, Jim spoke with us about his proposal to solve the mental health crisis in Australian prisons.

Can you go into detail about your proposal?

The basic model that I am proposing is one that operates like a British bail hostel. It is a required overnight residence where, if medication is the treatment the medication would be applied and applied compulsorily. It would require giving the courts or a tribunal the power to make the person comply so that it’s an alternative to imprisonment, but which has fairly strict controls built into it. The advantage of that is that even though it would require the establishment of these institutions, they would be much cheaper to run than jails which typically cost more than $100,000 a year per inmate.

This is a proposal for a change of policy, which means there must be institutional change. We have to be reasonable and get the best possible result for the money that’s being expended, and the money being spent on corrections is monumentally large and a great drain on the resources of the state. The advantage of the scheme I’m proposing is that it actually provides treatment for people who need it at a price that is a lot lower than keeping them locked up without treatment. The way in which that occurs would depend on the nature of the client and the nature of the mental illness.

In regards to the current model, how many inmates are able to get the treatment they need compared to your system?

I have come to this from the point of view of a magistrate faced with somebody who has committed some offence that would otherwise warrant jail, and look at whether or not a mental illness is a sufficient reason to deal with them differently.

At the moment in NSW the Department of Corrections has a hospital for mental health at Long Bay, which at most can house 300 people. If the estimates by the NSW Bureau of Crime Statistics are right in excess of 2000 and possibly as much as 6000-7000 of the prison population of about 11,000 have a mental illness that needs treatment. 300 beds in one prison hardly gets anywhere with the problem. If you get people treated and their mental illness is a substantial cause of their offending behaviour, they don’t re-offend.

The present legal situation allows magistrates to discharge people, even when the facts are proven, on the basis that they will not offend if they are under psychiatric treatment under section 32 of the NSW Act. It’s done increasingly often, but it requires the agreement of a private practitioner to undertake and to guarantee the treatment will be complied with. That’s a heavy burden to place on a practitioner when it may simply not be feasible. “Involuntary patients” who have been detained on a schedule  appearing before the Mental Health Review Tribunal, come out of those hearings very often with what’s called a community treatment order which has legal force, but the institutional backup for it is simply not sufficient. Most of these patients would be lucky to see a treating professional every two weeks, and as most psychiatrists will tell you, somebody who has a psychotic episode or who has one of those mental disorders, they can become out of control within a couple of days just by not taking medication.

What is needed is something that can, to some extent, guarantee that where somebody needs to be medicated that they are, and that they are under at least daily supervision even if they go to work or spend their days out in the community.

What would be the best way to implement this? What would be the best way to get the State Government to invest?

This model is less expensive than operating jails that don’t treat people. The cost of having someone in jail is $100,000 a year. What is needed is something that actually provides treatment and actually provides some fairly direct supervision, and it would save a huge amount of money. You could close at least two or three jails, and maybe more if there were more people under such a regime. How do you get politicians to do it? You just keep banging away, and that’s what I’ve been doing for the past 5 years.

Jim will be speaking in further detail about his proposal at the 6th Annual Correctional Services Healthcare Summit. For more information, including the current agenda, please head to our website.

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