‘Significant shortfalls’ in prison crisis care
A report by the WA prison inspector has shone a light on the failing mental health care in the state’s jails, with ‘significant shortfalls’ in staffing and infrastructure.
The Western Australian prisons watchdog has called for a range of issues relating to mental health and crisis care to be fixed as a matter of urgency.
A report by WA Inspector of Custodial Services Eamon Ryan on people in custody requiring crisis care was tabled this week, and paints a dire picture of the level of care offered to those in crisis within the state’s prison.
It reveals a system buckling under significant strain and without adequate resourcing or infrastructure to properly care for the people who need it the most.
Instead, those with several mental health conditions in prison are placed in “cold and sterile” units for extended periods of time, sometimes with several other people also in crisis, with little health and therapeutic professional support on offer.
The Inspector also found that the number of mental health nurses in WA prisons would have to nearly triple in order to meet an international standard ensuring equivalent care in places of detention.
Ryan called for immediate actions for the issues in the report to be addressed.
“With the soaring adult prison population, which stands at just over 8400, the extraordinary demands on mental health staff and crisis care infrastructure are only likely to increase rather than diminish,” Ryan said.
“Data shows there is a significant shortfall in meeting the needs of even the most acutely unwell prisoners.”
“There is an imperative to address these issues and concerns as a matter of urgency.”
‘Bleak’ conditions
When it comes to staff and environment, the inspector found that the WA system fails on both counts.
The inquiry focused on the seven crisis care units within the state’s prisons, which it found to be “largely cold sterile” and previously described as “untherapeutic and not compatible with community standards”.
Those spending time in these units described the experience as “bleak”, and sometimes left in a worse condition than when they entered.
“We found the experience of prisoners in crisis care was one of isolation and loneliness and likely exacerbated, rather than improved, mental health outcomes,” the report said.
“Crisis care units across Western Australian prisons are in need of considerable investment to keep pace with the rapidly increasing prison population and increasingly complex prisoner cohort.”
There are also “critical shortages” of mental health nurses, counsellors and psychiatrists in these prisons, the inspector found, meaning treatment is nearly entirely focused on the prevention of self-harm or suicide, rather than therapeutic clinical intervention.
“Most, if not all, the prisoners sent to crisis care units are suffering a serious mental health crisis requiring ongoing clinical intervention,” the report said.
“They are no less worthy of appropriate specialist care than someone suffering a serious general health issue, such as a broken bone or heart complaint.
“The difference is the former are sent to a cold sterile untherapeutic environment where the focus is on prevention of self-harm or suicide, whereas the latter would be placed in an ambulance, taken to a hospital, assessed by medical staff and, if required, admitted for treatment.
“It begs the question as to why treatment of mental health is somehow seen in a different light to general health.”
Staffing shortages
As of April last year there were 37.5 full-time equivalent (FTE) mental health nurses across the WA prison system, a figure the inspector said was “inadequate”. The Sainsbury Centre for Mental Health in the UK sets a benchmark of 11 FTE mental health nurses per 550 prisoners in order to provide equivalent care.
This means the number of mental health nurses in WA prisons would have to increase from 37 to 98 to meet this benchmark.
The inspector also found that while there is funding for three psychiatrists, there was less than one FTE psychiatrist across the entire prison system at the time of the inquiry.
The crisis care units are designed to be short-term accommodation sites, but with a lack of beds at the state’s only secure forensic hospital, some people are staying in the units for extended periods of time.
Eighteen people spent more than 100 days in a crisis care unit, while three people spent more than a year.
Previous reports have found that 40% of all people entering a prison in Australia have a mental health condition, and just under a quarter are on psychiatric medication.
The NSW prison inspector has also scrutinised the level of mental health care in NSW prisons.
In reports released last year, it found there was an average of six self-harm incidents per month at the Bathurst prison, while just under 250 inmates had a recorded history of mental illness, representing nearly a third of its capacity of 780 people.
It also found that the Mid North Coast Correctional Centre has one full-time and one part-time mental health nurse, with more than 230 people on the waitlist to see a mental health nurse, nearly a quarter of its capacity.
If you need help in a crisis, call Lifeline on 13 11 14.