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Are prisoners getting the mental health care they deserve?

Medicine, Nursing, Occupational Therapy, Psychology

In light of the momentum given to the issue of mental health in the federal budget, and reports of a psychiatric patient being kept in prison because of a lack of appropriate high security mental health facilities, several health industry organisations have raised concerns about the state of mental health care of prisoners in Australia.

The Royal Australian & New Zealand College of Psychiatrists (RANZCP) and Occupational Therapy Australia gave insights to the state of mental health care in Victorian prisons while the Royal Australian College of Surgeons discussed proper procedure for prisoners refusing care.

RANZCP noticed the lack of support for inmates with mental incapability, detailing that prisoners are two to three times as likely as those in the general community to have a mental illness. Furthermore, they are 10 to 15 times more likely to have a psychotic disorder.

Considering this data, the RANZCP Victorian Branch Chair, Associate Professor Richard Newton, argued “those that do commit crimes while mentally ill deserve the right to be treated by an appropriate service”.

Professor Newton mentioned that the history of chronic underfunding of mental health in Victoria for instance has led to lack of appropriate facilities to treat people with mental illness especially those who have come into contact with the justice system.

To counter this problem, the organisation calls for more beds at forensic psychiatric hospitals and provision of appropriate services to forensic patients with intellectual disabilities or cognitive impairment, especially those who have been found unfit to stand trial but still end up in prison.

In support of advocating for the welfare of prisoners with mental care needs, Occupational Therapy Australia proposes enabling occupation with prisoners experiencing mental illness.

Ms Caitlin Bragg, a Melbourne based occupational therapist, acknowledged the efforts of 11 Victorian occupational therapists working with people under custodial services.

Ms Bragg said, “Each person experiences varying levels of engagement in meaningful occupation as a result of their mental and physical health, their offence and their prison location. Victoria currently has 11 occupational therapists working within prisons, which is substantially more than other prison services across Australia. These occupational therapists are working in a variety of complex settings to enrich the occupational opportunities available.”

Ms Bragg also highlighted the important work the current occupational practice is developing, working on what the tools, strategies and barriers are for enriching occupational opportunities for prisoners.

“This field of practice is expanding with the acknowledgment of prison services about the value occupational therapy can provide people in custody. Practice based evidence, data gathering and formalised research would strengthen and evidence current practice and contribute to the identity of the occupational therapy profession,” she stated.

The Royal Australasian College of Surgeons (RACS) touched on the issue of appropriate standard procedure for prisoners who refuse medical treatment in NSW.

Dr Shrenik Hegde, a Senior Resident in Surgery based at Westmead Hospital recognized the increase of prisoners with mental, cognitive, and multiple disabilities in NSW. During the Royal Australasian College of Surgeons’ Annual Scientific Congress in Sydney, he tackled this issue to enlighten medical professionals on what to do when prisoners opt out of treatment.

“There are a multitude of reasons why a patient may refuse medical treatment, regardless of whether they are a prisoner or otherwise.

“This may include a range of language communication barriers, the physical illness itself (which may temporarily impact upon judgement and capacity to make informed decisions), and particularly psychiatric disorders.” Dr Hedge explained.

To develop a set of guidelines that will simplify the process for medical practitioners, Dr Hedge consulted senior legal sources. He clarified that in NSW if a prisoner is brought to a hospital the standard policy for obtaining consent applies and with the right to refusal being applicable only for competent patients.

“During my process of investigation, I found useful avenues of information which assist medical practitioners who find themselves with similar uncertainties. Practitioners may contact their own medical indemnity insurer and in particular, their relevant appointed solicitor who can provide expedient clarity on a range of medico-legal queries,” added Dr Hegde.

Photo by Carles Rabada on Unsplash

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