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Prisons guilty of lack of mental illness support: study

Health professionals looking after prisoners with a mental illness lack the required skills, knowledge and resources, new research has found.

Under-resourced, undertrained and overburdened. This is the current situation of Western Australian health professionals and correctional staff looking after male prisoners with mental illnesses, research has shown.

And as a result, this group of inmates, which is increasingly being over-represented, are not receiving appropriate care.

More than 65 per cent of staff who participated in the study by Curtin PhD student Kate Hancock, said they had not received any, or enough, training managing mental illnesses.

For the study, Hancock interviewed and surveyed 184 health professionals, correctional staff and prisoner patients in 2006 and 2007 at eight West Australian prisons, including metropolitan and regional sites.

A number of problems were raised, including lack of support for staff, not enough appropriately trained staff and the struggle to find a balance between security and therapy, and the subsequent conflict this can cause with the guards.

“Health professionals in prison suffer from a systematic lack of recognition, support and leadership from both the health and justice spectrums and report they are merely crisis managing prisoners,” Hancock said.

“Over a third of the staff sampled say they are coping day to day, and the majority of staff report they are doing the best they can with the facilities and knowledge they have.”

Staff reported a “total lack of direction and leadership from health services” and that the prison administration attitude is “manage as best as you can with no support.”

They also expressed an urgent need for additional specialist mental health staff, particularly in regional prisons, and that these staff should be permanent employees of the Department rather than contracted agency staff.

In particular, extra nurses were needed, with more than 75 per cent of staff saying there were not enough mental health nurses to adequately deal with the numbers of mental health clients.

“We need more mental health nurses and occupational therapists would be good. I am aware when I say this it is like a wish list but to be honest it is imperative,” one staff member said.

“There is a whole mix of things; mainly we need really need more trained and dedicated mental health nurses. It is important to be spending time with people to be able to treat them,” said another.

Health professionals stated that training opportunities were limited in the prisons they worked in and they would like access to additional training and professional development.

“No one has any training other than the nurses and they are not trained mental health nurses,” a staff member said.

Lack of training was also seen as an issue by prisoner patients, with 80 per cent saying all prison staff needed more training in mental health. More than 60 per cent believed only trained medical staff should be able to work with prisoners who had a mental illness.

Prisoner patients also expressed concerns regarding their limited access to medical staff. Participants spoke of insufficient levels of nursing and clinical staff, stating that the numbers affect the level and quality of care they were provided.

“They need more staff to help us out. There are not enough and it means we do not get the proper care,” said one.

On the positive side of the prison work experience almost three-quarters of the staff participants reported that they are part of a great team who work well together to achieve positive outcomes, Hancock said.

“Moreover, prisoner patients in the sample reported that prison can be a helping hand providing them with access to some mental health services.”

But Hancock said the findings also demonstrated the complexity and frightening situation experienced by prisoner patients living in prisons, not only coping with a mental illness, but with people who generally did not understand them and with limited services to adequately address their needs.

More than half of the prisoners reported they were treated differently by other inmates because of their mental illness with many taunted and discouraged from taking their medication.

“There was a general sentiment that individuals with mental health issues are vulnerable and isolated in the prison system,” Hancock said.

Prisoners said that knowledge of mental illness was important if other people were to empathise with them and that at present there was a lack of education provided to staff, themselves and other prisoners.

“Most prisoners have no idea of what I am going through and what is wrong with me, they just think I am kooky. There should be pamphlets and information available in the medical centre and mental health education for staff and prisoners so people understand better,” a prisoner patient said.

The study found a very real perception by prison staff that the number of prisoners with a mental illness was increasing, with the rise attributed to deinstitutionalisation, overburdened community mental health services, and illegal drug use.

Hancock said there was a need for increased mental health services, particularly in regional prisons as well as improved training and professional development for staff.

“There is a need to develop multifaceted and team approached services that are personalised to the individual needs of the mentally ill,” she said.

“Prisons provide a captive audience and an opportunity to work with the mentally ill who unfortunately come into contact with the justice system,” she said.

“There is a need to develop a correctional approach to health and mental healthcare delivery because the present model is ineffective.

“Hopefully this is something the outcomes of the Western Australian Mental Health Commission will be able to address.”

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