Tuesday, December 7, 2004

Isolation, psychiatric treatment and prisoner' control

The 2003 NSW Corrections Health Service (now Justice Health) Report on Mental Illness Among NSW Prisoners states that the 12 month prevalence of any psychiatric disorder in prison is 74%, compared to 22% in the general community, and while this includes substance disorder the high rate cannot be attributed to that alone.

Incidentally "Justice Health" may seem more 'just' that's why they changed their name "common government ploy" because they were not "correct" and even worse than hospitals outside the prison- about 10 times worse.

So they weren't correct and they're certainly not just. The twelve-month prevalence of psychosis in NSW inmates was thirty times higher than in the Australian community. The most common disorder was an anxiety disorder with the most common anxiety disorder being Post Traumatic (which can be very severe and disabling and indicates the horrors that many prisoners have experienced prior to and in jail).

One in twenty prisoners had attempted suicide in the twelve months prior to interview. This study only touches the surface of evaluation and statistics of the nitty-gritty of what's going on - it excluded many people, including those "too unwell" to be interviewed. It also reflects the attitude of the professional, but considering that we regard 'labelling' to be covered by the term 'psychiatric disability' we consider the report of great use.

This outrageously disproportionate situation arises from both prison conditions and the discriminatory nature of the "criminal justice system".

Injectable antipsychotics in prisons

This response was received from Justice Health Re: Anti-psychotic medication.

I write in response to your request for information dated 16th November 2004 regarding long acting depot anti-psychotics prison preparations.

There are certain clinical circumstances where certain anti-psychotics are required in the care of forensic patients. Their use is governed by the Mental Health Act and overseen by the Mental Health Review Tribunal.

In the case of patients discharged to the community under community treatment orders, the Mental Health Review Tribunal plays a similar role.

Justice Health aims to use the lowest possible dose and to minimise side effects on patients in all circumstances. There are quite a few preparations on the market and the dosage range ofthese preparations is outlined in MIMS.

It would be 'uncommon' for Justice Health psychiatrists to exceed recommended dosage ranges without careful clinical consideration and peer review.

Many of our patients are now being placed on newer atypical anti-psychotic depot preparations like Risperdoi, Consta and hopefully use of this medication and the new generation of depot anti-psychotics will in the future minimise even further side effects and discomfort for patients.

It is very uncommon for force to be required to administer these medications. In an acute phase of illness where patients are very unwell and not able to cooperate injectable medications might be utilised but these tend to be short acting agents rather than depot preparations.

Generally depot preparations are only used in the maintenance phase of illness by which time the majority of patients are accepting of the requirement to take this medication. I hope this information is helpful to you.

Yours sincerely
Dr Richard Matthews
Chief Executive Officer
26 November 2004

Justice Action has received many complaints about the use of injectable anti-psychotics used in the NSW prisons and mental health facilities.

We express concern that "Corrections Health" now "Justice Health" psychiatrists can prescribe over the recommended dose, without clinical &/or peer review?

[Regarding forensic prisoners, we have received written confirmation from Justice Health that not just short acting but also depot anti-psychotics can be and are administered using force, and that recommended dosages can be and are exceeded (which may occur without careful clinical consideration and peer review).

This is a great concern, regardless of the frequency of such events, as we have been informed prior of a Death in Custody case, where a prisoner suffered Neuroleptic Malignant Syndrome, and according to staff died in a terrible manner following large doses of anti-psychotics.]

So prisoners can, and have died as a result of injectable anti-psychotics, and that this is a worry regarding Deaths in Custody, as well as being an extremely harrowing experience to undergo if it doesn't kill you.

'A'typical anti-psychotics have their own problems, and over medication does not disappear just because an older drug is not used.

An example is the increased risk of diabetes, or effects on heart function, and many prisoners are already at risk of such diseases, due to conditions inside and also to conditions outside relating to discrimination and deprivation (eg Indigenous people).

What is being done about these effects on prisoners'? Are prisoners' given information about these effects? What danger signals should they watch out for? Can they report to Justice Health staff if they experience it?

Prisoners' have complained to Justice Action many times that injectable anti-psychotics are used as a non-medical tool, eg as punishment for disagreeing with a Correctional Officer, or as a convenience, and that these uses are in breach of International Rights Instruments.

How does the process of Correctional reporting to Health staff work? And what do they think they can do to improve the situation?

What are the procedural details on how Corrections information fits into a decision of forensic status? Why are prisoners' complaints showing us they are not receiving adequate information about the process and what medications are being administered to them?

Prisoners have a right to know these things and ask what is going wrong. Prisoners should be offered copies of their medical records and provided with them if they want them.

We question the "very uncommon" statement regarding use of force - and need statistics from Justice Health. Justice Action receives a fair number of incident complaints, and the difference doesn't make sense.

Why are short acting anti-psychotics used with force anyway? Why can't the use of force for depots be banned? We argue prisoner's consent should be sought and the prisoner should be worked with rather than against.

Prisoners should be allowed to work out plans for what actions to take in case of loss of capacity and to communicate and discuss this with Health staff.

A Correctional environment should not prevent that, nor should it obstruct the carrying out of such a plan. This is a right and it is reasonable.

These provisions should allow prisoners to access a psychiatrist in an emergency, eg to express concern that they are deteriorating and to give input into their treatment so as to prevent the use of force or high doses.

Prisoners housed at the HRMU High Risk Management Unit or in other segregation units at all jails end up with mental illness.

The transfer of Juveniles to the Department of Corrective Services from Kariong and the use of isolation were reported to be one way of preventing hostility at the centre? But prisoners who are isolated for prolonged periods end up with mental illness. They can self-harm or even commit suicide.

Furthermore, it can easily be predicted that those placed in isolation will suffer mental illness. These are not necessarily forensic patients but they end up being mentally ill and treated like they're forensic patients - after prolonged periods of isolation?

So you take those prisoners you don't like that cause all the trouble and give them a mental illness as a way to change their offending behaviour. Brilliant?

After a prolonged period of isolation you take them to the long bay prison hospital and they're forced onto medication for the rest of their life, as a way of control. Under the heading prisoners programs this must rate as a complete failure in terms of solving problems, like lack of education, social skills or life skills.

By Gregory Kable and Just Us 7 December 04


Call for royal commission into NSW prison health system
Mr Tony Ross a social justice activist said yesterday that a royal commission into the health system in NSW should be wide reaching to ensure that the Corrections Health Service is also exposed because of reported widespread cover ups in the prisons health system.

Doctor Ron Woodham I presume?
"Corrections Health staff provide medical care. However, its staff's authority is essentially limited to making recommendations to corrective services on treatment. Corrective services staff can then decide what treatment can be given."

Carr's Castle the real story H.R.M.U.The High Risk Management Unit Goulburn Correctional Centre. A prisoner writes, " I was unsuccessful in my letters to Dr Matthews CEO of the Corrections Health Service on my problem regarding air - claustrophobic effect the cells have on me. Just recently the management decided my injuries are not seriously affecting me so no further discussions are necessary.

We the prisoners at the High Risk Management Unit at Goulburn Correctional Centre would like to ask you for help in receiving equal treatment and opportunities as other prisoners throughout the system. As we are told that we are not in a segregation unit but we are treated as though we are in one.

On the treatment of prisoners at the NSW HRMU
Prisoners sister's letter from her brother: Following our phone conversation some weeks ago I would like to set out a few points on the treatment of prisoners in the High Risk Management Unit at Goulburn (Super Max) (Guantanamo Bay).

Review of Justice Ministers claims about conditions at HRMU
There is no fresh air in our cells only Air conditioning pumped out of an 8 x 8-centimetre vent over our beds. Conditions change with filthy moods of the prison guards. Induction clothing "one set" mostly shorts and a prisoner remains there for two weeks depending whatever suits the staff. If a prisoner shuts up about the abuse, and freezing conditions (Goulburn cold in winter hot in summer taking into account you're housed in concrete) then you may go to units 8 or 9.

Watchdogs slaughtered in NSW
On Tuesday the Carr Government reduced transparency and accountability yet again and New South Wales is in danger of becoming entrenched with cronyism and intimidations with the Carr Labor Government that continues to slaughter the watchdogs.

Conditions in the HRMU
Justice Action is trying to obtain documents on behalf of prisoners held in the Goulburn High Risk Management Unit (HRMU) from the Federal Attorney General's Department, Corrective Services Minister's Conference regarding the process described below, in which the Standard Guidelines for Corrections in Australia were adopted. This documentation will help explain the justification for the conditions in the HRMU.

Death in custody: In memory of Scott Simpson
Scott Simpson 34 died in custody on 7 June 2004 leaving behind a child. It is alleged that he hanged himself in a segregation yard at Long Bay Prison Complex. Justice Action has reasons to believe that Scott had been mistreated from the time he was taken into custody and the subsequent events that ensued that led to his sad death. We think that his treatment may well have caused his death.

Justice Denied In NSW Corrective Services
There used to be a (VJ) or Visiting Justice who would go into the prison and judge any claim or accusation that was made by any prisoner or prison guard. If it were found that a prisoner had offended then punishment was metered out.

Escape proof but not so the prisoners mind
Fewer prisoners escape from prison these days because they're "cemented in" by materials that do not break and by legislation that can keep prisoners in jail until they die.