Inquest into the death in custody of Scott Simpson

On the first day of the inquest into the death of a prisoner Scott Simpson, then 36, who was found hanging in his segregation cell [solitary confinement cell] at Long Bay jail in 12-wing area 2, at approximately 8.45 pm on 7 June 2004, the court heard evidence that there was a bureaucratic problem that may have led to his death.

But his family has said that he didn't deserve to die behind bars.

Penrith police had originally charged Scott Simpson with malicious damage after striking a car windscreen with a baseball bat during a domestic dispute in March 2002, which landed him in custody.

He was sent to the Silverwater Remand Centre to await trial on the malicious damage charge.

On the first day that Scott arrived at Silverwater Remand Centre he was supposed to be assessed in relation to his medical condition. He was subsequently placed in a cell on his own, in the main prison.

But about an hour later a child sex offender X, who was on protection from the main prisoners who was brought up from Junee prison, was placed in the same cell with Scott.

In the morning the prisoner on protection was found dead in the cell.

Scott was subsequently charged with murder of X and sent to the High Risk Management Unit (HRMU) at Goulburn Correctional Centre.

The HRMU is a box within a box with no fresh air or sunlight used for the treatment of the worst of the worst offenders in the prison system, including some prison scapegoats alleged to be gang members and those that buck the system. The HRMU is also now used for suspected terrorist scapegoats dragged off the street by ASIO.

Shortly after Scott was sent to the HRMU the brother of the alleged sex offender, that Scott Simpson killed Mr Y, who was also in prison at Junee jail and also a sex offender, contacted Justice action with grave fears that, "he thought he was going to be next."

"My brother was sent to his death and placed into the main," he said.

"Am I going to be next? Will they do that to me?"

He was quite fearful that his brother might have been set up by the authorities and sent to his death. [My understanding is that is in fact the case.]

He asked Justice Action how he could avoid this danger? Justice Action reminded him that reporting it was the first step and that we would make some enquiries, which we did. But as usual when making enquires with the Department of Corrective Services we didn't get very far. But at least we could keep an eye on his case if there were any more problems.

Shinning a light by asking questions can prevent some abuse by authorities.

Justice Action also received numerous letters during that time from Scott during his 26-month lockdown.

"Mum, I'm freezing and starving," he said.

He told JA that he was being hit with microwaves and that ASIO was behind it.

He sounded acutely paranoid about his situation and it appeared that he was not getting any help. It also appeared that his psychiatric illness was being exacerbated by his segregation [solitary confinement] and it is our understanding that segregation causes mental illness.

JA followed his case and found the psychiatric report that was also available to the Department of Corrective Services, suggesting that they were well aware of his mental condition as a psychiatric report was obtained by the Serious Offenders Review Council for assessment.

The psychiatric report dated 7 January 2003, claimed that, " For the past 13 months or more Mr Simpson has been suffering from an acute psychotic major psychiatric illness."

Edited Conclusion:

Mr. Simpson is suffering from a mental illness as defined in the New South Wales Mental Health Act and requires treatment in a psychiatric hospital. He suffers from a psychotic disorder, which involves systematised paranoid delusions. He also has auditory hallucinations. Although he is receiving anti-psychotic medication, he remained psychotic at the time of the interview. He was clearly distressed and paranoid in his interactions with others. He has been in custody for almost four months.

If Scott wasn't getting any help with his psychiatric illness then it was clear to JA that it was possible he was being mistreated. It was also possible that he was not properly assessed on at least two of his last two placements and that had put him at risk.

Justice Action sent all the prisoners at the HRMU an authorisation to make some enquires on their behalf, as at least 25 prisoners had complained by then, of being mistreated in the unit. The authorities were telling them they were not segregated [in solitary confinement], when they insist they were. That they had to earn small things and that was insensitive to their basic needs. That they were not getting proper medial treatment had no constructive lifestyle, fresh air, sunlight or decent exercise, amongst many other complaints.

They sent their signatures on a signed application through another concerned person who had visited a prisoner at the HRMU.

Subsequently all the authorisations sent to the those prisoners who requested JA's help were confiscated by the Governor at the prison for approximately 11-13 months - during the period Scott Simpson remained helpless, sick and isolated.

(PIAC) the Public Interests Advocacy Centre was notified and assisted Justice Action to have the Governor and the Commissioner of Corrective Services review and release the authorities sent by JA so the prisoners could get help.

The reason the prisoners needed to send JA the authorities was because if those who want to assist them are not related to the prisoner then they are prevented from making enquiries about prisoners under the provisions of the Privacy Act. [?]

Why JA needed the authorities from the prisoners was because the signed application the prisoners had originally sent never specified Justice Action in particular. A catch 22 but it meant no help for all those who suffered and probably still suffer unbearable consequences in extraordinary inhuman conditions at the HRMU even today.

Tracey Simpson Scott's sister said, "Why did they put him in segregation for 26 months, locked down for 23 hours a day and no contact with human people?

In June last year Scott was found not guilty of the murder of his cellmate on the grounds of insanity because he suffered from schizophrenia.

A few days later Scott Simpson 34 was found hanging in his long bay segregation cell in 12-wing area 2, hanging by a bed sheet with a hand written letter to his family on the floor of his cell.

His family say that they warned authorities that Scott needed psychiatric help.

Detective Senior Constable Chris Hogan from Maroubra police has told the inquest that he could not contact the prison officer, Paul McCormack who was the first person to find Scott Simpson hanging and that he never obtained a witness statement from him.

When questioned further Constable Hogan told the court that McCormack had left the department of Corrective Services shortly after Simpson's death and that he had tried on numerous occasions to contact him but to no avail and that he was unable to get a statement from the prime witness.

The court asked Senior Constable Hogan if McCormack could be located to see what he has to say? Hogan acknowledged that it was important and said he'll do that!

The president of the Mental Health Review Tribunal professor Duncan Chappell has told Simpson's inquest that there was a beaurocratic problem that the Supreme Court did not pass on his papers for psychiatric assessment.

"We were not getting rapid referrals...we were simply not aware of Mr Simpson's case," he said.

Professor Chappell has told the court that as many as one time there could be as many as forty inmates waiting to be admitted to the jails psychiatric hospital. He said if there is no bed for them they are likely to be placed in another part of the prison system.

"There are simply not enough places in the hospital for the number of forensic patients that exist."

He said that this is a tragedy that should have been averted and that this is inadequate treatment of a forensic patient.

Forensic Psychiatrist Professor David Greenberg told the court that Simpson's psychiatric illness could have been made worse by his segregation [solitary confinement] depending on how he handled the isolation and his previous experience of that environment.

"In his acute psychiatric state he was at risk of self-harm", he said.

His sisters say that he should have been in hospital not solitary confinement.

His sister Kelly Simpson said, "They just locked him up and threw away the key, that's how I feel about it."

And Tracey said, "and then they tell us in the paperwork that a bed had become available to him when he died."

The Simpson's say that there brother was supposed to be receiving medication in custody yet he was found with just 3mg of paracetamol in his system.

Questions arise about the duty of care by DCS:

Why was Scott not diagnosed upon his arrival at Silverwater if he had a mental illness?

If he had been assessed as having a mental illness, would he have been placed in a difficult situation or with another person?

Why was a child sex offender put in the main and in Scott's cell? There is also an obligation because of peer pressure in the main to beat up a protection prisoner in the main or be put on protection for being a dog and not doing something about it!

Did the Department of Corrective Services have a duty of care 'not to place Scott in a difficult situation without any treatment?

Why was Scott not placed in a mental health facility if as the psychiatric report states he has a mental illness?

Why wasn't he sent to a hospital for treatment immediately after being found not guilty of murder due to mental illness and many months of segregation?

There is also another strange twist if you want to believe it is possible!

The authorities had known Scott Simpson very well from his previous time in jail, he was very well known by the system and they knew that he would stand up for himself and would not allow the authorities to compromise his human rights. That is if he had a way of preventing that from happening. In jail they call it staunch but outside they'd call it dissent! Standing up for your rights!

But in the HRMU there is no such thing, there are no hanging points and no way out but gas and then you will do anything that the authorities want, right or wrong.

Modern jails don't burn and modern glass doesn't break. One wonders whether Scott had some idea that he was going to be sent back to insanity, after all, he never made it for any sort of treatment?

Many prisoners in segregation self harm and I think if they could not escape it that would be insanity so the sight of prison bars in an old style jail could be seen as a chance to escape 'insanity'. [And in Solitary Confinement at Long Bay Prison that's where he found the bars to hang himself.]

So there is a greater possibility of suicide or I think in this case you may call it euthanasia. It's just a possibility that ran through my own mind having some understanding of what it's like freezing and hungry in a segregation [solitary confinement] cell in Goulburn in the middle of winter without any hanging points, to some people that could be unbearable.

The inquest continues for two days and then resumes on February 28 at the Glebe Coroners Court Sydney.

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.

By Justice Action 28 November 05

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Number of prisoners sent back to jail trebles
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Top judge says crowded prisons cannot break cycle of crime
UK: Reoffending rates after a prison sentence are at an "unacceptably high level" and the failure of the criminal justice system to stop prisoners reoffending should shock the public, England's top judge, [Ruling Class] Lord Woolf, said last week.

All the World's a Prison: History
No doubt many of my readers, even those who are well-educated or widely read, think that the prison -- the place where dark deeds are darkly answered[2] -- is an ancient institution, a barbaric hold-over from barbaric times. In fact, the prison is of relatively recent origin, and this tells us a great deal about the pretentions and realities of modern times, and the wisdom and high degree of development of the ancients.

Decade after inspector left in disgust, report tells of filth
UK: Dirty, mice-infested cells, high levels of self-harm, and widespread bullying over drugs and medications were just some of the damning findings of a report into conditions at Holloway, Britain's largest women's prison.

Most women 'should not be jailed'
Women make up 6% of the prison population in England and Wales. Imprisonment of women should be "virtually abolished", a prison reform group has said.

Youth 'murdered for officers' pleasure'
UK: An Asian teenager was murdered by a white racist after they were placed in the same cell as part of a game to fulfil the "perverted pleasure" of prison officers, a public inquiry heard on Friday.

Deaths in isolation as prison segregation increases
The use of segregation [solitary confinement] of prisoners as punishment has been increasing recently in Australia, the US, and the UK. Segregation can be used for protection or punishment, but in both cases it results in extreme psychological stress. An indication that segregation is being over-used is the appearance of deaths in custody from suicide of those placed in segregation.

Inquest blames jail for overdose death
UK: An inquest jury returned a verdict itemising a catalogue of faults at Styal prison in Cheshire, concluding that the prison's "failure of duty of care" contributed to the death of Sarah Campbell, 18, who took an overdose of tablets on the first day of her three-year sentence.

Put in the way of self-harm in a place intended to protect others
UK: Sarah Campbell, 18, spent the last hours of her life in the segregation unit of Styal prison, Cheshire. "The seg", as those places are referred to, used to be known as "the block", short for punishment block. [ Seg is a bullshit word for Punishment, Solitary Confinement, Torture, Mental Illness, Self-Harm, Human Rights Abuse and that is State Terror.]

Britain 'sliding into police state'
The home secretary, Charles Clarke, is transforming Britain into a police state, one of the country's former leading anti-terrorist police chiefs [false flag police chiefs] said yesterday.

UK solitary confinement
UK: Segregation units are prisons within prisons - the places where the most unchecked brutality is meted out to prisoners. In recent years conditions in high security segregation units have deteriorated, and the use of long-term segregation as a control mechanism has increased.

Inquiry must root out prison racists
UK: It is difficult to imagine a more brutal murder than that of Zahid Mubarek. The 19-year-old was clubbed to death by his cellmate at Feltham Young Offender Institution in the early hours of 21 March 2000. He was due to be released just a few hours later.

Prison suicides soar as jails hire 'babysitters'
UK: Prison officers are being taken off suicide watch and replaced by unqualified 'babysitters' because the system is overwhelmed by an epidemic of self-harm.

Plan to sell off juvenile jails as job lot
UK: The government is to put out to tender all its dedicated juvenile jails that hold children under 18 in a departure in Whitehall's privatisation programme.

Failure to sack 'racist' prison staff condemned
UK: Two prison officers suspended for racism are still on full pay three years after a stash of Nazi memorabilia, neo-fascist literature and Ku Klux Klan-inspired 'nigger-hunting licences' was found in a police raid on their home.

Report slams 'unjust' jailing of women on remand
UK: Six out of 10 women sent to jail while they await trial are acquitted or given a non-custodial sentence, a report published today reveals. Introducing the report, Lady Kennedy QC calls for a complete review of the use of remand and bail for women saying it is "inhumane and unjust".

Concern as UK prison suicides hit record level
UK: More prisoners took their own lives in English jails in August than in any other month since records began, prison reformers said today.

End of years of despair as Holloway closes its doors
But now Holloway prison in north London - where Ruth Ellis, the last woman to be executed in Britain, was hanged in 1955 - has been earmarked for closure, along with several other women's prisons, which have been hit by a spate of suicides.

How detox and self-help brought suicide jail back from the brink
UK: Six suicides in 12 months made Styal jail notorious and the Prisons Ombudsman criticised the prison and its staff for serious failures. But things are changing.

Belmarsh detainees consider suicide, says freed man
UK: The first of the Muslim detainees released from Belmarsh high security prison after being held on suspicion of terrorism has told the Guardian his fellow prisoners are suffering such severe mental problems that they constantly consider suicide.

Adelaide's Glenside psychiatric hospital: Escape from hell?
A third person has escaped from the Adelaide's Glenside psychiatric hospital as health authorities prepare to begin a second review of security.

Suicides and unrest have soared, admits Home Office
UK:The already overcrowded prison population is set to go on rising and will top 80,000 within the next three years, a senior Home Office civil servant warned yesterday.

England tops the EU in imprisonment
England and Wales jail more offenders per capita than any other European, Union country, according to new figures.

Statement of the Villawood Hunger Strikers

Posted at the request of the Chinese hunger strikers in Villawood, on strike since 19 October

Statement:

(translated from Chinese)

We are six hunger strikers from Villawood Immigration Detention Centre (VIDC) in Sydney, Australia. In order to protest against the compulsory detention policy and mental and physical impairment caused by the long-term detention in VIDC, during which many people have suffered from long-term insomnia, dysphoria, and even mental breakdown, six of us detainees started the hunger strike on 19th October, 2005.

Six of us all came from the mainland China, among us five people are seeking refugee status while another person is asking for family reunion.

We were persecuted by the communist regime in our own country where people lost their fundamental freedom, human rights, democratic rights and rule of law. We were forced to flee from China to come to Australia where people enjoy their fundamental freedom, human rights, democratic rights and rule of law.

Like newly born babies, we are seeking protection here in a democracy. But due to the inadequacy of the detention policy in Australia, we were forced to lose our freedom again and may, at any moment, be deported back to China and face severe persecution again.

Our hearts are bleeding

Is it that hard for us to live as a normal human being? Is it that hard for us to be treated like the staying Chinese after the Tiananmen Square Massacre?

Has the communist regime in China returned us the fundamental rights of freedom, human rights and democratic rights? Has the rule of law become dominant in China now?

Has the Chinese Communist Party stopped persecution against political dissidents, "underground churches" and Falun Gong?

All the above questions explain themselves, and certainly do not need our explanations.

Hereby we solemnly declared that we request the Australian Government to provide us the refugee status, family reunion and humanitarian refuge. It is also the aspirations of all the detainees at the Villawood Immigration Detention Centre, Sydney.

Australian people, we need your help!

From six hunger strikers in Villawood Immigration Detention Centre, Sydney 30th October, 2005

Villawood detainees go on hunger strike

A refugee advocacy group says up to 200 detainees at the Villawood Detention Centre, in Sydney, have begun a hunger strike to draw attention to their situation ahead of the federal election.

By Chinese hunger strikers in Villawood posted 2 November 05

Related:

Hundreds attempt self-harm in detention
More than half of the 900 self-harm incidents over three years occurred in the Baxter detention centre.

Justice for Vivian Alvarez Solon
The Refugee Action Collective organised Melbourne's contribution to a National Day of Action to demand compensation for Vivian Alvarez Solon and an end to forced deportations...

Lawyer contradicts Vanstone over detained kids' case
The lawyer for two Sydney school children held for four months in immigration detention has disputed the version of their experience given by the Immigration Minister Amanda Vanstone.

Is Cornelia Rau running for her life?
Wrongfully detained woman Cornelia Rau has travelled to Melbourne, in breach of a South Australian mental health order.

Baxter visit convinces Burke of need for royal commission
AUSTRALIA/CUBA Federal Labor's new immigration spokesman Tony Burke says after visiting the Baxter detention centre he is now more convinced then ever of the need for a royal commission into immigration detention.

Gov't Failure Card: Community
The controversial plan was yesterday raised by Queensland Premier Peter Beattie, who suggested a national ID card to prevent unlawful detention similar to that suffered by Cornelia Rau and Vivian Alvarez.

Some people want to remain anonymous
The federal attorney-general has suggested that two women wrongfully detained by the Immigration Department could have avoided being locked up if they had cooperated more with authorities.

'Anna's nightmare' in detention's living hell
Australia: IN his whitewashed report on the detention scandals, government employee Mick Palmer refers to Cornelia Rau's four months in Baxter detention centre as "Anna's journey".

Detention policy: Change Your Mind
It would not be wrong to answer in the affirmative. Another reason is that our political system is adjusting to the highly publicised breaches of human rights via individual cases such as Peter Qasim, Cornelia Rau and Vivian Alvarez Solon.

Psychiatrists dismiss Vanstone's call to limit role
Psychiatrists treating mentally-ill Baxter detainees have rejected the Immigration Minister Senator Amanda Vanstone's call for them to restrict their role to the immediate care of patients.

HREOC's deadline on child detainees passes
"We detainees request from human Australian to release us from Nauru cage" Years of waiting took their toll on asylum seekers. There are still two men there! They are suffering. (April 2006).

Tampering with Asylum
HAVE YOU EVER THOUGHT THAT AUSTRALIA'S recent policies on asylum seekers are wrong, but don't quite have the statistics to back up your views?

Baxter,'akin to the time in Nazi Germany'
I went to Baxter this Easter just past, and became more aware that this time is akin to the time in Nazi Germany when the concentration camps were being set up.

Asylum seeker denied medical help, court hears
An Iranian asylum seeker was denied access to psychiatric help, despite slashing himself several times inside South Australia's Baxter detention centre, the Federal Court in Adelaide has heard.

Once You've Been to Baxter You Can't Sit on the Fence
I spent this Easter in the desert. I spent this Easter protesting at Baxter detention centre to draw the world's attention to the injustice of Australia's racist and inhumane mandatory detention system and treatment of asylum seekers.

Detention Centres, Solitary Confinement
On Friday night the NSW Council for Civil Liberties awarded Sydney solicitor John Marsden honorary life membership. Julian Burnside was invited to make the speech in Marsden's honour. In the course of his speech, Burnside referred to the unregulated use of solitary confinement in Australia's immigration detention centres, criticising it as inhumane and also as unlawful.

MP urges asylum seekers' release
A federal Coalition MP has called for the release of all asylum seekers being held in immigration detention centres.

Australian held in Baxter detention centre
It has been revealed an Australian resident has been locked up in Baxter Detention Centre in South Australia for the past four months. Authorities had been unable to establish her identity since she was found wandering in far north Queensland last September.

Did Cornelia Rau have a mental illness?
CORNELIA Rau returned to psychiatric care in Adelaide, just days after being released into the community, appears to be very suspicious indeed!

Submission to Senate: Inquiry into Mental Health 2005
We appreciate that the urgent issues of Human Rights and other abuses including institutionalisation and the use of force, and the lack of progress on Burdekin are being examined by the Committee.

Govt defends decision to detain Korean woman?
The Immigration Department says there was no unlawful detention in the case of a Korean woman recently held at South Australia's Baxter detention centre?

Rau ordeal a raw deal
Ms Rau spent time in a Queensland prison and a hospital before being handed to immigration authorities who kept her in detention for another four months.

Australian held in Baxter detention centre
It has been revealed an Australian resident has been locked up in Baxter Detention Centre in South Australia for the past four months. Authorities had been unable to establish her identity since she was found wandering in far north Queensland last September.

Lawyers want Baxter detainee released for treatment !
Lawyers acting for a hunger-striking detainee inside South Australia's Baxter detention centre have asked the Federal Court to order a psychiatric assessment for the man, saying he needs to be in mental health care, not detention.

Baxter protesters 'being denied water, sleep'?
One of the three Iranian men has been on the roof of the gymnasium since Sunday last week, with two others joining him on Tuesday.

Detainees urged to abandon rooftop protest!
Kathy Verran from Rural Australians for Refugees, says one of the men has since come down and has been taken into the management unit. solitary confinement for Xmas?

Advocates warn of detention centre riot risk
A prominent refugee advocate warns South Australia's Baxter Detention Centre is on the brink of a major riot. A protest involving about 25 male detainees broke out at the centre on Tuesday, over a new system which is delaying the process of dispensing medication to detainees.

Advocates warn of detention centre riot risk
A prominent refugee advocate warns South Australia's Baxter Detention Centre is on the brink of a major riot. A protest involving about 25 male detainees broke out at the centre on Tuesday, over a new system which is delaying the process of dispensing medication to detainees.

Villawood detainees go on hunger strike
A refugee advocacy group says up to 200 detainees at the Villawood Detention Centre, in Sydney, have begun a hunger strike to draw attention to their situation ahead of the federal election.

Afghan children lose High Court battle against detention
Lawyers have lost their constitutional challenge to the detention of four children at a South Australian immigration centre. Four siblings from Afghanistan, aged between seven and 15, have been in detention since they arrived in Australia in 2001.

Democrats to keep up pressure over asylum seekers
The Australian Democrats will maintain their pressure on the next federal government over Australia's treatment of asylum seekers, if the party can retain its strength in the Senate.

Don't rock the Boat Howard!
PRIME Minister John Howard today denied the children overboard affair had swayed the 2001 election? Mr Howard has spent the week defending himself against claims he had been informed that nobody in Defence believed children had been thrown overboard by asylum seekers.

Baxter detainee continues hunger strike
A detainee at the Baxter detention centre near Port Augusta in South Australia has been on a hunger strike for a week. Sri Lankan Zeldon Daggie, 23, says he has been detained since arriving in Australia four years ago.

Senior cleric damns Baxter as 'disgraceful'
A senior world religious figure has called on the Federal Government to scrap its mandatory detention policy after visiting the Baxter detention centre in South Australia's north.

Australia's "GITMO" System
Australia's "GITMO" System In June 2002 on the PM program on ABC radio, PHILIP RUDDOCK is quoted as saying: "Well, let me just say, detention centres are not prisons. They are administrative detention.

Detention centre media ban criticised
The Howard Government has been criticised in a report by media freedom advocate Reporters Without Borders for stopping journalists covering the conditions in refugee detention centres.

Restraint methods prone to disaster

Illustration: RESTRAINT ASPHYXIA – SILENT KILLER

UK: In May, 24-year-old Azrar Ayub, a patient at the Edenfield secure mental health unit, part of Prestwich hospital near Manchester, died after being restrained by hospital staff.

Azrar Ayub

It was a tragic reminder of the death of the 38-year-old mental health patient David "Rocky" Bennett in similar circumstances in a Norwich hospital in 1998. Bennett's death caused a public outcry and resulted in an official inquiry, which led earlier this year to the issuing by the National Institute for Clinical Excellence (Nice) of new guidelines on the use of restraint.

David "Rocky" Bennett

So why, six years after Bennett's death, does it appear that deaths as a result of restraint are still occurring?

First, the big picture. There were 116,000 incidents involving violent or verbal abuse in the NHS in England and Wales in 2002/03. About half were in mental health settings. Many of these would have involved a patient being restrained. It is generally believed that deaths caused by restraint are rare, but there are no reliable figures on injuries or deaths.

Restraint is often regarded by mental health nurses as a vital, if undesirable, measure of last resort for dealing with violence on wards. Establishing why some techniques might lead to injury or death is not easy. Each individual case is different, and a range of factors need to be taken into account - for example, whether staff were trained properly or whether the technique had been applied incompetently.

The Nice guidelines were designed to help guide staff and trusts on what is acceptable, but have been criticised for not going far enough to protect vulnerable mentally ill people against, in particular, prone restraint, where the patient is held face down, and which risks death from asphyxiation.

At a conference called Care or Abuse? last week in Derby, more than 100 mental health professionals, trainers, educators and service users discussed and challenged some of the most controversial and questionable restraint methods. During one dramatic presentation, a former mental health service user recounted - at times in tears - what it was like to come close to death while being held face down on the floor by four nurses when she suffered a "psychotic episode" in 2003.

One mental health trust director called for a ban on methods that, in his view, caused distress or pain to patients. He claimed that at his trust, such methods had been abandoned, leading to a cut in the number and severity of violent incidents. But he was accused by one delegate (a restraint trainer) of being sensationalist. Their exchange illustrated that even after the Bennett inquiry and the Nice guidelines, there is still a fissure in the mental health establishment over what is and what is not ethical and acceptable practice when it comes to restraint.

The conference shed light on why some forms of restraint remain problematic. Some acute mental health services in the UK are managed badly and are short of cash and staff, putting extraordinary pressure on nurses to react to incidents by restraining patients rather than talking to them to defuse potentially violent situations. These difficulties are exacerbated because trusts do not agree on which restraint methods to use or when to apply them.

There are around 2,500 restraint techniques currently being taught by a multitude of private companies, but there has never been a national evaluation to standardise training. Some research has been conducted but it is patchy and the results are far from conclusive. The Department of Health has plans to collect more accurate figures on injuries and deaths caused by restraint, but scepticism persists over their reliability because of fears of under-reporting.

In the absence of robust evidence on physical restraint or injuries caused by it, we are gambling with the lives of some of the most vulnerable people in our society. It is a matter of urgency that we identify what works, what does not, and that we act on it.

By Mary O'Hara posted 27 October 05

Related:

Ohio's Abu Ghraib
In January 2001, Charles Austin and 28 other prisoners filed a lawsuit claiming that Ohio had violated their Eighth Amendment rights. The prisoners argued that medical and psychiatric care and recreation were inadequate at the supermax, and physical restraints were too harsh. Prisoners received medical injections through their narrow food slots, for example, and had both hands handcuffed to the wall during medical exams.

Abu Ghraib, USA
In another incident reported by Amnesty International that happened during McCotter's watch, an inmate at the Utah State Prison "was shackled to a steel board on a cell floor in four-point metal restraints for twelve weeks in 1995. He was removed from the board on average four times a week to shower.

On Solitary Confinement
I have witnessed prison guards from 2002 to 2004, while I was in Angola's even more restrictive punishment unit, who have thrown buckets of ice water (in winter) on men who were in 4- point restraints, wearing only paper gowns.

Schizophrenia: Think again!

New research on schizophrenia suggests that the drugs won't always work

The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations. When it has absorbed the juddering contents of the latest edition of one of its leading journals, Acta Psychiatrica Scandinavica, it will have to rethink many of its most cherished assumptions.

Not since the publication of RD Laing's book Sanity, Madness and the Family, in 1964, has there been such a significant challenge to their contention that genes are the main cause of schizophrenia and that drugs should be the automatic treatment of choice.

With his colleagues, guest editor John Read (whose name I shall use as a generic term for this body of evidence), a leading New Zealand psychologist, slays these sacred biological cows. The fact that some two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse is shown to be a major, if not the major, cause of the illness. Proving the connection between the symptoms of post-traumatic stress disorder and schizophrenia, Read shows that many schizophrenic symptoms are directly caused by trauma.

Before proceeding any further with Read's evidence, two important caveats must be entered. Firstly, many parents of offspring with the illness may find what follows deeply upsetting or infuriating. But this is not about blame, and it is not being suggested that all cases are caused by parental care. It is also important to realise that the new evidence is far more optimistic in its implications than the psychiatric establishment's view, for patients, parents and carers alike. Secondly, it is important to stress that plenty of psychiatrists do not subscribe to all the tenets of the establishment view. I recognise that many are working in good faith with an incredibly testing patient population, and do a tremendous amount to help them.

The cornerstone of Read's tectonic plate-shifting evidence is the 40 studies that reveal childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients (see, also, Read's book, Models of Madness).

A review of 13 studies of schizophrenics found rates varying from 51% at the lowest to 97% at the highest. Crucially, psychiatric patients or schizophrenics who report abuse are much more likely to experience hallucinations. The content of these often relate directly to the trauma suffered. At their simplest, they involve flashbacks to abusive events which have become generalised to the whole of their experience.

For example, an incest survivor believed that her body was covered with ejaculate. The visual hallucinations or voices often tyrannise and belittle the patients, just as their tormentors did in reality, creating a paranoid universe in which intimates cannot be trusted.

More research is needed to establish if abuse also heralds the other key symptoms of the illness, for example, incoherent, confusing or downright weird language. Studies already show that this is much more likely if the subject of conversation is emotionally charged. When asked to talk about sad rather than happy memories, speech becomes measurably more disordered, increasingly so the more personal the subject matter. We need research to investigate if verbal incoherence is abuse-related.

Another symptom is dissociation (feeling disconnected from oneself and surroundings). This has been shown many times over to be more common in the abused. It remains to be seen if catatonia (complete withdrawal from the world) is so related, although it seems extremely likely that it will be because elements of this are often found in victims of trauma. The same may be true of depressive thoughts, which many schizophrenics suffer and which are rife in the abused. About 15% of schizophrenics die by suicide, and depression is the norm in the suicidal. Suicide attempts are more common among people who have been abused as children, suggesting an abuse-schizophrenia connection, via depression and suicide.

Among the sexually abused there is a greater risk of developing schizophrenia the earlier the abuse happened, the closer the relation to the abuser and the more invasive the acts. Of course, not all schizophrenics suffered trauma and not all abused people develop the illness. What makes the difference?

Apart from the possible role of genes, less overtly cruel early childhood maltreatment, other than actual abuse, may be important. In a review of the 33,648 studies conducted into the causes of schizophrenia between 1961 and 2000, Read found that less than 1% was spent on examining the impact of parental care. What is more, the amounts have decreased steadily, from 1.6% during the 1960s, to four times less than that during the 1990s. Despite this, enough studies have been done to suggest negative or confusing early care may be an important addition to abuse as a cause.

Since mothers spend far more time caring for children than fathers (who account for much of the abuse), their role may be critical in this regard. There is now a vast body of evidence that early infantile deprivation and erratic or unresponsive care as a toddler make adults more vulnerable to depression and personality disorder (a close diagnostic relative to schizophrenia. See my book They F*** You Up - How to Survive Family Life).

It is very possible that maternal deprivation creates a vulnerability to schizophrenia if there is subsequent abuse. Children with schizophrenic mothers are twice as likely to develop the illness as those with an afflicted father. This could be because disturbing mothers are a major factor. Equally, it could be due to gender-linked genetic inheritance, but there are strong reasons to doubt it.

For instance, the mothers of 11,000 Finns were asked if they had considered an abortion for their child during pregnancy, a clear sign that the child was unwanted, increasing the likelihood of subsequent maternal deprivation. Followed up 28 years later, the offspring of mothers who had sought abortions were four times more likely to be schizophrenic - not likely to be anything to do with genes.

Parents' negativity and tendency to be mystifying - paradoxical, contradictory injunctions - may also be important. These were measured in families with problem boys who had not yet developed signs of schizophrenia. After 15 years, the more negative and mystifying the parents had been in a son's childhood, the greater his likelihood of being schizophrenic or of having symptoms.

Of course, that does not rule out the possibility that genes may play a significant role in plenty of schizophrenia, but, even in these cases, the only recent study of the role of early environment shows how important it is. Fifty-six children born to schizophrenic mothers who had subsequently been adopted at a young age and who were therefore, in theory, put at higher genetic risk of developing the illness, were compared with 96 adoptees who were at low risk because none of their biological parents had it. The families were observed extensively when the children were small and all the adoptees were assessed for psychiatric illness in adulthood.

On its own, simply having a greater genetic risk (because of schizophrenia in the biological mother) did not increase the likelihood that the child would develop schizophrenic symptoms. Genes alone did not cause the illness. However, if there was a high genetic risk and it was combined with mystifying care during upbringing, the likelihood was greater. This suggests that genes can be implicated, but only if the family environment is of the kind that fulfills schizophrenic genetic potential.

What, then, is the main case for genes playing a role? A recent review by Robert Plomin, the world authority on genetic causes of human behaviour, revealed that, apart from for Alzheimer's, not a single gene has been shown to play a critical role in any mental illness. There is no evidence that the genetic material of schizophrenics differs in any way from people without the illness.

For the time being, this places the burden of genetic proof on studies of identical twins and adoptees. Putting to one side the fact that there are serious doubts over the validity of twin studies as a method (see Jay Joseph's The Gene Illusion), suppose 100 schizophrenics all had genetically identical siblings. Studies show that half of the identikits will also have the illness. What explains its absence in the other half? Because both have exactly the same genes, the one thing of which we can be certain is that differences in genes are not the reason. It proves beyond peradventure that environment plays an important role in causing some schizophrenia.

More general evidence of the crucial role of environment comes from sociological studies. Schizophrenia is around 12 times more common in children of West Indian immigrants to Britain. Increased rates have been found for immigrants to other countries. Poor people are several times more likely than the rich to suffer schizophrenia, and urban life increases the risk.

Rates of schizophrenia vary as much as 16-fold around the world, as does its course. It is less common in developing nations and tends to last much longer and be more severe in rich, industrialised nations compared with poor, developing ones (even so, about 20% of schizophrenics in developed nations recover completely without taking anti-psychotic drugs). In fact, if you become ill in a developing nation where hardly anyone is treated with drugs, you are 10 times less likely to have any recurrence of the illness - a huge difference, also nothing to do with genes.

What it may have a lot to do with is the administration of drugs (see British psychologist Richard Bentall's book, Madness Explained). They have been shown to impede traumatised people from understanding their voices or visions and recovering from them. There is a close relationship between the drug companies and the psychiatric establishment. While it may not be the intention, the establishment explanation of the causes of and solutions to schizophrenia are crucial components in the process of selling drugs. If patients can be persuaded their illness is an unchangeable genetic destiny and that it is a physical problem requiring a physical solution, drug companies' profits will grow. Read shows those who buy this genetic fairytale are less likely to recover, and that parents who do so are less supportive of their offspring.

The huge importance to drug company profits of the bio-genetic refrain becomes apparent when you learn that most people do not hum along with it. Surveys find that the majority of people mention such environmental factors as trauma, stress and economic hardship as the commonest causes of schizophrenia. It may be seen that the drug companies have an uphill struggle to persuade them otherwise, for which they badly need the help of the psychiatric establishment's towrope. In Read's analysis, letting go of that rope will prevent it strangling the many schizophrenics whose illness has been caused by abuse. Genes may still emerge as a major cause of vulnerability to schizophrenia, as may problems during pregnancy. There is already no question that illicit hallucinogenic drugs are a major reason some vulnerable people become ill. But even if this is true, following Read's important work, it will be hard to ignore its implications.

All patients will need to be asked in detail about whether they have been abused. Anti-psychotic drugs will no longer be doled out automatically, psychological therapies will be employed much more frequently. The psychiatric establishment will have to spend more research money on investigating the role of nurture in causing the illness. Above all, as advisers to government, it will have to recommend much better systems for early detection of traumatised individuals and the funds to provide the kind of support for parents that could prevent much, if not most, schizophrenia.

There are already signs of a change in perspective. In August, the president of the American Psychiatric Association bemoaned his profession's subservience to drug companies and the fact that "we have allowed the bio-psycho-social model to become the bio-bio-bio model". As Read reports in his earth-shattering edition of Acta Psychiatrica Scandinavica, for too long the role of trauma has been ignored by the establishment and "the possibility of a relationship with psychosis has been minimised, denied or ignored". Read's earthquake may trigger a landslide.

By Oliver James posted 27 October 05

* Oliver James trained and worked as a clinical psychologist. He is the author of They F*** You Up - How to Survive Family Life.

Related:

Mental Treatment and Pharmacy Profit $$$$$
Mentally ill patients are being kept in solitary confinement within maximum security NSW prisons as punishment, against the most basic principles of human rights law.

Drugs firms 'creating ills for every pill'
The power of Britain's multi-billion-pound drugs industry has turned this country into an over-medicalised society that believes in a pill for every ill, a Commons inquiry will claim this week.

Family Wonders if Prozac Prompted School Shootings
US: RED LAKE, Minn., March 25 - In their sleepless search for answers, the family of Jeff Weise, the teenager who killed nine people and then himself, says it is left wondering about the drugs he was prescribed for his waves of depression.

Mother's Little Helpers
Approved for adults only, Prozac is being used to medicate children as young as 8 years old. Why are we using powerful drugs to raise our daughters?

Big Pharma snared by net
UK The web has helped consumers turn tables on the drug giants, says Cheryll Barron.

Prozac must have suicide warning
All antidepressant drugs must carry the strongest possible public warning that they could cause children to harm themselves or commit suicide, US authorities said yesterday in a landmark ruling which has repercussions for the whole class of drugs.

The drugs industry and its watchdog: a relationship too close for comfort? Critics say the drug regulator and the industry are too close. Their proceedings have long been shrouded in secrecy because of the drug companies' insistence on the commercial sensitivity of information relating to their products.

Schizophrenia: talking may help when drugs don't
New research has strengthened the case for using 'talk therapy' in the treatment of schizophrenia, especially for those who don't respond well to drugs.