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Untitled Prezi

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Natasha Sergent

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MENTAL ILLNESS WITHIN CORRECTIONAL FACILITIES
History of Mental Health in
Prisons
Mental illness and how it is dealt with in the criminal justice system has always been problematic. For a long time offenders with mental illnesses were not given any concessions in how they were treated in prisons. Insane asylums were established in Australia in 1810, but were not designed to facilitate criminals until the Darlighurst Gaol in 1878 (NSW Health, 2003). Medical examinations for prisoners only became mandatory in 1865 under the Prison Act (Smith, 1981), with doctors being instructed to look out for signs of the mental illnesses that were prevalent in prisons. In 1895, reforms were brought about by Cpt F.W. Neitenstein that did not allow 'mentally disturbed' offenders to be placed in prisons (4Corners, 2005). In practice, however, these reforms have encountered obstacles in the screening processes of offenders. Often it is "cursory and ineffective" (Mitichison et al, 1994) and leads to inmates not getting the treatment they require. After the removal of mental institutions in Australia, people with mental illnesses were often released back into the community with inadequate support, frequently leading to re-offending (National Centre for Victims of Crime, 2004). Forensicare was established in Australia in 1997 to provide mental health for inmates, and established the Thomas Embling hospital in Fairfeild to give inmates therapy, support and medical services. Involuntray treatment is provided here under the Mental Health Act of 1986, as Victorian prisons cannot facilitate that (Department of Justice Victoria, Forensicare, 2013). The Thomas Embling Hospital is frequently over-crowded, with 96% of the beds occupied for the first quarter of 2013 (Cook, 2013). The prevalence of mental illnesses upon entering prisons is estimated to be 14.5% of men and 31% of women and roughly 1 in 7 inmates are likely to have psychotic illnesses or major depression (Fazel, S., & Danesh, J. 2002).
STATISTICS (Taylor, 2012)
1 in 5 prisoners aged 16- 85 years will experience some sort of mental illness during their life.

30% of female prisoners and 37% of male prisoners require some sort of mental health treatment, assessment or care.

The number of psychiatric beds across Australia decreased from about 30,000 in the 1960's to 8,000 in the 2000's, as a result of de-institutionalisation.

From June 2000 to June 2010- the number of prisoners with a serious mental illness increased by 43%.

According to the 2003 Victorian prisoner health study, approximately 25% of prisoners had a history of a major mental illness, with rates of schizophrenia and bipolar disorders reportedly almost 10 times higher than in the community

There is a shortage of mental health beds for male prisoners who are acutely mentally unwell.

Mental illnesses increase from the age of 25 years onwards.

Mental health is estimated to affect 20% of the population.

30% of Mentally ill prisoners are already on medication treatment for their disorders.
Some Victorian voters have long held the view that the Kennett government’s closure and sale of mental asylums in the 1990s led to a direct increase in the prison intake of individuals who would have previously been treated in mental institutions. A closer inspection of the argument for and against deinstitutionalisation during this period appears to negate that assumption. The first National Mental Health Plan (1993 – 1998) under which Victoria implemented a program of total deinstitutionalization of its mentally ill population coincided with Jeff Kennett serving as Premier of Victoria 1992 – 1999. There are multiple reasons to incorrectly assume that mental health patients would be diverted into prisons over that time. The first is economic withdrawal from funding the plan, the accumulation of money from federal grants and the sale of properties previously housing mentally ill patients was set aside for implementing effective treatments within a community setting, however after the governments re-election mental health reform lost priority and the money was reallocated (Gerrand, 2005). Public perception was fuelled by notions of deinstitutionalisation meaning that people with mental illness would not be treated in ‘institutions’ therefore the only place they could go was ‘out on the streets’, or ‘in prison’(Richmond, 2005). Perceptions were further fuelled by “the media’s exploitation of violent events (Morrall, 2004; Nairn & Coverdale, 2005, as cited in Richmond, 2005). The Burdekin report Human Rights and Mental Illness (1993) received submissions stating that “if you decrease the number of mental health system beds, there will be an equivalent rise in prison system beds, as those with mental health problems will be channelled into prisons” (Marion Leach, Outcare Civil Rehabilitation Council of WA submission p. 3) The Burdekin report did not find this to be the case. The report did find untreated people were ending up in jail as their symptoms were misunderstood or not recognised.
Mental Illness within Correctional Facilities

There have been dramatic changes in the treatment of mental health within the criminal justice system of Victoria between 1810 (when asylums were first established) and now. This presentation will provide a critical analysis of these changes.
Current issues regarding mental illness in Australian Prisons
Assessment and Screening by Police
Assessment and Screening by the Courts
Assessment and Screening in Corrections
• Police tend to arrest people for behaving irregularly rather than treating the behavior as mental condition (Ogloff, Davis, Rivers, Ross, 2007).
- this is because the abnormal behaviour caused by some forms of mental illness exhibit themselves as antisocial behaviours.

• This is a symptom of a lack of training and the practicalities of dealing with the problem in another way is oten beyond the capabilities of the officers


• Only conducted upon admission into corrections facilities
• There is no ongoing assessment
• Main focus of corrections employees is to watch for signs of suicide.
• There is however, a higher focus upon mental health in youth criminal justice


Diagnosis Techniques in the justice system
References
1. Referral Decision Scale (Teplin & Swartz 1989),
2. the Brief Jail Mental Health Screen (Steadman
et al. 2005)
ABC News. (2012, June 26). Mentally Ill Jail Outrage (Video file). Retrieved from

ABC News. (2012, July 12). Concerns held for Autistic Inmates (Video file). Retrieved from

Australian Bureau of Statistics (2008). National survey of mental health and wellbeing: Summary of Results, 2007. Canberra.

Birmingham, L. (2001). Screening prisoners for psychiatric illness who benefits?. Psychiatric Bulletin, 25(12), 462-464.

Bowen, R.A., Rogers, A. & Shaw, J., (2009). Medication management and practices in prison for people with mental problems: A Qualitative Study. International Journal of Mental Health Systems. 3.34.

Burdekin, B. (1993). Human rights and mental illness (Report of the National Inquiry into the Human Rights of People with Mental Illness Volume. 2). Canberra, Australia: Australian Government Publishing Service.

Cook, H (2013), Prisoners Push Mental Health To The Limit. The Age Victoria, retrieved from http://www.theage.com.au/...

Department of Justice, Victoria (2013), Mental Health Care. Retrieved from http://www.corrections.vic.gov.au/.../mental+health+care/

Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys. The lancet, 359(9306), 545-550.

First National Mental Health Plan. (1993). Retrieved from Australian Government Department of Health and Ageing website: http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-midrev2-toc~mental-pubs-i-midrev2-2~mental-pubs-i-midrev2-2-fir

Forensicare (2013), Thomas Embling Hospital. Retrieved from http://www.forensicare.vic.gov.au/page.aspx?o=teh

Gerand, V. (2005). Can deinstitutionalisation work? Mental health reform 1993–1998 in victoria Australia. Health Sociology Review, 14(3), 255-271. doi: 10.5172/hesr.14.3.255

Justice Action. Deinstitutionalisation why community living has been accepted as the appropriate model. Retrieved from http://www.justiceaction.org.au/cms/mental-health/campaigns/item/421-deinstitutionalisation

Mentally-ill mother acquitted of baby's murder. (2006, July 12). ABC News. Retrieved September 20, 2013, from www.abc.net.au/news/2006-07-12/mentally-ill-mother-acquitted-of-babys-murder/1799610http://

Mitchison, S., Rix, K. J., Renvoize, E. B., & Schweiger, M. (1994). Recorded psychiatric morbidity in a large prison for male remanded and sentenced prisoners. Medicine, science, and the law, 34(4), 324.

NSW Health Department (2003), The Lunatic Asylum. Retrieved from http://www0.health.nsw.gov.au/.../history/h-asylums_pdf.asp

Ogloff, J., Davis, M. R., Rivers, G., & Ross, S. (2007). The identification of mental disorders in the criminal justice system Trends and Issues in Crime and Criminal Justice: Criminology Research Council

Richmond, K., & Savy, P. (2005). Insight in mind mental health policy in the era of deinstitutionalisation. Closing asylums for the mentally ill. Health Sociology Review, 14(3), 215-229. doi: 10.5172/hesr.14.3.255

Rogers, R., Sewell, K. W., Ustad, K., Reinhardt, V., & Edwards, W. (1995). The referral decision scale with mentally disordered inmates Law and Human Behavior, 19(5), 481-492.

Smith, R. (1981) Trial by Medicine. Edinburgh: Edinburgh University Press.
Stalking. The National Center for Victims of Crime. 2004. Retrieved from http://www.popcenter.org/problems/pdfs/MentalIllness.pdf

Steadman, H. J., Scott, J. E., Osher, F., Agnese, T. K., & Robbins, P. C. (2005). Validation of the brief jail mental health screen. Psychiatric Services, 56(7), 816-822.

Taylor, J., (2012). Implementing human rights in closed environments: Mental Health in Prisons- monitoring and oversight. Monash University Faculty of Law, Australia.

Veysey, B. M., Steadman, H. J., Morrissey, J. P., Johnsen, M., & Beckstead, J. W. (1998). Using the referral decision scale to screen mentally ill jail detainees: Validity and implementation issues. Law and Human Behaviour, 22(2), 205-215.

Wallace, W. (n.d.). Sent to the asylum: The Victorian women locked up because they
were suffering from stress, post natal depression and anxiety. Mail Online. Home | Mail Online. Retrieved September 29, 2013, from
http://www.dailymail.co.uk/home/you/article-2141741/Sent-asylum-The-Victorian women-locked-suffering-stress-post-natal-depression-anxiety.html

http://www.forensicare.vic.gov.au/page.aspx?o=teh

http://www.vic.gov.au/contactsandservices/directory/?ea0_lfz99_120.&officeLocation&6960ee65-3d85-4319-84e2-99778c7fb37d

http://en.wikipedia.org/wiki/Dame_Phyllis_Frost_Centre

4Corners, (2005), Chronology -
A History of Australian Prison Reform, Australian Broadcasting Company. Retreived from http://www.abc.net.au/.../prison-chronology.htm

7News. (2012, June 21). Woman’s Prison in Lockdown (Video file). Retrieved from

The Referral Decision Scale (RDS) is a mental health assessment and screening tool developed by Teplin and Schwartz in 1989 (Veysey, Steadman, Morrissey, Johnsen, & Beckstead, 1998). It is a interview based procedure that relies on self-report and observations of the assessor to detect issues. Such issues are informed by the Diagnostic and Statistical Manual of Mental Disorders (DSM), although the scale only has 3 major diagnostic categories; schizophrenia, major depressive disorder and bipolar-manic disorder (Rogers, Sewell, Ustad, Reinhardt, & Edwards, 1995; Veysey et al., 1998). Various researchers have assessed the validity of the RDS and found that while it is relatively effective at detecting schizophrenia and depression, it is ineffective at detecting bipolar disorders (Rogers et al., 1995; Veysey et al., 1998) In conclusion, this technique is relatively useful for gross testing of prison populations, but not for individual cases.

The Brief Jail Mental Health Scale (BJMHS) is similar to the RDS, in its operationalization; it utilises self-report and interview techniques to assess patients. However, in comparison, it is a much shorter process taking only 2.5 minutes per patient. This amount was introduced as a cost-saving function, with budgeting favouring efficiency over effectiveness (Steadman, Scott, Osher, Agnese, & Robbins, 2005). Studies assessing the effectiveness of the BJMHS found that while it is relatively effective at diagnosing male patients (73.5%), it is unacceptably ineffective at diagnosing women with only 61.6% of patients correctly diagnosed in one study(Steadman et al., 2005). In conclusion, this technique is relatively useful for gross testing of prison populations, but not for individual cases


• Conducted during court liaison programs
• Usually conducted by psychiatric nurses – not as highly educated as psychologist or psychiatrist
Where Prisoners end up after Assessment
Thomas Embling Hospital
• 116 bed facility designed to house mostly patients from the criminal justice system, who have been either ordered to attend by the courts or who have been assessed as having acute mental illness
• Specialises in acute care, designed to treat conditions in the early stages.
• Largely focused towards males, with the majority of beds devoted to males

Melbourne Assessment Prison
• All male facility designed to house less mentally ill patients
• Assessments for males in the justice system takes place here

Dame Phyllis Frost Centre
• Specialist womens maximum and medium security prison, also provides specialised mental health treatment and housing

References
Some Victorian voters have long held the view that the Kennett government’s closure and sale of mental asylums in the 1990s led to a direct increase in the prison intake of individuals who would have previously been treated in mental institutions. A closer inspection of the argument for and against deinstitutionalisation during this period appears to negate that assumption. The first National Mental Health Plan (1993 – 1998) under which Victoria implemented a program of total deinstitutionalization of its mentally ill population coincided with Jeff Kennett serving as Premier of Victoria 1992 – 1999. There are multiple reasons to incorrectly assume that mental health patients would be diverted into prisons over that time. The first is economic withdrawal from funding the plan, the accumulation of money from federal grants and the sale of properties previously housing mentally ill patients was set aside for implementing effective treatments within a community setting, however after the governments re-election mental health reform lost priority and the money was reallocated (Gerrand, 2005). Public perception was fuelled by notions of deinstitutionalisation meaning that people with mental illness would not be treated in ‘institutions’ therefore the only place they could go was ‘out on the streets’, or ‘in prison’(Richmond, 2005). Perceptions were further fuelled by “the media’s exploitation of violent events (Morrall, 2004; Nairn & Coverdale, 2005, as cited in Richmond, 2005). The Burdekin report Human Rights and Mental Illness (1993) received submissions stating that “if you decrease the number of mental health system beds, there will be an equivalent rise in prison system beds, as those with mental health problems will be channelled into prisons” (Marion Leach, Outcare Civil Rehabilitation Council of WA submission p. 3) The Burdekin report did not find this to be the case. The report did find untreated people were ending up in jail as their symptoms were misunderstood or not recognised.
De Institutionalization the Kennett years
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