Prisons as Dumping Grounds for the Mentally Ill

The link between mental health and crime has long been established; with inmates around four times more likely to experience mental health issues compared to the general population.

Given these statistics, you might think that mental health services are easily accessible in prison.

But this couldn’t be further from the truth.

High demand for mental health services has created a backlog in the prison system, meaning that a growing number of inmates never get the help they need. This can result in inmates finding themselves back behind bars soon after being released; trapped in an endless cycle of offending and incarceration.

And with the closure of specialist mental health institutions over the years, together with funding cuts to community mental health services, experts say that prisons are increasingly becoming a ‘dumping ground’ for the mentally ill.

The Statistics

Statistics compiled by the Australian Institute of Health and Welfare in 2012 indicate that 44% of men discharged from prisons have been diagnosed with some form of mental health disorder. The rate for women is even higher at around 56%.

Around 38% of inmates enter the prison system requiring mental health treatment – and from then on the problems only seem to get worse. Many inmates report no change in their mental condition whilst in prison, while close to 10% report getting worse.

Inmates also suffer far higher rates of self-harm and suicidal thoughts compared with the general population.

Reasons behind higher rates of mental health problems include socioeconomic factors and physical disability. Those who enter the system often come from disadvantaged backgrounds or have experienced a traumatic childhood.

Many have a family history of mental health problems and lack the means to identify them early on in life. Others have suffered severe physical disabilities, such as traumatic head injuries, which can make them more susceptible to mental health conditions.

Given the link between mental health and crime, it is likely that such appalling statistics go some way towards explaining the high rates of re-offending by those released from prison.

The Australian Institute of Criminology has reported that around 60% of those in prison have been imprisoned in the past, with mental health being identified as a key factor behind that statistic.

Problems Accessing Treatment in Prisons

Given the link between mental health and offending, you might expect that inmates are being encouraged to seek support and that those who reach out for help are being given the treatment that they need. But regrettably, the opposite is true in many instances – with inmates finding it increasingly difficult to access appropriate treatment.

Access to prison mental health services is administered by Justice Health, which runs hospitals and manages various programs at correctional facilities.

When a person becomes an inmate in NSW, they are assessed by Justice Health to determine whether they need to be referred to a mental health service or are a suicide risk. Incredibly, only 58% of new inmates who reported experiencing ‘very high distress’ upon entering prison are referred on to a mental health service.

Furthermore, just 64% of those diagnosed with mental health conditions report being offered any form of treatment whilst in prison.

This is despite the fact that section 72A of the Crimes (Administration of Sentences) Act 1999 states that an inmate:

‘must be supplied with such medical attendance, treatment and medicine as in the opinion of a medical officer is necessary for the preservation of the health of the inmate, of other inmates and of any other person.’

The Big Picture

On the surface, the problems faced by inmates with mental health conditions could be simply resolved by allocating extra funding to Justice Health and allowing inmates to access mental health facilities in prisons.

However, the issue is more complex than this – as there is simply not enough funding for programs in the community, many of which supply mental health programs to the prisons, and not enough treatment centres.

The process of ‘deinstitutionalisation,’ which involved closing down long-stay psychiatric hospitals, began in the 1980’s following the publication of the Richmond Report.

Psychiatric hospitals had been plagued by issues and complaints for years – allegations of abuse within facilities emerged, including the use of electro-shock therapy, and patients were often committed for life, without any efforts to rehabilitate them.

The report suggested that mentally ill persons would instead benefit from being placed in small group homes, and that their care could be complemented by specialist community services.

While studies have found that deinstitutionalisation has generally been successful in promoting rehabilitation, there is also considerable evidence that the process forced many mentally ill persons out onto the streets, with nowhere else to go. Many such people ended up committing crimes and found themselves behind bars – essentially criminalising the mentally ill.

Though funding for mental health has generally increased over the last decade, recent funding cuts to mental health services, housing and welfare mean that Australians suffering from mental health conditions will lose access to crucial support services, potentially increasing their propensity to commit crimes.

The government recently drafted the Social Services Legislation Amendment Bill, which is expected to save $29.5 million across four years.

The Bill proposes stripping those accused of ‘violent crimes’ of social security payments on the basis that these people are already being cared for on a permanent basis in live-in facilities – and therefore do not require any extra monetary payments. Social Services Minister Scott Morrison says that the facilities themselves will continue receiving government funding.

But mental health experts have cautioned that the legislation will ‘equate people in state care with people who are guilty of very serious offences,’ and further, that people will be left without any financial support if they ever leave the facilities.

Criminal lawyers have also warned that the laws could negatively impact upon those who are found ‘not guilty’ of criminal offences due to their mental incapacitation.

Another recent study found that spending on schizophrenia is particularly limited – especially in remote areas, where Indigenous people are three times more likely to suffer from the illness than the general population.

Furthermore, Australia lags behind most OECD countries in funding mental health services. Whereas most countries spend between 12 – 16% of their health budget on mental health services, Australia spends just 8%.

At the same time, the cost of incarcerating those with mental health conditions costs the public billions of dollars every year.

Perhaps some of that money could be better spent on a co-ordinated diversionary solution which would enable people to get help early on.