People with serious and complex mental health conditions languishing in NSW prisons

New South Wales (NSW) psychiatrists are calling for key reforms to the state’s corrections system to reduce isolation and give prisoners the same access as the public to mental health support.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) NSW Branch has urged a rethink how mental health care is delivered in detention settings and acknowledged sustained advocacy from RANZCP members to improve mental health services in the justice system.

A series of ABC investigative reports into coronial inquests show that placing acutely mentally unwell prisoners into monitored isolation cells, instead of providing immediate care, compound their symptoms and put them at higher risk of intentional or unintentional self-harm, or even death.

RANZCP NSW Branch Chair Dr Ian Korbel said 8% of the more than 14,000 people in NSW prisons and detention settings experience a psychotic disorder.

“The current system prioritises security over care,” Dr Korbel said. 

“We are incarcerating a large number of people with acute mental health needs and not meeting them with comprehensive services or pathways to provide treatment through to recovery.

“There simply isn’t capacity in NSW’s prison system right now to provide quality mental health evaluation and care to everyone that needs it – psychiatrists have been trying to sound the alarm on this for years.”

Dr Korbel said early intervention and specialised programs that allowed judges to divert patients from the criminal justice system into mental health treatment had successfully reduced recidivism among those with a mental illness. A recent study shows that, following a diversion program, only 38% of people reoffend (a 12% reduction). 

“These more holistic approaches provide care, psychosocial support, and help offenders, especially who are young, connect back with their community and reintegrate with society, which should be the fundamental aim of the justice system,” Dr Korbel said.

“We can’t continue to hope that locking up those with mental health conditions will make the problems go away. Prisons are not the right place for mental health treatment, and many of the critical decision around care and escalation are not made by mental health specialists and clinicians, which must change.”

Dr Korbel said the issue was also one of human rights.

“We can’t have this conversation without mentioning the high rates of incarceration of First Nations people and the need for responsive culturally safe services that are, sadly, often sparse or hard to access,” he said.

“Programs led by Aboriginal-controlled, and community organisations are critical - they help empower children and young people who have grown up in poverty and with intergenerational trauma, and connect them with culture, kin and community. 

“You cannot punish trauma out of a child, but you can make a significant difference by fostering a more equitable system that recognises and addresses the specific challenges faced by Indigenous youth.” 

Dr Korbel said the issue wasn’t isolated to NSW and represented a national problem.

“We need both State and Federal Governments need to consider the impact of continually putting mentally unwell members of the community into prisons without also investing in adequate, culturally safe pathways for recovery. Without that, many will continue to return to the justice system,” he said.

“Prisons don’t fix problematic or damaging behaviour, but the right mental health treatment can. Deliberate, long-term systematic changes would not just benefit people who are incarcerated, but reduce recidivism and help keep our communities safer, too.”

ENQUIRIES: For more information, or to arrange an interview, call on +61 437 315 911 or email media@ranzcp.org.

The Royal Australian and New Zealand College of Psychiatrists is a membership organisation that prepares medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises governments and other groups on mental health care. For information about our work, our members or our history, visit www.ranzcp.org.

In Australia: If you or someone you know needs help, contact Lifeline on 13 11 14 or www.lifeline.org.au or the Suicide Callback Service on 1300 659 467 or www.suicidecallbackservice.org.au.

In New Zealand: If you or someone you know needs help, contact Lifeline NZ on 0800 543 354 or www.lifeline.org.nz or the Suicide Crisis Helpline on 0508 828 865 or www.lifeline.org.nz/suicide-prevention.