Like many countries, Australia calls the governmental departments in charge of its prisons "Corrective" or "Correctional" services. Also like other countries, this framing of their purpose, the idea of prison being a place where men and women are reformed ("corrected") for a successful reintroduction into society, is a bad joke everyone is in on. According to the Australian Bureau of Statistics, more than half of the people in prison have been imprisoned before. Clearly it's not working.
Given such a poor success rate of fulfilling their stated function it's not surprising that prisons fail to provide adequate care to inmates who suffer from a psychiatric disability. This is important because, as a 2012 study by the Australian Institute of Health and Welfare (AIHW) revealed, 44 percent of male and 56 percent of female prison dischargees have been told by a professional that they have a mental disorder. In other words, roughly half of all Australian prisoners require some sort of mental health care.
By law they're entitled to "reasonable access within the prison or, with the Governor's approval, outside a prison to such special care and treatment as the medical officer considers necessary or desirable in the circumstances." In reality such care and treatment is haphazardly achieved. Some get it and some don't. In the AIHW survey almost half of the female respondents and 35 percent of the male ones reported no change in their mental health after their time in prison. Seven percent of women and 9 percent of men said it got a little or a lot worse.
Roughly half of all Australian prisoners require some sort of mental health care.
Aboriginals and Torres Strait Islanders constitute a disproportionate percentage of the prison population (27 percent compared to 3 percent of the general population) and Indigenous Australians who aren't in prison lack access to adequate or appropriate mental health services. So what you have here is a "correctional" system that fails even to accomplish it's purported purpose saddled with the responsibility of being, too frequently, the first place of treatment for disabled Indigenous Australians.
Recent research in Victoria had 72 percent of male Aboriginal prisoners and 92 percent of female Aboriginal prisoners meeting the criteria for a diagnosis of a major mental illness. As reported on theconversation.com, other states had similar findings.
This is a huge problem. Especially give even the first step to treatment—the diagnosis of the individual—is riddled with issues.
For instance the AIHW report on prisoner health found that 21 percent of the Indigenous people entering prison expressed high or very high levels of distress. Meanwhile, the Australian Bureau of Statistics (ABS) 2012-13 survey on the health of Aboriginal and Torres Strait Islanders found that almost one third (30 percent) of Aboriginal and Torres Strait Islander peoples aged 18+ reported high/very high psychological distress while outside of prison.
Now, a blank reading of that would lead you to the bizarre (and incorrect) conclusion that Indigenous Australians entering prison are less mentally distressed than those living at home.
VICE spoke to Patrick McGee, co-chair of the Aboriginal disability justice campaign, about this discrepancy.
"There's a significant gulf between white Australia and the cultural specificity of the way we ask and answer questions, and Indigenous Australia, which has a completely different cultural response to these things," McGee told VICE.
72 percent of male Aboriginal prisoners and 92 percent of female Aboriginal prisoners meet the criteria for a diagnosis of a major mental illness.
"We have a culturally bound definition of what 'distress' means. To an Indigenous Australian from a remote community who doesn't have English as their primary language, who may have only come into contact with government services at the time of their arrest—their concept of distress might be very different from what you or I would imagine," McGee added.
A member of the AIHW who agreed to speak off the record but said it was OK to pass on their analysis told VICE the first reason for the difference was that the ABS used a different questionnaire ( the Kessler Scale was used for both but the ABS used the K5, which has five questions, and not the K10, which has ten). Secondly, the member said, as a rule prisons vary in terms of the culturally appropriate systems they have available to Indigenous inmates. Without the correct sort of intermediary it can be difficult to overcome cultural misunderstandings as to what constitutes a mental illness.
The opinions of both Patrick and the AIHW fall in line with those expressed in a 2012 study published in the Medical Journal of Australia. "Indigenous concepts of mental health tend to be broader than psychological distress and behavior problems, and are usually described using the term 'social and emotional wellbeing,'" the study states. "This term acknowledges the importance of factors beyond the individual, such as cultural identification, spirituality and the community."
But even if prisons were to overcome all cultural barriers to mental health assessment, the meager resources devoted to mental health care for Australia's prisoners are chronically overburdened. Prisoners are not serviced under Medicare (Australia's system of universal healthcare) but rather by the Justice system in each state. In Victoria and Western Australia (WA) mental health beds for prisoners typically operate at full capacity, meaning there are long waits for treatment. This is particularly problematic when there are emergencies involving the simultaneous admittance of multiple patients requiring acute psychiatric care.
In WA these events are called "Code Yellows" and Australian Medical Association WA psychiatry spokesman Paul Skerritt told the West Australian that when they happen, the directive to find space in full wards meant unit administrators were "encouraged to kick people out who aren't ready to go."
But it's not just beds. VICE spoke with Jonathon Hunyor, the principal legal officer with the North Australian Aboriginal Justice Agency, about the ability of staff at prisons to assess symptoms related to mental illness. "There's undoubtedly quite a lot of low-level mental illness, particularly things like depression, that are not routinely picked up," he said.
Without the correct sort of intermediary it can be difficult to overcome cultural misunderstandings as to what constitutes a mental illness.
Prisoners are given an initial assessment of mental wellbeing upon entrance, he said, but there isn't regular screening. "It's not always that it's being missed but that it almost isn't looked for."
An alarming case of this from three years ago was detailed in a Sydney Morning Herald story. New South Wales (NSW) barrister Tania Evans reported that one of her clients was "a complete psychotic" but that he managed to spend months in jail with no visit from a psychiatrist because he didn't request one, and inexperienced staff didn't identify the signs of his condition.
And with regards to treatment there are often mistakes. A common misunderstanding when talking about prisoners with a disability is the difference between a psychiatric disability and a cognitive one. As Patrick McGee explains it, "Psychiatric disabilities are a medical illness that can be treated—cured in some cases—but can always be more or less managed with both medication and psycho-social activities."
But the same is not true for people with cognitive impairment. These are people with intellectual disabilities like acquired brain injuries and fetal alcohol syndrome. In cases such as these, care and monitoring are helpful, but there are limits to what they are able to achieve in terms of looking after themselves and behaving within cultural norms.
For them the kind of outpatient mental health treatment offered by the best prisons (where psychiatric professionals case plan a prisoner's medication, therapy, and follow up on crisis calls) is simply not enough.
An example of someone with cognitive impairment receiving inadequate treatment in prison is the 23-year-old Aboriginal man identified as Mr. KA in the Australian Human Rights Commission 2014 report into inhumane detention and the rights of people with disabilities. Diagnosed with epilepsy and brain injury at 13 months, and intellectual impairment at around six years old, his violent tendencies escalated from aggressive behavior with other children to the alleged dismembering of a puppy and, finally, to the crime that sent him to prison—the stabbing death of his uncle.
Even though he was found unfit to stand trial due to mental impairment, and was returned a qualified verdict (a special acquittal on the grounds of insanity) the report says he was "committed to custody in the Alice Springs Correctional Centre, because there was no practicable alternative considering his circumstances."
On October 6, 2012 Mr. KA bashed his head into the wall of his cell until it bled. Six officers were required to restrain him. His guardian noted in November 2013 that there were 16 occasions where he had been tied to a chair for at least an hour and injected with a tranquilizer. On an average day he spent 16 hours a day in isolation in max security, and was frequently shackled when he was outside his cell.
They effectively got the full-blown mental-asylum treatment—Victorian-madhouse-style.
The Human Rights Commission's report details three other cases . All of them involve Aboriginal men staying in correctional services for longer than their sentences called for because there was no safe way to release them into the community and, because the Northern Territory doesn't have a proper forensic mental health service, nowhere more appropriate to place them. So rather than being held in a prison where they could receive "reasonable access" to "special care" in regards to a cognitive disability, they effectively got the full-blown mental-asylum treatment—Victorian-madhouse-style.
Those cases might seem like the sharp end of the issue but the problem is ongoing—particularly in the Northern Territory, Queensland, and Western Australia.
"One of the saddest things is dealing with the families and the mothers of some of the young men who are in prison," Jonathon Hunyor said. "And they obviously love their son or their brother. And they recognize that that person needs more help than they can give. And it's tragic—the family feels they are failing."
Hunyor said this extends into people who suffer from something that other than a cognitive impairment, who could respond to treatment. "A client [of mine] with schizophrenia spent much longer in prison than he would've on a regular sentence. And there were real concerns raised about the extent of mental health care he was provided over those years in prison, and the lack of things like a proper psycho-education regime for him."
The Aboriginal Disability Justice Campaign is dedicated to stamping out the use of prisons as asylums, releasing a statement, which reads, "There are practical alternatives. In Victoria and NSW, disability services operate specialist accommodation and support programs backed by a wide body of international research."
It's been argued the way forward for criminals suffering from both cognitive and psychiatric issues is community diversion, screening people when they first encounter the justice system, improving access to out-of-prison care for prisoners, and providing better care-on-release services.
And indeed many organizations are dedicated to just that: covering all issues from prisoner welfare to sentencing reform. But there is a relentless back and forth. Tough on crime remains an effective political position and in the past this has resulted in the rolling back of successful policies that diverted the mentally ill from prison, like when Queensland ditched its successful Drug, Murri, and Special Circumstances Courts or when the Northern Territory cut funding for Aboriginal legal services.
Australia's prison population, and the number of prisoners per adult in the population, are both at a ten-year high. Western Australia is on the brink of introducing one of Australia's toughest sentencing laws yet, involving a three strikes rule and yet more punishing mandatory sentences. Earlier this year former Prime Minister Kevin Ruddwarned Australia it was "facing an Indigenous incarceration epidemic."
Given the lay of the land prisons in Australia will remain and perhaps even gain greater significance as the de facto mental health clinics of Australia — already overburdened, this a dangerous future. There is some hope; all the people we spoke to all referred to the justice reinvestment scheme, which "involves the redirection of resources from Corrections budgets to various forms of community provision". It has some popularity overseas.
Hunyor described the tension between law and order and treatment like this, "There's a genuine need to balance community safety with the rights of the individual."
However, "When we want to get serious about trying to make the community safer we will have to start dealing with the causes of offending. And recognize that where people have mental illness and cognitive impairment, that is contributing to their offending, that treatment is going to be a lot cheaper and more effective than just locking people up."
Follow Girard on Twitter.