PACIFIC HEADS OF PRISONS CONFERENCE

Mental Health Workshop

Session Outline

• Overview of Prison Health Services in Queensland

• 2 Hypothetical cases

• General Questions / Discussion

Prison Mental Health Services in Queensland

• Outpatient Services purchased from Queensland Health

• Queensland Health also have responsibility for inpatient services

• Services provided at two private centres and 7 public sector centres

• One other centre has a private psychiatrist supported by QH mental health worker

Prison Mental Health Services in Queensland

• Historical budgets

• Outpatient service distinct from prison psychologists

• Links with medical and nursing staff

• Facilitate post release follow up of clients of the service

• Focus on psychosis, mood disorder and anxiety conditions

MENTAL DISORDER IN THE NSW PRISONER POPULATION

• 43% of those screened had at least one of psychosis, anxiety disorder or affective disorder.

• Reception (46%) > Sentenced (38%)• Females (61%) > Males (39%)• 9% : psychotic symptoms in previous year• 20% : suffered at least one mood disorder• PTSD most common (26% of receptions,

21% of sentenced)

Mental Health Act 2000

• Emphasis on treatment needs rather than type of offence

• Inpatient care in any Authorised Mental Health Service (security needs influence placement)

• Voluntary and involuntary inpatient care of prisoners

• Involuntary treatment orders don’t apply to prisoners

Corrective Services Act 2000

• Enables involuntary treatment on medical indication if necessary to avoid harm to self or others

Hypothetical Case 1

• 33 year old male

• Armed Robbery x 2

• No family history of mental illness

• Has used amphetamines for last ten years with recent escalation of use

Hypothetical Case 1

• 2 brief admissions to inpatient mental health units in last 2 years

• Hospital diagnoses of intoxication / amphetamine psychosis with background of Antisocial Personality Disorder

OVER TO YOU!

• Does this man suffer from a mental illness?

Hypothetical Case 1

• Received in Prison on Friday afternoon

• Noted to be quite paranoid

• Triaged by mental health service 3 days later

• Concerned about being killed

• Conspiracy of prisoners and officers

• Very anxious

Hypothetical Case 1

• Possibility of psychosis

• Kept in medical area

• Behavioural problems ++

• CCO concerns

OVER TO YOU!

• How do you manage cases such as this while waiting for specialist psychiatric review?

Hypothetical Case 1

• Review by psychiatrist

• Persecutory concerns

• Voices (derogatory)

• Advises he plans a pre-emptive attack to protect himself

• Prisoner agrees to some interim treatment

OVER TO YOU!

• What are possible diagnoses?

• What immediate management is required?

OVER TO YOU!

• What about if this prisoner refuses any form of treatment?

CASE 1 - ISSUES

• Diagnosis

• Acute management

• Voluntary and involuntary treatment options

• Need to consider mental illness in prisoners with behavioural difficulty

• Mental illness may be exacerbated by prison environment

Hypothetical Case 2

• 23 year old Indigenous female

• Common assault and property damage

• Mother of four, all children in foster care

• Currently 29 weeks pregnant

• Sentence of 4 weeks – full time release

Hypothetical Case 2

• Referred to PMHS for behavioural issues

• Past history of 8 brief admissions – diagnosis of personality disorder, substance abuse. No follow up.

• Vague historian; guarded

• Vague concerns about unborn baby

• Non urgent referral to psychiatrist

OVER TO YOU!

• Urgent or non urgent referral in these circumstances?

Hypothetical Case 2

• Psychiatrist review after 1 week (3 weeks prior to release)

• Guarded / suspicious

• Hearing voices from a dead child and another dead relative

• Past history of treatment with an antipsychotic, but nil now

OVER TO YOU!

• What issues have to be considered with this patient?

• Should any treatment be considered for her?

Hypothetical Case 2

• Low dose antipsychotic treatment offered and accepted

OVER TO YOU!

• What treatment and ethical issues are involved here?

Hypothetical Case 2

• Due for psychiatrist follow up one week later, but missed due to lockdown

Hypothetical Case 2

• Psychiatrist review 1 week prior to release

• Condition worsening – increasing aggression

• Non compliant with antipsychotic

Hypothetical Case 2

• Threats to unborn baby which she believes to be “white” and the result of a rape by a Caucasian male

• Unborn baby being influenced by sources of external control

• Food refusal resulting in limited intake

OVER TO YOU!

• What issues have to be taken into account here?

Hypothetical Case 2

• Referred to inpatient care

• Returned to centre after 3 days

• Due for release in 4 days

OVER TO YOU!

• What are the imperatives for her management?

CASE 2 - ISSUES

• Cultural factors

• Ethics of trials of antipsychotics

• Treatment in pregnancy

• Compliance concerns for short term prisoners / community referral

• Different opinions of previous inpatient providers

• Child safety issues

GENERAL DISCUSSION / QUESTIONS

THANK YOU