Thursday, December 11, 2008


Jails jammed with mentally ill prisoners

Julie Robotham, Medical Editor, smh

December 11, 2008

COURT diversion programs are keeping mentally ill people out of the criminal justice system, new state statistics show, but there is no evidence this has reduced the high proportion of prisoners living with severe depression, anxiety or psychosis.

John Basson, the statewide clinical director of forensic mental health within NSW Justice Health, said mental health nurses now worked regularly in 21 of the state's approximately 150 magistrates courts and screened 14,000 defendants a year for possible mental illness, including 2000 who underwent more detailed psychological evaluations with the nurse and sometimes a psychiatrist.

Of these 2000, about 1600 were "diverted from the criminal justice system into the mental health system", Dr Basson said. "They've come in the wrong door in our view. They were mentally ill, were feeling very disturbed and unhappy. They've had false perceptions and they've misbehaved and got themselves into court."

In the 400 cases where magistrates insisted on a custodial sentence, he said, "usually the reason is the seriousness of the crime". "The safety of the general public is a prime consideration. If we're diverting someone we have to divert them to a place where they will be safe, where their relatives and friends and the general public will be safe."

The statistics, to be published in Justice Health's annual report, illustrate the immensity of the task of tackling psychiatric problems in the justice system.

About 43 per cent of the constantly changing prisoner population has a mental illness, a 2005 study from the University of NSW found. Women and those on remand are even more likely to be affected.

But despite the growing scale of court diversion, there is still no proof that the proportion of mentally ill people in the state's jails is falling, or that the program - started in 2002 - has reduced crime rates.

Dr Basson said he was encouraged by evidence from Britain that suggested court diversion plus community treatment had reduced the number of homicides committed by people with psychiatric disorders. But comparable figures had not been collected for NSW.
Jane Sanders, the principal solicitor at Shopfront Youth Legal Centre in Darlinghurst, said she had seen an improvement in mental health awareness among those working in the criminal justice system. But sometimes magistrates were reluctant to make diversion orders because they feared the treatment would not be adequately enforced.

She said community mental health teams still appeared unwilling to take on people with the most intractable disorders and it was difficult to organise full psychiatric assessments for people who needed them most. She said despite the experience and skills of mental health nurses attached to courts, magistrates preferred reports from psychiatrists, because these gave a confirmed diagnosis.

Such assessments usually had to be arranged privately and cost up to $1000, she said. "[That] has to come out of the Legal Aid budget and that's a huge expense."

Ms Sanders suggested establishing an organisation apart from the Probation and Parole Service to make pre-sentencing psychiatric reports.