This article appeared in the Weekend Australian 12 June 2004 p28

Penal prescription
a poor cure

Elisabeth Wynhausen exposes our rising dependence on prisons to take the mentally ill and the repression that results from it.

Scott Simpson was at Sydney's Long Bay jail when he was found dead in his cell, apparently after he hanged himself. By then Simpson, a tormented man described in prison documents as a delusional paranoid schizophrenic, had spent about two years in the high-risk management unit at Goulburn jail, locked in his cell 23 hours a day.

At the official opening of the unit in 2001, NSW Premier Bob Carr boasted that the HRMU- a prison within a prison often called the Super Max-would contain "the psychopaths, the career criminals, the violent standover men, the paranoid inmates and gang leaders".

Carr didn't say that its population would also include prisoners on remand, such as Simpson, who was there for 23 months before he was found unfit to stand trial.

His case is emblematic of our treatment of the mentally ill. Rather than being treated in hospital, thousands of them are now warehoused in prison, part of a political response to crime that has resulted in the nation's jail population rising by nearly half since the mid-1990s.

"The prisons are doing the jobs of the psychiatric hospitals that emptied out all the patients after the Richmond report," says NSW Independent federal MP Peter Breen, referring to the report to the NSW government by David Richmond, now director of the Graduate School of Government at University of Sydney.

For reasons understandable at the time to anyone who had visited the back wards of psychiatric hospitals and seen the terrible consequences of institutionalisation, Richmond's 1983 report proposed progressively shutting down the large psychiatric hospitals in NSW where patients could be involuntarily admitted.

This philosophy had already taken hold in the rest of Australia.

But the policy of the institutionalisation wasn't counterbalanced with the community-based care that Richmond, then a senior public servant, also recommended, which left some mentally ill people fending for themselves.

Critics of deinstitutionalisation, claimed governments were simply using it to cut mental health costs.

This staggering failure of public policy means that those who bounce between the streets and the prisons may find themselves in so-called management units where they are locked in isolation for up to 23 hours a day.

In the HRMU in May 2002, according to documents obtained by Enquirer, Simpson was being kept under observation until he could be transferred to the acute-care psychiatric ward at Long Bay prison in "a week, possibly 10 days".

Simpson was still in the Super Max in March 2003, nine months llater, when Chris Ricardo, a registered nurse at the prison, wrote about him to Anne Doherty, director of mental health services for Corrections Health (subsequently rebranded Justice Health).

"He cannot be given the psychiatric attention he requires at Goulburn. The psychiatrist visits here for only six hours each fortnight," Ricardo informed Doherty."I am concerned about the legal implications under duty of care if this man is not given the recommended psychiatric attention."

In May 2003, another medical professional once again urged the priorities to transfer Simpson out of the unit.

"It appears that little can be achieved in this setting. I think he should be transferred to D Ward Long Bay [prison hospital] as a matter of urgency, especially as his life may be in danger."

That's barely six weeks later, NSW Corrective Services Commissioner Ron Woodham wrote to Simpson's mother, Terri: "I can advise that Scott's placement at the HRMU is considered to be beneficial to him and his future management."

In fact Simpson spent nine more months there before the judge who found him unfit to stand trial ruled that as a forensic patient he must be given psychiatric treatment at Long Bay. According to his family he was relegated to a cell in the segregation unit of the prison, which is where he died on May 7 last year. He was 39.

though he was supposed to be on anti--psychotic medication, the autopsy revealed that Simpson had nothing but 3mg of Panadol in his system. The state coroner is considering if he will hold an inquest.

It would appear the incarceration of the mentally ill for various alleged and proven offences is adding to the prison population and consequently adding to government spending anyway. Last year there were more than 24,000 people in Australian prisons, according to the Australian Bureau of Statistics figures. The number has risen almost 50per cent in a decade, as state politician after state politician campaign on a promise to "get tough on crime".

"Governments are creating laws that criminalise more people, like public nuisance offences," says Debbie Kilroy of Sisters Inside, a Brisbane organisation that supports women in prison."People who are homeless or mentally ill get charged with these offences if they're hanging around in a mall. In Queensland now if a homeless person asks you for a dollar for the bus she can be arrested. Homeless and mentally ill people go to jail after accumulating these types of offences because they are often in the eye of police."

In the Northern Territory, where more than three-quarters of prisoners are indigenous, Chief Minister Clare Martin was re-elected only last month, promising to swell the prison population by locking up itinerants habitually drunk in public. The territories world-class rate of incarceration (512 out of every 100,000 people) is already more than twice that of Western Australia, it's nearest rival.

NSW has just edged out Queensland for third place. The state is in the grip of a prison-building boom that will see capital expenditure on prisons increase 48.9per cent this year. NSW will spend a total of $928.3 million on prisons, compared with $854 million on mental health.

The pattern was set in the US, where there are three times as many mentally ill people in jail as in psychiatric hospitals, according to a report by Human Rights Watch.

The two-decade prison boom in the US put about 2 million people (most of them black or Hispanic) behind bars. But with estimates suggesting that prison costs across the country rose more than 1000 per cent in 15 years, there are diminishing returns, since two-thirds of inmates are re-arrested within three years of their release.

The Christian Science Monitor reported last month that California, for one, had vowed to stop building prisons and to focus more on rehabilitation. There is no sign of such a change of heart in NSW, though the escalating prison costs around could hardly be called cost effective.

More than 17,000 people a year pass through NSW prisons, which seem to be operating as crime schools. "NSW has the second highest recidivist rate after WA, 44.7 per cent compared with 44.9 per cent returning to jail in two years," says Brett Collins of Sydney-based Justice Action, which advocates on behalf of prisoners.

Eileen Baldry, a senior lecturer in social work at the University of in NSW, says prison numbers are not rising at the same rate in all states, however, "Victoria has managed to reduce the number of people in prison, with no consequent rise in the crime rate," she says." "But NSW they continue to build prisons rather than putting the additional resources into rehabilitation."

The expansion of existing prisons at Cessnock and Lithgow and the building of a $125 million correctional facility elsewhere in the state stands to cost NSW taxpayers an additional $257.7 million over five years (at least on present figures, which are sure to balloon).

In is 40 years in the NSW prison system, the controversial Woodham has come through a series of court cases and official inquiries. He made his mark as the officer in charge of Malabar Emergency Unit, officers to quell riots and disturbances in prisons.

Woodham made the headlines years later. In 1993 the NSW Independent Commission Against Corruption found that Woodham, then assistant commissioner, had acted corruptly in his dealings with informers.

This finding was overturned by the NSW Supreme Court (which essentially decided that the informers Woodham had relied on through the years were unreliable witnesses).

Though the Labour Party had called the Woodham's sacking while in opposition, in 2001 the Labour Government gave him the chance to stamp the system in his image, appointing him commissioner.

"In his four years as commissioner, he has always emphasised security issues," says Baldry. "Nevertheless, even he has expressed extreme concern about the number of mentally ill people in prison."

A 1996 study by Corrections Health found that half the women and one-third of the men in prison in NSW said they had been diagnosed with a mental illness at sometime in their lives.

A subsequent report found that 40 per cent of people admitted to prison have suffered from a mental disorder in the past year. The rate of psychosis was a startling 12per cent, 30 times what it is in the general population.

These figures may vary from state to state, but there is a shocking sameness to the stories about the fate of mentally ill prisoners, who may be treated with the callous incomprehension that conjures up echoes of the insane asylums of the 19th century.

In prisons in Queensland, says Kilroy, "women with a mental illness are kept in crisis support units, locked in isolation 23 hours a day. If they are psychotic, they will be restrained chemically or with body belts and handcuffs."

In Reston prison in Hobart, says Carolyn Dean, who worked there as a reintegration:-ordinator, "there's a young man with symptoms of schizophrenia. Daily he's the butt of jokes and abuse by prisoners and officers. He's teased unmercifully. Prisoners throw things at him. The prison officers aren't trained well enough to deal with mental illnesss. They get really impatient with him. Some harass him."

It is a common pattern, according to Jonathan Carne, and visiting consultant forensic psychiatrist in NSW prisons until he resigned in disgust several years ago."You'd see mentally ill people tormented by prisoners and guards," he says.

John Basson, in NSW director for forensic mental health, tells Inquirer he was appointed last year to do something about it. Though there are still 20 people on the waiting list for the psychiatric ward at Long Bay Prison Hospital, he says, the state Government is not expanding the prison hospital.

"We don't think it's appropriate to lock up mentally ill people 23 hours a day if they've been misbehaving and we talking to Corrective Services about alternatives," Basson says.

He doesn't know or doesn't say if there are other seriously mentally ill prisoners locked up in the HRMU.

Neil Funnelled, a final-year law student at the University of NSW who has written about the Super Max, tells Inquirer that NSW Justice Minister John Hatzistergos has already answered the question in parliament when asked "are there any high-risk prisoners suffering from mental illness… ever placed in the HRMU".

"Yes," the minister said.

Whether or not NSW seems to be leading the race to the bottom, it has to be said that Tasmania is already there, with the prison system that seems to be in free fall.

According to the Productivity Commission's report on Corrective Services for 2003-04 Tasmania had the highest rate of assaults by prisoners on other prisoners, the highest rate of assaults of officers by prisoners, the highest rate of deaths from unnatural causes and the highest rate of escapes from open custody.

Asked about this, a Tasmanian government spokesman said: "[While] it is acknowledged that the increase in Tasmanian assault figures is partly due to an increase in incidents of assault, it must be stressed that improvements in data collection have further increased the figures."

This fine distinctions seem to have eluded the prisoners at Risdon prison. During a siege at the prison last May, a group of prisoners held prison officer and several inmates hostage the 41 hours. The prison was already under the spotlight following a spate of suicides. Five years ago, the coroner recommended that prison authorities remove all hanging points, but this has not been done, says Dean, now spokeswoman for Arison Action and Reform Inc.

The Government seems to concur. "Since the recommendations of the coroner in 2000, all suspension points were removed from cells within the prison hospital. It was identified as virtually impossible to remove all suspension points from other accommodation divisions at Risdon," says the Tasmanian spokesperson.

It seems the situation will be rectified when a new prison is built.

Asked by NSW Greens leader Lee Rhiannon how many mentally ill people were held in solitary confinement in NSW prisons, Hatzistergos said: "The diagnosis of serious mental illness within the correctional system is the domain of psychiatrists employed by Justice Health. Any decision regarding the placement of inmates in beds for mentally ill patients at Long Bay hospital does not involve the Commissioner for Corrective Services."