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

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