Justice system criminalising mental illness, psychiatrists say

Australia's peak psychiatrists' body has backed calls to transform mental health care in NSW prisons, including an end to isolating suicidal prisoners in so-called "safe cells".

It follows an ABC investigation into mentally ill inmates who have died after being isolated in a safe cell, purportedly for their own protection.

Readers are advised that this article includes the names and images of Indigenous people who have died, used with family permission.

"Safe cells are a custodial response rather than a health response," Dr Ian Korbel, chair of the Royal Australian New Zealand College of Psychiatrists (RANZCP) NSW branch, told the ABC.

"What people at risk of suicide should have is good, close support with nursing staff, psychologists and psychiatrists. Sometimes they might need medication.

"Often they'll need support and they'll need to be preferably in a cell with other people, rather than by themselves."

Earlier this week, forensic psychiatrist Dr Kerri Eagle called for prison health agency Justice Health, an arm of the NSW health department, to be the lead agency managing mentally ill prisoners.

"It is not appropriate for Corrective Services to be managing those health conditions because their goals are security and law enforcement," she said.

Dr Eagle is a clinical director at Justice Health but was speaking as a private practitioner.

Currently, at-risk inmates are assessed by a team of two CSNSW staff and one Justice Health worker, and inmates sent to safe cells are monitored by guards.

Dr Korbel agreed health workers, not correctional officers, should be assessing and monitoring prisoners with serious mental illness.

"I've worked in the prison system myself, I've seen that we have many caring and good guards that work in the system too, but they're not trained to deal with the sorts of psychiatric problems that we're seeing in prison."

In Victoria, Indigenous groups also want oversight of prison health care transferred to the health department, as recommended by the Yoorrook Justice Commission, with a model of care led by Aboriginal community-controlled health organisations.

Last week, the ABC revealed that 48 NSW coronial inquests since 2015 had identified failures in the care or supervision of people with mental illness. Of these, 14 related to the death of an Indigenous person.

These include interim findings into the case of Tammy Shipley, a 47-year-old Aboriginal woman with schizophrenia who died from water intoxication after spending 10 nights in a monitored safe cell.

She was the third NSW prisoner with schizophrenia to die from polydipsia in less than two years, with 35-year-old Daniel Turnbull also dying in a safe cell just two months earlier.

The RANZCP wants greater focus on diverting people with severe mental illness out of the justice system and into treatment.

Dr Korbel cited a 2019 UNSW study that found NSW prisoners with psychosis who received a court treatment order rather than a sanction were less likely to reoffend.

"We see a lot of people with serious mental illness … who are homeless, living on the streets, and that puts them at risk of committing relatively minor crimes just to survive," he said.

"When they go into care, their rates of recidivism decrease, they can access supports and housing … and we can see them become functioning members of society."

Giancarlo de Vera, CEO of BEING Mental Health Consumers, said the mental health crisis behind bars followed years of under-investment in community care.

They pointed to internal NSW Health documents, released last month, which estimated there was a $600 million annual shortfall for frontline mental health staff.

"We are treating the justice system and prisons as a de facto mental health system," they said.

Asked about Dr Eagle's comments on Monday, Premier Chris Minns defended the delivery of mental health care in NSW prisons.

"It may be not reasonable in all circumstances for a prisoner in psychological distress to be seen by a psychiatrist, at least initially," he said.

"Most of the interaction is with prison staff and is with Corrections officers and that's the nature of prison."

A Corrective Services spokesperson previously told the ABC it "adheres to strict legislative and regulatory frameworks to safely, securely and humanely manage people within its facilities."