Prisons psychiatrist says NSW Corrections failing mentally ill inmates

Mentally ill inmates in the NSW Corrections system should be the sole responsibility of the prisons health agency, not prison officers, a leading forensic psychiatrist says.

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

Kerri Eagle, a frequent expert witness at coronial hearings, says radical change is needed in the care and supervision of mentally ill prisoners, whose needs should only be met by people with clinical training.

Her call follows an ABC investigation that reveals dozens of NSW coronial findings identifying failures in the care of prisoners with mental illness since 2015.

Staff from two agencies — Corrections Services NSW (CSNSW) and Justice Health — currently assess how inmates in crisis are housed and treated.

"[Justice] Health should be managing health conditions and Corrections (CSNSW) should not be responsible for health conditions," Dr Eagle said.

"[Corrections] need to be responsible for helping identify people who are vulnerable and in distress or have health conditions but, once identified, Health should be the lead agency in managing all of these problems."

'No evidence' to support current system

Dr Eagle is a clinical director for Justice Health but spoke to the ABC as a private practitioner.

Currently, inmates identified as at risk of suicide and self-harm are referred to the Corrections officer-in-charge.

That officer develops an immediate support plan (ISP) to assess the prisoner's risk, where they should be housed, and the level of observation needed.

That often involves sending an inmate to a "safe cell" where hanging points are minimised, and inmates are monitored via CCTV and in person.

The ISP remains until the prisoner is reviewed by a risk intervention team (RIT) made up of two staff from CSNSW and one from Justice Health — usually a guard, a CSNSW services and programs officer and a general nurse.

Disputes about how the prisoner should be managed are referred to the prison governor to decide.

"The RIT system is in and of itself a system that's run by Corrective Services for the benefit of Corrective Services," Dr Eagle said.

"There's no evidence for it in terms of a health intervention."

CSNSW rejected a recommendation from the 2021 coronial inquest into Bailey Mackander's death that RIT teams should include a psychologist, or at least access to their advice.

Dr Eagle said correctional officers did not have the skills or training to make judgements about mental health.

"Mental health practitioners are properly trained and qualified to assess people's mental state, their mood, their level of distress, and their clinical needs," Dr Eagle said.

"If you're not doing that assessment, then you're never going to understand why the person is experiencing the distress and suicidal ideation.

"So any attempt then, without that comprehensive assessment of their mental state, to suggest that the person's risk has reduced or been addressed is superficial and meaningless."

Inquests find CSNSW unable to provide adequate care

People with serious mental health conditions are vastly over-represented in prison.

Almost half of people entering NSW prisons have had a mental health condition, according to 2020 AIHW data, with First Nations people having even higher rates.

Of the prisoners with a mental health condition, half had been treated for depression, 39 per cent for anxiety, 18 per cent for schizophrenia and 14 per cent for bipolar disorder.

A series of inquests have determined NSW inmates died in prisons when they should have been in specialist care.

"This inquest highlights that CSNSW is not and should not be placed in a position to care for a mentally ill person," said the coroner investigating the 2021 death of Simon Cartwright after he waited 17 days for a mental health bed.

Forensic psychiatrist Jeremy O'Dea told another inquest into the death of an inmate known as MH that governments were not prepared to provide funding required to meet demand.

"Prisons are the new asylums and the level of psychiatric morbidity within prisons is enormous," he said.

"Unfortunately, in closing psychiatric beds, severe mental illness hasn't gone away; it's just been relocated."

Dr Eagle said Justice Health was "committed to ending involuntary treatment in custody", but it required high-level co-operation from all health and justice agencies.

Currently, inmates can be scheduled and transferred to a mental health facility, but multiple inquests have heard the wait lists are long and doctors can be reluctant to make referrals for beds that are not available.

Dr Eagle said medical staff in prison hospitals had to defer to Corrections staff on security matters, which constrained care.

"We are visitors in their house … Corrective Services has the ultimate control of a jail," she said.

'Complex' intersection of health and justice

In October 2023, the NSW government committed to an additional 109 forensic mental health beds over four years, increasing capacity by 50 per cent.

Dr Eagle said a key barrier to moving more prisoners into mental health facilities was that, under current legislation, inmates remained the responsibility of CSNSW.

"Corrective Services has to accompany that patient into the mental health ward and mental health wards don't want Corrective Services officers in the ward and they don't want patients being handcuffed to the bed," she said.

Asked about Dr Eagles' comments, a CSNSW spokesperson said it worked collaboratively with Justice Health through "multidisciplinary teams" to deliver mental health services.

"The intersection of mental health and the justice system is complex, and meaningful progress requires a coordinated, whole-of-government response," the spokesperson said.

A spokesperson for Justice Health said it was "committed to maintaining health principles and continuing to work closely with CSNSW to further identify and address risks and improve access to treatment."

Corrections Minister Anoulack Chathivong declined an ABC request for an interview.

"I expect people in custody to have access to appropriate healthcare and mental health support, and I recognise the need for agencies to work closely together to deliver those services," he said in a statement.

He said specific questions about clinical care, treatment models and operational arrangements were matters for the relevant agencies.