Modern prescription for mental illness: go directly to jail

Richard Ackland | SMH | July 29, 2011

"Most are ill people locked in a system that can't provide proper treatment."

A comfortably-off, middle-class woman from a nice suburb suddenly finds herself at the Silverwater metropolitan remand and reception centre. She's been charged with a serious driving offence and is awaiting trial.

The reception centre is a madhouse. It's so crowded people are swinging off the rafters. There are three or four people to a small cell. Our middle-class inmate shares with two others.

There's an Aboriginal woman clearly suffering a dreadful mental trauma, who spends the entire night screaming and bashing her head against the wall. There is blood everywhere.

The lady on the driving charge repeatedly calls the guard for something to be done, only to be told when someone in authority finally gets around to sticking their head in (twice in 12 hours), ''don't worry about it''.

The guards would have seen this sort of scene innumerable times. Someone might die, but the resources can't cope and the system is choked with mentally ill prisoners.

A group of us who attended the most recent forum of the Crime and Justice Reform Committee heard this story from Kat Armstrong, an articulate former prisoner who nowadays works for the Women in Prison Advocacy Network.

Former District Court judge Chris Geraghty, who chaired the lunchtime session of the CJRC, said he quite frequently had to sentence mentally damaged people to jail who said their heads were filled with voices. Sending these people to prison is unlikely to improve their capacity to function. It also compounds the difficulties of daily life for other prisoners and prison officers.

Prison is a concentrate of mental disorder. These illnesses run at three to four times the rate in the prison population that they do in the unimprisoned community. About 54 per cent of women and 47 per cent of men in prison are reported as having been assessed or treated for a mental health problem. This includes anxiety, depression, psychosis and bipolar disorders. The really deeply disturbed inmates have to find room at the limited facilities of prison forensic hospitals. Ninety per cent of women in the reception centres have experienced a mental disorder within 12 months of imprisonment.

In one sense, this is not surprising because the prison population is largely drawn from people with a profile of chronic unemployment, low level of skills and education and drug and alcohol dependence. What has been quietly happening under our noses is that the prisons have become the largest psychiatric institutions in the country, but without the therapeutic resources to deal with the problem.

Prisons are not entirely full of bad people. Most of them are just ill people locked in a system that can't provide proper treatment.

Eighty per cent of women in jail have been subjected to domestic violence, sexual abuse and drug addiction, or all three. Prisoners are released back into the community often in a more damaged condition than when they went in.

Twenty per cent of the prison population is on methadone. Prisoners who are really troublesome are given antidepressants and they wander about like zombies struggling to stay awake. From the prison officers' point of view, they are easier to control in that condition.

It's also pretty horrendous for most prisoners when they are released. They have no job, no skills and no money. Very soon they're back inside. In fact, some released prisoners plan to commit a crime fairly promptly after release so they can get back to prison - the only place where there are daily certainties.

Yet what are the alternatives? There's the MERIT scheme (Magistrates Early Referral Into Treatment), which allows the Local Court to divert people with drug and alcohol abuse away from the prison system and into treatment. It applies at the less serious end of the criminal spectrum.

There's also section 32 of the Mental Health (Criminal Procedure) Act, which also allows defendants to be diverted out of the criminal justice system. But these arrangements struggle to replace recidivism with treatment. In 2007, the latest figures available, just 1.6 per cent of defendants appearing before local courts were diverted under section 32. This does not reflect the numbers of accused, who most certainly would qualify for a section 32 order.

What is really needed is a massive injection of funds into addressing human dysfunctionality somewhere other than in the prison system. Judicial reinvestment is the buzz term.

Of course, the money is not there although there are some encouraging first steps, including a 300-bed drug treatment prison going in at the John Moroney Correctional Centre in Windsor.

At the moment conditions in the system are so dreadful that, as Kat Armstrong put it, ''You do your jail easier if you're off your face.''