PACIFIC HEADS OF PRISONS CONFERENCE

1. PACIFIC HEADS OF PRISONS CONFERENCE Mental Health Workshop

2. Session Outline • Overview of Prison Health Services in Queensland • 2 Hypothetical cases • General Questions / Discussion

3. 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

4. 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

5. 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)

6. 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

7. Corrective Services Act 2000 • Enables involuntary treatment on medical indication if necessary to avoid harm to self or others

8. 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

9. 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

10. OVER TO YOU! • Does this man suffer from a mental illness?

11. 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

12. Hypothetical Case 1 • Possibility of psychosis • Kept in medical area • Behavioural problems ++ • CCO concerns

13. OVER TO YOU! • How do you manage cases such as this while waiting for specialist psychiatric review?

14. 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

15. OVER TO YOU! • What are possible diagnoses? • What immediate management is required?

16. OVER TO YOU! • What about if this prisoner refuses any form of treatment?

17. 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

18. 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

19. 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

20. OVER TO YOU! • Urgent or non urgent referral in these circumstances?

21. 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

22. OVER TO YOU! • What issues have to be considered with this patient? • Should any treatment be considered for her?

23. Hypothetical Case 2 • Low dose antipsychotic treatment offered and accepted

24. OVER TO YOU! • What treatment and ethical issues are involved here?

25. Hypothetical Case 2 • Due for psychiatrist follow up one week later, but missed due to lockdown

26. Hypothetical Case 2 • Psychiatrist review 1 week prior to release • Condition worsening – increasing aggression • Non compliant with antipsychotic

27. 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

28. OVER TO YOU! • What issues have to be taken into account here?

29. Hypothetical Case 2 • Referred to inpatient care • Returned to centre after 3 days • Due for release in 4 days

30. OVER TO YOU! • What are the imperatives for her management?

31. 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

32. GENERAL DISCUSSION / QUESTIONS

33. THANK YOU