Mental health patients in jails

An average wait of 50 days for a bed at Auckland’s forensic psychiatric service the Mason Clinic means many would-be patients are held in prison before they can be admitted.

In the past 12 months, the wait time for a bed for patients with severe mental health issues has doubled from an average of 25 days up to 50, data released by Te Whatu Ora shows.

Chief Ombudsman Peter Boshier said he was “deeply concerned” about psychiatric care being defaulted to prisons and it was an ongoing issue between the Department of Corrections and the Ministry of Health.

The Mason Clinic holds people with mental illness or intellectual disability, some of whom are extremely dangerous and have been detained as patients.

The clinic covers the Northern region, from the Bombay Hills up to the top of the North Island, and for offenders with intellectual disabilities it covers the entire country.

Since July 2019, the Health and Disability Commissioner said 34 complaints had been received about the Mason Clinic, with two of those citing a lack of access to services as the primary issue.

The lack of beds in mental health forensic services was a “chronic issue”, deputy health and disability commissioner Dr Vanessa Caldwell said.

“We support endeavours to ensure that people who need this level of specialist help have access to this as soon as possible.”

While would-be patients wait for a space at a forensic facility, they are often kept in intervention and support units in prison.

These units could be “isolating”, psychiatrist Dr Hiran Thabrew said, and they may not have the chance to see the sun or get fresh air for up to 23 hours a day.

Corrections’ chief mental health and addiction officer Dr Emma Gardner said prisons were “doing all they could” to support people but it did not replace mental health services.

“These units aren’t just for people waiting to be transferred to a forensic unit, they’re for any prisoner at heightened risk of selfharm or who needs a high level of mental health monitoring.

“The units are intended for short-term care however, and we don’t want people in that environment for long periods of time.”

Former public health leader Dr Erik Monasterio said people in acute need of mental health services tended to do “very badly” in prison and their condition was likely to worsen.

“It’s unacceptable that these units are being used as a stop-gap — they’re effectively solitary confinement, which is unethical. These are people who are in the midst of a medical emergency.”

The rates of mental health issues globally have been increasing, Dr Thabrew said, with the Covid-19 pandemic playing a part.

“Despite that, our mental health system hasn’t been keeping up with the increase in demand.”

Psychiatric services have been underfunded by successive governments, Dr Monasterio said, and had to compete for resources with other in-need health services.

“I think there’s limited public sympathy for prisoners. They need advocacy, but most people in need aren’t able to do this for themselves, so people like me attempt to become their advocates.

“To build more space for beds will take seven plus years and we needed these beds years ago.”

In a statement, Te Whatu Ora said the need for more forensic inpatient beds was “wellrecognised across the country”.