Prison or mental health institution?

In an editorial in the latest issue of the Medical Journal of Australia, Dr Paul White, of the Queensland Centre for Mental Health Research, and Dr Harvey Whiteford, of the University of Queensland, have highlighted the disturbingly high rates of mental illness in prison inmates.

Some mental health researchers argue that there has been a recent transmigration of people from psychiatric beds to remand centres or prisons.

Australian and New Zealand studies have shown that many people involved in the criminal justice system have had psychiatric contact before entering the system.

In addition, the authors say the rates for all psychiatric illnesses in the prison population are markedly higher than those observed in the community.

"There is no doubt that many people with serious mental illness are not being managed well in the community," say the authors.

The Federal Government's recent $1.8 billion commitment towards mental health reform over five years provides a clear opportunity to improve prison mental health services.

"This must include…court diversion programs and well resourced inpatient and community forensic services that link mental health, judicial and correctional services, and provide specialist pre-release assessment, consultation and liaison for clinical managers," say the authors.

Diversion from the criminal justice system of mentally ill people who have committed minor offences is one of the few opportunities for community-based prevention.

Access to stable housing and to appropriate vocational rehabilitation services is essential for functional recovery.

"All of these programs will need specially trained and supported mental health and custodial personnel . . .. Adequate training of other personnel involved, such as court and police staff, is also necessary."

The Medical Journal of Australia is a publication of the Australian Medical Association.