People with mental illness falling through the cracks

This month, in response to the pressing need for more supervised care, the Dunedin Night Shelter Trust, of which Mr Brown is chairman, has opened Phoenix Lodge. The supervised, rental accommodation takes ex-prisoners for three months, giving them a stable, supportive place to live while they are helped to reintegrate into society. But it has only six beds.

Today, with so many people with mental illness falling into the criminal justice system, their health care, including mental health, is split between the Department of Corrections, which runs prisons, and the Ministry of Health through district health boards (DHBs).

The department employs nurses and contracts others such as dentists to provide primary health care. The DHBs run public health promotion and preventive services such as communicable disease control, as well as secondary and tertiary health care including specialist mental-health services and alcohol and drug services.

But problems and critics abound.

Even what would seem to be basic - effectively identifying which prisoners have mental illness - has taken 13 years to materialise.

In 1999, Corrections commissioned a report which for the first time quantified the high rates of mental illness in New Zealand prisons.

Compared with the general population, inmates are 23 times more likely to have a schizophrenic disorder and 18 times as likely to be suffering from post-traumatic stress disorder. The stress disorder rates are 28 times more prevalent among women in prison.

The report said the high level of need was "quite beyond the capacity" of the prisoner mental-health services that then existed. It called for a "significant increase in mental health provision" and recommended screening techniques be introduced to identify who had mental illness and to what degree.

Eight years later a screening tool was given a trial, and Corrections said although it wanted to implement it nationwide the funds were not there to do so.

In June this year the department rolled out its mental-health screening tool, which it said "lifts Corrections' ability to detect mild or moderate mental illness in prisoners".

The department has been unable to say how effective the tool has been since it was introduced.

Corrections' director of offender health Bronwyn Donaldson said the department had made "significant progress" since the 1999 report.

All prisoners with significant health needs have a health-treatment plan which can include, if needed, placement and care in a forensic psychiatric facility.

Corrections worked closely with district health boards to ensure the care prisoners received was "equivalent to that provided in the community", she said.

But others disagree.

Two years ago the Ministry of Health's National Health Committee said "service gaps are built into the [prison health care] system and people cannot help but fall through" both inside prison and when they are released.

The committee said its investigation had "raised the question of whether any agency charged with custody can or should be a health provider". It believed there was a "strong case for transferring responsibility for prison primary health care from the Department of Corrections to the health sector".

The call was repeated this year by Wellington-based Dr Paula King, who said such a transfer of responsibilities had led to better health care for prisoners in England, Wales, France, Norway and several states in Australia.

Dr King said New Zealand's Child, Youth and Family service handed responsibility for primary health care of its charges to DHBs in 2009 and had since seen health outcomes "significantly improved".

But as seems to be the way when it comes to prisoners, it is unlikely to happen any time soon.

Minister of Corrections Anne Tolley and acting Minister of Health Jo Goodhew both said they favoured the status quo.

At the same time, however, the call from various quarters to effectively tackle the causes and repercussions of mental illness among prisoners and former inmates is growing louder.

Kim Workman, executive director of Rethinking Crime and Punishment, which promotes debate about the justice system and alternative forms of punishment, says significant change is needed if we want prisoners who, when they are released, are not a burden on or danger to society.

A former head of the prison service, Mr Workman said an article in the Otago Daily Times earlier this year highlighting 23 murders committed by offenders on bail since 2006 had caught his attention.

He obtained the judges' notes on 20 of the cases, which revealed "nearly all had mental health and drug and alcohol issues", Wellington-based Mr Workman said.

"If someone had said 'Let's deal with the causes', some of these murders could have been prevented.

"Our prisons have become de facto institutions for the mentally ill ... and those with serious drug and alcohol issues."

He wants to see more money spent on treatment and support of prisoners and their families, greater investment in early intervention drug and alcohol treatment, and a trial of mental-health courts similar to the two drug and alcohol courts opened in Auckland this month.

Pushing the cost of incarcerating and treating a prisoner from $94,000 to more than $100,000 a year would save money in the long-term, Mr Workman believes.

"We would be putting back in to the community a functioning human who won't be a burden on society and instead would be a productive member of it."

Equally concerned, but coming from a different perspective, is Garth McVicar, spokesman of the Sensible Sentencing Trust, which advocates policies it believes will reduce crime.

Napier-based Mr McVicar says his organisation wants the number of psychiatric hospital beds increased and will be calling for a government inquiry into the mental-health system.

The number of police callouts that had a mental-health component had risen from 6860 in 2002 to 10,734 in 2011. And the number of acquittals due to insanity had risen 300% in the past decade, he said.

"In the whole area of mental health, something is going seriously astray," Mr McVicar said.

In the meantime, while the poor mental-health of prisoners and former inmates is not in anyone's interest, the complexity and paucity of solutions remains, foremost, the stark, moment-to-moment reality of those living under its shadow.

When Vincent first got out of prison earlier this year he wanted to go straight back inside.

"I admit I've been institutionalised," he said.

"It's in my comfort zone. I feel safe in there, locked away where no-one can get at me." And without support on the outside it is too easy to get into trouble again, he says.

"A lot, when they get out, say stuff it, I'm going to get on the juice and drugs." But Vincent says he wants a future that is "out of jail, crime-free and mentally well".

He has interests and aspirations. He quite enjoyed being a cook in the Air Training Corps as a teenager. And he earned some maritime certificates through Otago Polytechnic after his time at Cherry Farm and before he "went off the rails".

Two weeks ago he moved into Phoenix Lodge.

"A friend of mine, he's there. He's doing well. We want to help each other."