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- 16 November 2006
Correctional Centres Mental Illness Treatment
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Page: 4205
The Hon. Dr ARTHUR CHESTERFIELD-EVANS [8.02 p.m.]: The Public Interest Advocacy Centre represented the family of Scott Simpson at the coronial inquiry into his suicide in custody, and Coroner Dorrell Pinch handed down her findings on 17 July 2006. Mr Simpson was seriously mentally ill at the time of his death, and the Coroner was critical of the fact that Mr Simpson did not receive adequate and timely medical care for the treatment of his mental illness. In presenting her findings Coroner Pinch said that "more could have been done, should have been done, and it wasn't." Mr Simpson had been recognised as at acute self-harm risk by his treating psychiatrist, but was not transferred to the psychiatric ward of Long Bay Prison Hospital. Instead, Mr Simpson was kept in solitary confinement for the final 26 months of his life. The Coroner made important and broad-reaching recommendations, including that inmates diagnosed with a serious mental illness should only be placed in solitary confinement in exceptional circumstances and for limited periods.
The Human Rights and Equal Opportunity Commission also made a submission to the Coroner on the treatment of Scott Simpson. The commission made submissions that the treatment of Mr Simpson during his incarceration was inconsistent with the rights to humane treatment in articles 7 and 10 (1) of the International Covenant on Civil and Political Rights in the following respects: one, the prolonged detention of Mr Simpson in segregation, particularly in light of his mental illness; two, the failure to transfer Mr Simpson to hospital; and, three, the failure to provide adequate psychiatric care to Mr Simpson while he remained in the correctional environment. The following recommendations were made by Magistrate Pinch, Deputy State Coroner. I seek leave to incorporate those recommendations in Hansard.
Leave granted.
To the Minister for Health
1. In relation to inmates of Correctional Centres who have been diagnosed with a mental illness and require treatment in hospital:
A. There should be a standardised procedure for admission to hospital.
• That procedure should be based on the provision of Sections 97 and 98 of the Mental Health Act 1990 and the completion of a Schedule Three form. The procedure should be set out in writing and circulated to all visiting consultant psychiatrists and Justice Health Staff.
• The members of the Committee making the decisions about hospital admission (which has superseded Dr White's role) should hear personally from at least one of the medical practitioners who have examined the prospective patient and completed the Schedule.
B. There should be standard criteria for admission to hospital to be taken into account by the Committee. The criteria should be set out in writing and circulated to all visiting consultant psychiatrists and Justice Health staff.
(a) The criteria should be based on the Principles for the Protection of Persons with Mental Illness, namely that persons serving sentences of imprisonment for criminal offences, or who are otherwise detained in the course of criminal proceedings, and who are determined to have a mental illness, have the right to the best available mental health care.
(b) Specifically, in addition to the inmate's present clinical condition, the committee should have regard to:
• any likely deterioration in the person's condition;
• whether the person has been placed in segregation and, if so, for how long;
• any non-compliance with medication;
• the treatment options available outside a hospital environment, including the frequency of access to a psychiatrist.
C. Those persons in respect of whom a Schedule Three has been completed but who cannot be immediately placed in hospital should be placed under the care of a nominated appropriately qualified medical practitioner, who will take responsibility for their treatment and who will provide up-dated reports for subsequent meetings of the Committee.
2. In order to ensure that all relevant information is placed before Justice Health staff at the time of the Reception Assessment of inmates ie. prior to the arrival of Justice Health files, a Discharge Summary should be completed by Justice Health staff on all inmates diagnosed with a mental illness within 14 days of their discharge. This Summary should then be made available in electronic form for access by Justice Health Reception staff in the course of all subsequent assessments on admission.
3. Given that decisions about placement within Correctional Centres and the release of forensic patients are made in other States by either an independent Tribunal such as the Mental Health Review Tribunal or by superior courts, a review should be conducted as to whether the present system of Executive responsibility is best suited to ensure the placement and movement of inmates on clinical grounds. The review should specifically assess whether, under the present system, the decision-making process about the movement of forensic patients ensures the best use is made of the limited available hospital beds.
To the Minister of Health and the Minister of Corrective Services
4. In relation to inmates with a mental illness, an integrated approach between Justice Health and the Department of Corrective Services should be adopted in decisions about placing those inmates in segregation and reviewing the relevant Segregation Orders to ensure that the consequences for the inmates' mental wellbeing are taken into account. As part of that approach:
• an appropriately qualified medical practitioner nominated by Justice Health should examine the inmate within 48 hours after the initial placement in segregation and a written report should be forwarded from Justice Health to the Department of Corrective Services detailing any clinical concerns and recommendations to address those concerns;
• a similar assessment should then be conducted on a weekly basis and a written report forwarded to the Department of Corrective Services detailing any clinical concerns and concomitant recommendations.
To the Minister for Corrective Services
5. The Department of Corrective Services should adopt the policy that inmates diagnosed with a mental illness should be placed in segregation only in exceptional circumstances and for a limited period.
6. The Department of Corrective Services should ensure that Discharge Summaries on all inmates are completed and can be accessed by Reception staff within a reasonable time, at least within 14 days, after an inmate's discharge.
7. The Department of Corrective Services should ensure that sufficient resources are allocated to the Working Party for the Reduction of Hanging Points, including the appointment of a full-time manager, to enable the current work of the group to be carried out at the earliest opportunity. Additionally, the scope of works should be expanded to include, on a priority basis, all cells in maximum and medium security institutions.
8. The Department of Corrective Services should implement a policy to ensure that any violent or other aberrant behaviour by an inmate at the time of reception into a Correctional Centre is immediately brought to the attention of the Justice Health Staff member conducting the reception assessment of the inmate. This should occur irrespective of whether the assessment has been completed.
9. The Department of Corrective Services should note that the policy in relation to immediately cutting down an inmate found hanging and commencing resuscitative efforts was not followed in this case. The Department should consider the best way of reinforcing that the policy should be complied with in all circumstances.
To the Attorney General
10. A protocol should be developed between the referring courts and the Mental Health Review Tribunal to ensure that notifications of the court's decision that a person has been found not guilty on the grounds of mental illness occurs at the earliest possible time and, at the outside, no later than seven days.
This is a damning report by Magistrate Pinch, Deputy State Coroner, chronicling the systemic failure of the handling and treatment of people with a mental illness in New South Wales who are a danger to themselves and others because of their condition. I call on the Government to formally and publicly address the criticisms and failings as elucidated by Magistrate Pinch. I note that Minister Hatzistergos replied to my question asked in the estimates hearing of 4 September 2006. I urge that this matter be addressed as soon as possible.
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