Transcript No Slide Title

Prison Mental Health Services in South East
Queensland
as provided by Queensland Health
Robert Pedley and friends
17 May 2006
Foucault quoting Esquoril in ‘Madness and
Civilisation’ [1965]
‘There are few prisons where the raving mad
are not to be found: these unfortunates are
chained in the dungeons beside criminals’
Why?
Never a time when the mentally ill were not
imprisoned.
Our society no different, commensurate rates
to comparable societies-with blips
If not Q-Health who?
Previous systems self contained without links
to wider health community-see diagram
QUEENSLAND FORENSIC MENTAL
HEALTH SERVICE
(QFMHS)
0.9m
il
2.3 mil
MULTIDISCIPLINARY CLINICAL TEAMS
COURT
LIAISON
SERVICE
(CLS)
PRISON
MENTAL
HEALTH
PROGRAM
(PMHS)
HIGH SECURITY
INPATIENT
PROGRAM
(HSIS)
COMMUNITY
FORENSIC
OUTREACH
PROGRAM
(CFOS)
Who?
• Has varied over time but currently we
service the 6 secure facilities in SE
Queensland.
AGCC
BWCC
Borallon
Wolston
Woodford
Maryborough
Who II ?
Numbers are on a steady incline which
reflects the overall number of those
incarcerated.
Generally these numbers reflect the literature
on how many seriously mentally ill will be
in custody. [With exceptions]
Who III?
Dynamic 500-600
•
•
•
•
~ 50 New cases / mth
~ 50 releases/ mth
10 new Ax’s – Week
10 discharges - Week
What [we do and how]
We work squarely within the parameters of
the expectations placed by legislation and
policy on us to treat the mentally ill equally,
regardless of where they are to be found
Our ambitions are thus broadly commensurate
with those of a district mental health service
Concentrating on serious Mental Illness rather
then broader psychological problems
What [we do and how] II
• We triage between 2000-3000 people per
year
• Accept referrals from absolutely anywhere
and from anybody [concentrating on
nursing / psychological]
• Extremely close links and communication
with Court Liaison Service
What [we do and how] III
• Palmer inquiry reminds us not to tolerate
mental illness in custody. It is contrary to
UN standards
• Since 1st March 2002 we can access any
appropriate AMHS.
• Done over 300 times. With relatively few
problems.
• Taken advantage of 2 or 3 / week
• Increasing acceptance of the necessity of
this process from AMHS
What [we do and how] IV
Treatment in correctional facilities is almost
never given involuntarily [there are rare
considered exceptions]
Initial attempts to introduce multi-disciplinary
treatment
Attempt to link up with services upon
discharge
What Now?
Obvious problems in treating serious illness in
this environment
Comments in various inquiries remarking
upon shortcomings
New model of funding with increase as of
July 2006
What Now II ?
Areas of most pressing need include inability
to track movements of so many patients
with so many movement variables
Gains made often entirely undone when
people leave custody due to lack of
resources or our inability to adequately link
people in to services
What Now III ?
Investigate how resources would stand
expansion of service to farms
Enhanced triage and education arm of service
Continue collection of data by which to map
trends for enhancement of service delivery
Transitional case management for the most
needy
What Now IV?
New funding PMHS 06-07
•
•
•
•
•
•
•
State wide clinical director
Building-Infrastructure
Admin support
Vehicles [and access to such]
Case Managers (SE Qld and Northern)
Increased medical coverage
Specific funding for NGO support workers
What Now V?
Transitional Case Management
• Focus on re-establishing social supports,
housing and employment
• Facilitating access to Mental Health follow
up and intervention
• Drug and alcohol support, legal support
and financial and social support systems as
and when necessary.
What Now VI ?
Transitional Case management II
• Designed to assist the most complex
patients
• Imperative that such a model have built in
linkages between ourselves and NGO’s
• Assist in funding such a model
What Now VII ?
Transitional Case management III
• Employ and resource transitional case
managers
• Employ and resource NGO community
[mental health] workers
• Start discharge process from point of
identification
What Now VIII?
Transitional Case Management IV
Who?
• High Risk Group [Mental Health]
• Those with considerable treatment needs
• Co-morbidity
• Substance misuse
• Risk of adverse event
• Interaction with multiple organisations
(DCS/Courts/Legal/DMHS/Health etc)