Session Outline
• Overview of Prison Health Services in Queensland
• 2 Hypothetical cases
• General Questions / Discussion
Prison Mental Health Services in Queensland
• Outpatient Services purchased from Queensland Health
• Queensland Health also have responsibility for inpatient services
• Services provided at two private centres and 7 public sector centres
• One other centre has a private psychiatrist supported by QH mental health worker
Prison Mental Health Services in Queensland
• Historical budgets
• Outpatient service distinct from prison psychologists
• Links with medical and nursing staff
• Facilitate post release follow up of clients of the service
• Focus on psychosis, mood disorder and anxiety conditions
MENTAL DISORDER IN THE NSW PRISONER POPULATION
• 43% of those screened had at least one of psychosis, anxiety disorder or affective disorder.
• Reception (46%) > Sentenced (38%)• Females (61%) > Males (39%)• 9% : psychotic symptoms in previous year• 20% : suffered at least one mood disorder• PTSD most common (26% of receptions,
21% of sentenced)
Mental Health Act 2000
• Emphasis on treatment needs rather than type of offence
• Inpatient care in any Authorised Mental Health Service (security needs influence placement)
• Voluntary and involuntary inpatient care of prisoners
• Involuntary treatment orders don’t apply to prisoners
Corrective Services Act 2000
• Enables involuntary treatment on medical indication if necessary to avoid harm to self or others
Hypothetical Case 1
• 33 year old male
• Armed Robbery x 2
• No family history of mental illness
• Has used amphetamines for last ten years with recent escalation of use
Hypothetical Case 1
• 2 brief admissions to inpatient mental health units in last 2 years
• Hospital diagnoses of intoxication / amphetamine psychosis with background of Antisocial Personality Disorder
Hypothetical Case 1
• Received in Prison on Friday afternoon
• Noted to be quite paranoid
• Triaged by mental health service 3 days later
• Concerned about being killed
• Conspiracy of prisoners and officers
• Very anxious
Hypothetical Case 1
• Possibility of psychosis
• Kept in medical area
• Behavioural problems ++
• CCO concerns
OVER TO YOU!
• How do you manage cases such as this while waiting for specialist psychiatric review?
Hypothetical Case 1
• Review by psychiatrist
• Persecutory concerns
• Voices (derogatory)
• Advises he plans a pre-emptive attack to protect himself
• Prisoner agrees to some interim treatment
CASE 1 - ISSUES
• Diagnosis
• Acute management
• Voluntary and involuntary treatment options
• Need to consider mental illness in prisoners with behavioural difficulty
• Mental illness may be exacerbated by prison environment
Hypothetical Case 2
• 23 year old Indigenous female
• Common assault and property damage
• Mother of four, all children in foster care
• Currently 29 weeks pregnant
• Sentence of 4 weeks – full time release
Hypothetical Case 2
• Referred to PMHS for behavioural issues
• Past history of 8 brief admissions – diagnosis of personality disorder, substance abuse. No follow up.
• Vague historian; guarded
• Vague concerns about unborn baby
• Non urgent referral to psychiatrist
Hypothetical Case 2
• Psychiatrist review after 1 week (3 weeks prior to release)
• Guarded / suspicious
• Hearing voices from a dead child and another dead relative
• Past history of treatment with an antipsychotic, but nil now
OVER TO YOU!
• What issues have to be considered with this patient?
• Should any treatment be considered for her?
Hypothetical Case 2
• Psychiatrist review 1 week prior to release
• Condition worsening – increasing aggression
• Non compliant with antipsychotic
Hypothetical Case 2
• Threats to unborn baby which she believes to be “white” and the result of a rape by a Caucasian male
• Unborn baby being influenced by sources of external control
• Food refusal resulting in limited intake
Hypothetical Case 2
• Referred to inpatient care
• Returned to centre after 3 days
• Due for release in 4 days
CASE 2 - ISSUES
• Cultural factors
• Ethics of trials of antipsychotics
• Treatment in pregnancy
• Compliance concerns for short term prisoners / community referral
• Different opinions of previous inpatient providers
• Child safety issues
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