Maintaining the health and wellbeing of offenders in custody

Reducing re-offending requires Corrections to identify and address mental health issues, provide primary health care and keep all offenders safe from harm.

Many offenders who experience physical and mental health issues can have difficulty complying with their conditions, completing their sentences and engaging in rehabilitation; this can lead to re-offending. Managing offenders who are experiencing physical and mental health issues is often difficult for staff, and effective management is essential to successfully reduce offenders risks of re-offending. Through increased awareness, particularly in the areas of mental health and suicide awareness, staff can build knowledge, understanding and skills and can support offenders to access health services and so address their needs.

Mental health

Offenders in prison are significantly more likely to suffer from mental illness than people in the general community. A 2015 study into the comorbidity of mental health needs of newly sentenced prisoners found that 62% of prisoners had experienced a mental health or substance use disorder, while 20% had experienced both in the 12 months before the study.

The study also found that more than half of prisoners had received some treatment for their mental health needs in the previous 12 months. Following the introduction of the mental health screening tool in 2012, Corrections has invested over $1 million per year in primary mental health services. This included more medical officer (prisoner doctor) hours of service, additional nursing resources and an increased budget for pharmaceutical items. In addition we contracted for packages of care – up to six one-on-one sessions for a prisoner, which can include education about healthy lifestyles, mental illness, medications, recovery and resilience, advice and support about mental wellbeing, problem solving strategies, solution focused therapy and cognitive behavioural therapy. Mental health in-reach clinicians at three prison sites also provide brief interventions to prisoners and support staff to understand and manage prisoners with mental health needs.

In June 2016, Corrections secured additional Justice Sector funding of $14 million to improve mental health services for offenders over the next two years.

High-Risk Response team

The High-Risk Response team provides oversight of the management of high-risk and high profile offenders across Corrections. The team works closely with the field to provide support in the management of offenders in prisons and the community, while aiming to reduce the risk of harm to others.

Health services in prison

Corrections provides primary healthcare in prisons, and we are required under legislation to provide treatment that is reasonably necessary, and the standard of healthcare must be reasonably equivalent to that which is provided to the public. The health service is comparable to what a person would access from a general practitioner in the community, though it is nurse led. Health services are important as they contribute to an offender being physically and mentally well enough to focus on rehabilitation.

Healthcare provided within the prison network has been near or above target levels in 2015/16. Over 100,000 consultations with healthcare staff have taken place, 99% of newly received prisoners received a health triage on their day of reception, and 92% of prisoners identified as requiring a cardiovascular risk assessment received one within eight weeks of reception. All prison health centres retained Cornerstone® accreditation following annual reviews.

The Cornerstone® accreditation is provided by the Royal NZ College of General Practitioners, and provides assurance that the systems, policies and procedures are in place to provide a service similar to a general practice.

High Dependency Unit

At the end of 2015 the High Dependency Unit (HDU) at Rimutaka Prison opened a new 10 bed wing, bringing the number of prisoners who can be accommodated up to 30.

Most older and disabled prisoners are managed in mainstream prison units, but the HDU opened in 2012 to house prisoners with health issues that make it difficult for them to function independently, but who are not eligible for release.

Most prisoners in the HDU are older (70s or 80s) with medical conditions, and need help with the activities of daily life such as showering, toileting and eating. They may suffer from dementia. Some are younger prisoners with significant health conditions, who need more help than they could easily access within a mainstream unit.

Prisoners are accommodated in a single cell, each containing a shower, toilet and a hospital-type bed. A disabled accessible shower room is available, along with a health office with medication administration facilities and a treatment room.

The prison population is getting older, in-line with the rest of the country. In June 2016 there were 130 prisoners aged over 70, compared with 51 in 2011.

Unnatural deaths in prisons

The most common cause of unnatural death in prison is suicide. Suicide is a serious health and social issue for New Zealand as well as for the offenders that Corrections has responsibility for. New Zealand has one of the highest rates of suicide among developed countries.

Statistics New Zealand⁶ measures the rates of suicide deaths per 100,000 every four years. In 2012, the number of men who committed suicide was 18.1 per 100,000 and the number of Mäori male who committed suicide was 25.6 per 100,000. The statistics are significant for Corrections as around 90% of our offenders in prison are male and just over half of our prison population identify as Mäori.

As a result of Corrections awareness around mental health and suicide, clear guidelines, good practice and capable staff, unnatural deaths were avoided in 70% of cases where staff intervened in instances of life threatening self-harm by prisoners. It can be difficult to prevent someone from harming themselves if they are determined to do so. The number of unnatural deaths in prisons has increased since last year, as has the number of self-harm threat to life incidents.

Following an unnatural death, a ‘Death in Custody Review’ is undertaken by the Chief Inspector of the Corrections Inspectorate (monitored by the Ombudsmen) and the Coroner undertakes an inquest, both of these outcomes can take 6-12 months depending on the complexity of the incident.

Justified complaints to the Corrections Inspectorate

The Inspectorate is Corrections’ second tier of complaints resolution. As such, it is effectively our last opportunity to resolve a complaint before the involvement of external agencies or court action.

There were over 1,000 complaints referred to the Corrections Inspectorate in 2015/16. Of the complaints received, 38 (3.5%) were found to be justified. Of the 38 justified complaints, six were upheld for reasons of materiality and 32 for not meeting process requirements.

6 http://www.stats.govt.nz/browse_for_stats/snapshots-of-nz/nz-social-indicators/Home/Health/suicide.aspx

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