Use of Medication in the Prison Population – Response

The Hon. K.L. VINCENT: I seek leave to make a brief explanation before asking the Minister for Correctional Services questions regarding the use of medication in the prison population.

Leave granted.

The Hon. K.L. VINCENT: A fortnight ago, the Australian Institute of Health and Welfare released a report entitled ‘Medication use by Australia’s prisoners 2015’. This report notes that about half of all prisoners are taking medication of some sort, ‘with many prisoners having complex health conditions, at times complicated by histories of trauma combined with underlying chronic and mental health conditions’. The report records that prisoners are nine times as likely as the general community to take antipsychotics, four times as likely to take medications used to treat addictive disorders, and more than twice as likely to take antidepressants or mood stabilisers of some sort.

The report also shows that prisoners begin taking medications for chronic illnesses at earlier ages, when compared with the general population. My questions to the minister are:

1. Is the minister aware of the Australian Institute of Health and Welfare’s June 2016 report ‘Medication use by Australia’s prisoners 2015’, and has he read the report?

2. If the minister has read it, does he agree that it demonstrates the critical need for adequate support programs and positive mental health support services in our prison system, given people with mental health conditions and substance abuse issues are overrepresented compared to the general population?

3. What general health and education programs and services are available in SA prisons to ensure prisoners have the opportunity to prevent chronic health conditions?

4. Is the minister concerned that people with mental illness and substance abuse issues are overrepresented in our corrections system and what does he intend to do to address this imbalance?

The Hon. P. MALINAUSKAS (Minister for Police, Minister for Correctional Services, Minister for Emergency Services, Minister for Road Safety): Thank you very much to the honourable member for her important question. I will try to deal with each of the honourable member’s questions. The first question was am I aware of the report? The answer to that question is yes. The second question was have I read that report? No, I have not read that report line by line, so unfortunately I cannot speak to some of the specific things that the honourable member referred to.

Generally speaking, the tenet of the question refers to the challenges that face us in the correctional system considering there is an overrepresentation of people within corrections who suffer from mental health problems, and this is something I think is well known in the community and presents an ongoing challenge for the department generally and us as a government.

Mental health is becoming an issue that we are becoming more aware of as a community. The challenge before corrections is substantial and as a government and department, we are constantly trying to review its efforts to ensure that, where it is in appropriate to do so, we are making sure that there are programs in place specifically to deal with the needs of those people who suffer mental health problems.

I think it is already commonly known that sometimes prison is not the best place to accommodate individual people’s needs. Prison is not always the best place to educate someone for instance, it is not always the best place to administer health care, nevertheless individuals find themselves in prison for a reason, so we have to be able to deal with the situation as best as we possibly can under difficult circumstances.

The government has been making investments along these lines. Earlier this year I opened a new health facility at Yatala prison that is equipped and designed in many respects to be able to deal with mental health issues. This is something that we want to continue to observe to see how this facility operates. We will continue to monitor how these facilities operate but the demand is growing, and I think the honourable member would be aware of that. I am happy to take the other points in her question on notice in regard to the specifics of the report, but the honourable member can rest assured that mental health within corrections is something that we are very cognisant of as a challenge that needs to be taken on. It is being dealt with in the full knowledge that it is an incredibly difficult issue in a complex environment.

The Hon. K.L. VINCENT: A supplementary: on the issue of administering health care, can the minister outline the process if there is one for reviewing medications which prisoners are taking while in prison? I am interested in the process for the review of medications, so where a prisoner is on medications is there a process for reviewing it to see whether they are on the correct dose or if they should be on that particular medication at the time?

The Hon. P. MALINAUSKAS (Minister for Police, Minister for Correctional Services, Minister for Emergency Services, Minister for Road Safety): I thank the honourable member for her supplementary question. Unfortunately, I will have to take that on notice but I will try to make sure we get an expedited response to the honourable member.

Response received 15/11/2016

In reply to the Hon. K.L. VINCENT ( 23 June 2016 ).

The Hon. P. MALINAUSKAS (Minister for Police, Minister for Correctional Services, Minister for Emergency Services, Minister for Road Safety): I am advised:

  1. The Department for Correctional Services is committed to providing opportunities for prisoners to undertake general health and education programs that provide them with the opportunity to prevent chronic health conditions.

Health Services available to prisoners are provided through Forensic Mental Health Services, SA Prison Health Service (SAPHS), Disability SA, the Department’s High Risk Assessment Teams and departmental psychologists.

SAPHS provides health care to prisoners within state managed prisons, they provide a primary healthcare model which includes a focus on chronic disease management in line with services that would normally be provided in the community.

Most prisons also have health expos and in reach programs, in which outside organisations come into the prisons to promote a wellness model of health.

The department partners with a number of agencies and community drug and alcohol services to help address dependence issues. This includes the Drug and Alcohol Services SA, Offender Aid and Rehabilitation Services and the Aboriginal Sobriety Group. In addition, Alcoholics Anonymous and Narcotic Anonymous have regular meetings set up in a number of prisons across the state.

QuitSkills mentor training is delivered by the Cancer Council, with training occurring at Port Lincoln Prison, Port Augusta Prison, the Adelaide Remand Centre, Yatala Labour Prison, and Mobilong Prison. Further to this, prisoners have access to a free 12-week Nicotine Replacement Therapy program funded by SA Health.

The department offers the pilot Therapeutic Community program, currently trialling at Cadell Training Centre, a structured environment in which residents work together to understand their past substance abuse issues, and to develop ways to change their thinking and behaviour to work towards a goal of developing a healthy and fulfilling life without drugs or alcohol.

  1. I am very concerned that people with mental illness and substance abuse issues are overrepresented in our corrections system. This issue is not limited to South Australia. Prisoners with mental health and substance abuse issues are overrepresented within corrections systems within Australia as well as in the United States and the United Kingdom.

Despite the challenges, the department remains committed to addressing the needs of prisoners identified as suffering from mental illness and those identified as having substance abuse issues.

All prisoners, on entering the prison system, are appropriately assessed in conjunction with the SA Prison Health Service (SAPHS) and information from South Australia Police, to determine their risk and needs. Issues such as mental health, drug and alcohol, and risk of suicide or self-harm are reviewed during the admission process, enabling appropriate supports and accommodation to be provided to prisoners.

Prisoners identified during this process as having mental illness and/or substance abuse issues are provided with appropriate supports.

These services can be provided by Forensic Mental Health Services, SAPHS, Disability SA, the prison High Risk Assessment Teams, and departmental social workers and psychologists.

SAPHS provides support to prisoners with substance withdrawal as well as providing a Medication Assisted Treatment for Opioid Dependence (MATOD) program within all prisons.

Forensic Mental Health Service, provides specialist psychiatry services within prisons with support from SAPHS that provides day to day primary mental health care to prisoners within state managed prisons.

Psychological services provided by the department have a priority focus on the assessment of prisoners and the provision of crisis intervention and support services.

If there is further cause for concern, prisoners can be transferred to the nearest hospital for mental health assessment. If a prisoner is detained under the Mental Health Act 2009, they are moved to a mental health facility. This is a decision for health professionals.

Over recent years the department has introduced a number of accommodation units that are specifically suited to prisoners with certain health and mental health needs.

In 2014-15, a 20 bed secure unit was completed at Adelaide Women’s Prison to accommodate high risk, high needs female prisoners with complex behavioural and mental health needs. The women’s prison also introduced a program to assist women with Borderline Personality Disorder.

In 2015-16, the High Dependency Unit and the new Health Centre at Yatala Labour Prison were completed. The High Dependency Unit provides inpatient mental health assessment and treatment services (and a continuum of care), for prisoners presenting with multiple and complex needs.

The department continues to strive to ensure access and inclusion for prisoners with a disability, ensuring this is reflected in programs and strategies, such as:

The department’s Disability Access and Inclusion Plan, which is aligned with the National Disability Strategy and the Attorney-General’s Disability Justice Plan;

A Memorandum of Administrative Arrangement has been established with Disability SA;

The SBC-me program has been introduced to target sex offenders identified as having a mild to borderline level of intellectual disability or cognitive deficit; and

The Department run Special Needs Program in Repay SA.

  1. I am advised that on admission to prison, all prisoners are reviewed within 24 hours by a nurse from SAPHS. Prisoners on medications are reviewed by a medical practitioner and depending on the prisoner’s clinical requirements continued on those medications and additional medicines commenced as clinically appropriate.