Photo: RNZ / Cole Eastham-Farrelly
The conditions faced by mentally ill prisoners are comparable to the notorious Lake Alice Psychiatric Hospital, a former public health leader says.
Dr Erik Monasterio says regular breaches of human rights gave him no choice but to quit his role as Canterbury's director of Area Mental Health two years ago.
"I wasn't making any substantial difference from the inside, so I felt the only option was to step out and see what could be done externally," he said.
An essay by Monasterio, published on Friday in the New Zealand Medical Journal, details his concerns about the treatment of prisoners with mental health disorders.
"Increasingly, psychiatric care is being defaulted to prisons. Prisons in New Zealand have become the new psychiatric institutions," he told RNZ.
"Often people who are acutely mentally disordered and appear before the courts, often on relatively minor charges and for whom there are no beds in hospital, end up being remanded in custody."
He said patients in prisons were cut off from the support they desperately needed.
"Prison staff were being put in an impossible position where people with serious mental illnesses were being entrusted into their care, and they neither had the resources or the training to deliver that to any sort of acceptable standard."
It was not only unethical, Monasterio argued, but unlawful.
"If somebody fulfils criteria for the Mental Health Act and ... [they] end up in prison, in my view that's unlawful," he said.
"The Mental Health Act is explicit, it binds the Crown. It's an obligatory clause on the ministry and the government to provide that care if the alternative is that they'll go into prison and suffer harm."
Intervention and Support Units do nothing to rehabilitate prisoners, Erik Monasterio says. Photo: Supplied
In the worst cases, Monasterio said patients were put in "Intervention and Support Units," which he said were equivalent to solitary confinement.
"Within those units people are held in conditions of seclusion for 23 hours of the day, often without access to a toilet or fresh air. I don't think there's any doubt that the rights of those people held in those conditions is [being breached]," he said.
"It's a travesty, really, to place somebody who is acutely mentally disordered who is having a crisis in a situation of solitary confinement."
Department of Corrections mental health and addiction services director Emma Gardner said Intervention and Support Units (ISU) were safe and supportive.
"In ISUs, prisoners who are assessed as at risk of self-harm and suicide are closely monitored and have access to specialised care," she said.
"[This is] to help them to return to a state of wellbeing before returning to their mainstream prison unit, or to support them while awaiting transfer to an inpatient mental health facility."
Gardner said only a handful of units didn't have toilets.
"You may find dry cells in ISU units which are cells that do not have a toilet, running water, or a privacy screen, and are designed for the management of people who are internally concealing items, such as contraband drugs, which can pose a significant risk to their health," she said.
"Dry cells can only be used in very limited circumstances in accordance with strict criteria."
Staff supporting ISUs included mental health specialist nurses, regional and other contracted mental health service providers, Gardner said.
"These services provide assessment, treatment and support for people in ISUs with the aim of improving their wellbeing and supporting their transition back into the mainstream prison population."
But Monasterio said Intervention and Support Units did nothing to help or rehabilitate prisoners.
"It almost guarantees a poorer outcome, there's plenty of evidence that prolonged detention in the ISU will make your underlying psychiatric condition worse and will contribute to cognitive impairment," he said.
Parallels to Lake Alice
Monasterio compared prisoners' treatment to the torture faced by patients at Lake Alice Psychiatric Hospital throughout the 1970s.
"There are real parallels here between what's happening in prisons and what happened in Lake Alice," he said.
"It's really tragic that after having the Royal Commission's Abuse in Care inquiry [at Lake Alice] we're not doing anything about a problem that everyone's aware of at the moment."
He urged the government to address the system's failings.
"We have to accept the severe nature of this, we have to accept that minimum standards of care are not being provided and the Bill of Rights is being breached," he said.
"[We need to] focus on the people who are most being harmed or excluded, and then refocus resources to make sure that group are adequately attended to and cared for."
Health New Zealand acknowledged that there were flaws in the mental health service.
"It is important to recognise that the change of the scale required in the mental health and addiction space will take time to implement and establish," a spokesperson said.
"There is extensive work underway to grow the mental health workforce. Since He Ara Oranga, Budget 2019 has invested $77 million over four years in mental health and addiction workforce development. This was topped up with a further $10 million from the Budget 2022 specialist services package."
Health New Zealand said it worked with the Department of Corrections to provide people with serious mental illness "appropriate specialist support [in] the right place".
Department of Corrections' Emma Gardner said the department planned to refurbish many of its ISUs.
"Refurbishment of the ISUs in our prisons has been part of a long-term plan to improve these units and create a more therapeutic environment for people with mental health needs," she said.
"Our Infrastructure Planning team has been working with our Mental Health & Addiction team since 2021 to understand the current issues with units across our network."
But Gardner said there wasn't a specific timeframe for when the work would be completed.