NZ's health system is "failing" inmates, says a psychiatrist. Photo: RNZ / Cole Eastham-Farrelly
- Contracts for the Improving Mental Health Service - which provided counselling and therapy to 4047 prisoners last year - due to end from June 2025
- Corrections says it will tender for new services shortly - but workers warn some vulnerable clients may slip between the cracks
- Health system "failing" inmates - psychiatrist
- History repeating for ex-state wards now behind bars.
Mental health workers fear some prison inmates who are suicidal, psychotic or suffering other serious psychological problems will be left without support when their contracts end.
Barely a week after the historic state apology to survivors of Abuse in Care, they warn that history is repeating itself, with many of those same children still suffering state abuse as adults.
A life 'in care'
Tony's life is starting over in his 60s, after serving a 27-year prison sentence for murder.
'History repeats' for ex state wards in prison
Sexually abused as a child by Catholic priests and put into solitary confinement at Sunnyside Mental Hospital at 15, he said it was only in recent years in jail that he received any kind of effective psychological therapy.
"There was nothing there, and if you went down that road [of asking for help], you would end up a padded cell and that was your lot. 'You're gone, it's over, you're not going to survive prison'."
It was the suicide of a cellmate, who had also been abused by priests, which spurred him to seek help again after previous knockbacks.
"I said: 'That's either going to be me, or I've got to do something here'."
He eventually received counselling under ACC.
"There were Corrections staff who helped too, but they can only do so much. It's not a hospital, they're not trained for any of it.
"I've seen people in prison who I look at and think: 'What are you even doing here?'
"Once those doors shut behind you, you're on your own."
Mental health contracts due to end
The Improving Mental Health Service, which started in 2017, provided counselling and therapy to more than 4000 prisoners last year.
However, all contracts finish in either June next year or 2026.
It was intended for those with "mild to moderate" psychological problems.
However, one mental health professional who works for one of the services said their caseload included inmates who had come from forensic services, and others who were psychotic, or actively suicidal.
"They are some of the most marginalised people in our community, yes they've done some horrible things, but they are not horrible people," said the worker, whom RNZ has agreed not to name.
"I've had hardened criminals cry to me and tell me I'm the first person they've ever told that they've been sexually abused, so I've been able to link them in with Male Survivors and ACC counselling because that's what they need. If they've got no one to tell them that, they will fall through the cracks."
The worker said the heads of all the Improving Mental Health Service providers recently had a meeting with Corrections, at which management admitted there was "no money" for the next six months, and "no time" to put out a new tender.
"Our contract finishes June next year but we all looking for new jobs now, so all of us could be gone by Christmas.
"If they [Corrections] are saying publicly there's going to be support from July 1 - what is that support? Just the ISP (Intervention and Support Team)? They don't have capacity. The nurses?
"The health team are shitting themselves because it's all going to fall on them - they have no capacity, they are already overwhelmed with physical needs.
"Is it going to fall on corrections officers? They're not trained, and it's not their job. There's going to be nothing."
The clinician had doubts that Corrections would be able to redesign services, put them out for tender and have them staffed and ready to go before the current contracts ended.
"They have so many unfilled positions for AOD [alcohol and other drug] counsellors now."
Time for new approaches, says Corrections
Corrections chief mental health and addictions officer Emma Gardner said the agency was not axing the services - they had simply come to the end of their "life cycle".
"We've used all of the extensions that were available to us, so according to government procurement rules we must go back out to the market to see if there are other services, which have developed since 2017."
Funding for the new services would continue at the same level as existing contracts, which cost $5.17 million in the year to June.
Meanwhile, Corrections was working to recruit internal vacancies, Dr Gardner said.
"As part of our mitigation for those services ending, we are working with the providers to ensure that there is a seamless transition to either our existing internal services or getting them to where they need to get to, and obviously we'll be going out to new services as well."
However, the Labour Party's mental health spokesperson Ingrid Leary was skeptical that Corrections would be able to get new programmes in place within seven months.
"We'll be keeping a very close eye on it, because this government has a track record of saying it's reorganising services and doing business as usual, when the track record shows it's cutting the front-line and cutting services."
Health system's 'failures' to blame - psychiatrist
Long-time forensic psychiatrist Dr Erik Monasterio - who quit as head of the the Canterbury Regional Forensic Service in 2021 - said many people with serious mental illness were locked up in so-called Intervention and Support Units within prisons.
These people were kept in solitary confinement for up to 23 hours a day without access to natural light or air.
"When I was providing clinical care in prisons, I was involved in many situations where people who had been held in conditions of solitary confinement as young people and children were similarly subjected to them in prison because of insufficient facilities inside psychiatric units."
It seemed New Zealand had yet to learn the lessons of the Royal Commission of Inquiry into Abuse in State and Faith-Based Institutions, he said.
"We've just had the Royal Commission of Inquiry into Abuse in State and Faith-based Institutions. I am almost convinced that we will end up with a similar inquiry of our treatment of the mentally disordered in prisons. Because what happened in state care and faith institutions is what's happening in prisons now. Please let's not let history repeat itself, because [they] are presiding over the abuses of vulnerable people yet again."
Dr Monasterio said it was "an indictment on the health system" that Corrections ended up being responsible for the care of people with serious mental illness: firstly to stop those people going to prison in the first place because they did not get the treatment they needed, and secondly to give them "equitable access to mental healthcare while incarcerated".
'What next?', asks survivor
Tony said he felt Prime Minister Christopher Luxon and Opposition leader Chris Hipkins were genuine in their apology to survivors.
"I believed them, it felt real. But then, as it went on a bit, I thought 'okay, now what?'
"People are talking about compensation but that's not going to change a thing - maybe [it will make things better] for 10 or 15 minutes of someone's life, but it won't stop it happening again.
"I just hope they get it right and fix the system, so all kids in this country get a chance in life.
"And why shouldn't they?"
Dr Gardner said Corrections had put "additional supports" in place following the state apology.
"For those people, it's a way for them to either signal if they are struggling, so we can help them get access to services, or there are tips and tools that they can use to manage their own distress as well. So we've put all that information out to the sites to support those people as best we can."
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