Mental health behind bars: why women prisoners are set up to fail

Inga Ting, Crikey, 9/12/2010

Jennifer (not her real name), a mother and university graduate, says she would not have considered herself at risk of suicide or self harm when she entered the prison system earlier this year. Before February, when she was arrested for a crime committed more than 12 years ago, Jennifer was enjoying a successful academic career, leading a vibrant social life and flourishing in a stable, long-term relationship.

But after just six weeks in Silverwater Women’s Correctional Centre — a maximum security facility where remand detainees are housed alongside the state’s most dangerous women offenders — her self-confidence, her outlook and her life are in tatters.

“They claim the system isn’t punitive, they claim it’s supposed to help you rehabilitate,” Jennifer says. “I feel like I’ve lost … my ability to interact with the world. I was a very confident and strong woman before all this started and I have trouble conceiving of ever getting back to that stage again … [T]he prison system has pretty much destroyed any semblance of mental health that I had.”
Jennifer was diagnosed with borderline personality disorder, anxiety and depression in her early 20s but after eight years of psychiatric treatment learnt to successfully manage these problems. Her psychiatrist, Dr Young, says her last major depressive episode before prison was more than five years ago. On the day she set foot on prison grounds, she was virtually diagnosis- and medication-free, he says.

During her health screening at reception, Jennifer admitted to a suicide attempt in 2002. She was put on an “observation cell” order, the standard response to inmates deemed to be a risk to themselves or others.

“A really large proportion of girls told me I was absolutely stupid for admitting to — and officers told me I was stupid for admitting to — a self-harm incident. Most of (the women) seem to have some kind of mental health issue but they didn’t tell the officers or the welfare or the nurses because of … their treatment of (mentally ill) people. People are terrified of going into those safe cells and after having been in them, I’m terrified of going into them,” she says.

According to a Corrective Services NSW spokesperson, an observation cell is “designed to minimise the opportunities of self harm, so therefore it’s got no hanging points, they’ve got special blankets, it has camera observation and nothing sharp or unscrewable”. The time an inmate is consigned to an observation cell “varies, but it’s usually a short time, like a day”.
Jennifer spent four days in an observation cell due to a two-day security lockdown in which inmates were forbidden to leave their cells. “It was horrific,” she says.
“The lights are kept on 24 hours a day and the officers are absolutely horrible to you while you’re in there. The air-conditioning is switched to freezing then switched off at four o’clock in the morning so you go to sleep in your tracksuit and wake up drenched in sweat thinking you’re sick. I was refused medical treatment while I was in there. I was refused access to a telephone. I wanted to call the Ombudsman. After I said I wanted to call the Ombudsman, they specifically refused to let me out of the cell.”
She describes how confusion, anger and sleep deprivation gave way to hysteria and paranoia. By the fourth day, she says, she was lying on the floor “unable to eat, shaking constantly, crying almost continuously and unable to sleep”.

Catriona McComish, a former senior assistant commissioner at Corrective Services NSW, says observation cells illustrate precisely why the prison system is incapable of rehabilitating the mentally ill.
“If someone is regarded as significantly distressed and is either self harming or is psychotic or is assessed as at risk of suicide in a hospital setting or a clinical setting, then you ensure that they stay with people; they’re calmed … with medication and talk and company and assistance and support,” says McComish, who served for 13 years in several senior roles at Corrective Services, including five years as director of Psychological Services. “Whereas in prison the kind of assessment would err, because of the inquiries that have been and because of the fear of the ramifications of death in custody … on the side of just containing the risk, which means containing the person.
“It is certainly not good for the longer-term outcome. If you put someone who’s got a mental illness, who is actually at risk of suicide … in (an observation cell, it) is going to make them much, much worse. They’re a symbol of all that’s wrong, that people like that end up in prison.”
The number of women being jailed in NSW has risen more than 60% in the past decade, compared to a 25% increase in the rate of imprisonment of men.
Of the state’s 850 women inmates, about 86% have at least one psychiatric disorder, according to data from Corrections Health (now Justice Health). The 2003 study of NSW prisoners found that women outnumber men across all categories of psychiatric disorder. Two-thirds of women compared to 50% of men have a substance-use disorder; 60% (compared to 38% of men) have a mental disorder; 55% (compared to 30% of men) have an anxiety disorder; and 29% (compared to 18% of men) have an affective disorder such as depression.
Such extraordinary levels of mental illness have significant consequences for the women’s prison environment, says McComish, who left the department in 2006.
“In corrections, just about everyone would say — whether it’s medical staff or program staff or correctional staff — that they much prefer to work in a male prison than a female prison. No one really wants to work with them,” she says. “They often get angry and aggressive and demanding and needy and they cut themselves and it’s messy and they don’t get better, so staff become punitive.”

But the behaviour of custodial officers is only one dimension of a much larger structural problem. The lack of beds for women in minimum and medium security correctional facilities means hundreds of women are imprisoned in higher security facilities than actually required by their classification.

At the time of the 2009 NSW Inmate Census, 72% of the state’s 854 women prisoners had a minimum-security classification yet only 32% were actually imprisoned in minimum-security centres. Conversely, only two women inmates had maximum-security classifications yet 214 women were being held in maximum-security centres across the state.
Prisoners in maximum security must abide by strict conditions that limit personal property, visit entitlements and access to programs, regardless of their classification. They also cannot access study leave or work release.

Prison reformers argue that the classification system discriminates against the mentally ill, because it equates mental health needs — which can manifest as difficult or unco-operative behaviour — with heightened risk concerns. Studies show the mentally ill are also more likely to re-offend and re-enter prison under higher security classifications. As a result, the women who most urgently need skills, education and support are least able to access work release, study leave and programs.

“So in the women’s system you also end up with an extraordinary mixture in terms of needs — so you have women who are psychotic, women who have a significant intellectual disability, women who have severe behaviour problems,” McComish says. “And because units are small, they all end up together and the unit becomes dysfunctional … (It) essentially becomes a punitive place were there needs to be significantly high levels of security and lockdown because the mix is so volatile.”

*Inga Ting is an associate of the Australian Centre for Independent Journalism. Part two of her special investigation in Crikey tomorrow.

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