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Chapter 6 Section E : Mental Illness, prisons and forensic facilities

If you are a prisoner (or a forensic patient in a forensic facility) you should expect the same standard of health care as people who are not prisoners, and those who are forensic patients in the community .

In reality, while the standard of health care NSW prisoners receive varies in line with other public health services in NSW, the access to health care is often limited because it is delivered in a prison  or forensic setting. Nevertheless, some services that prisoners and forensic patients may have never had real access to in the community for cost and social reasons, such as dental health care, may be more available to them in prison or in a forensic facility, than they are in the community.

Forensic patients in a forensic facility receive health and mental health care similar to that they would receive in an acute or sub-acute mental health facility. However, forensic patients in forensic facilities often have access to a greater diversity of treatment programs, including exercise and health programs and group psycho-education programs, than they would in an acute mental health facility. Usually, treatment related to the forensic patient’s mental illness are provided on a compulsory basis. With some exceptions, other medical and dental treatment is provided on a voluntary basis; that is, the patient must consent to this treatment.

Prisoners and forensic patients in forensic facilities, unlike others in the community, cannot access a general medical practitioner (GP) of their choice and cannot access public or private health services in the community.

This section of the Manual has information about:

6E.1: Access to health care in NSW prisons and forensic facilities

When you are in prison, you have a right to get health care, dental treatment and mental health care. Each prison has a clinic staffed by a registered nurse who works for Justice and Forensic Mental Health Network (the Network), which is part of NSW Health.

The clinic is open each day and the nurse should be able to help you with most health problems, give you your medication and, when needed, refer you to other health care professionals such as the doctor, dentist, or optometrist. You can also be referred to medical specialists but this referral has to be done by a visiting GP.

While in custody you may also request to go to the Health Centre at any time to have a health problem assessed and treated. In most centres you must complete a Patient Self- Referral form which can be found in the wings/pods or the Health Centre. You should place the completed referral form in the locked box in your wing/pod or at the Health Centre. Nurses will look at these referrals and organise an appointment depending on the urgency of your health problem.

If your health issues are urgent you should advise a Corrective Services officer and go immediately to the Health Centre. You do not require a Patient Self-Referral form. In an emergency you can contact CSNSW using the buzzer in your cell.

The Justice and Forensic Mental Health Network is the only provider of health care in NSW prisons (except at Junee Correctional Centre). Justice Health contracts out the provision of some health services (mainly to GPs visiting prisons).

Medicare doesn’t pay for health services for prisoners.

Justice Health and Corrective Services NSW do not stop outside health professionals visiting prisoners. However, there is no obligation on Justice Health to change treatment and/or medication, even if a doctor from outside the prison medical system disagrees with the treatment you are receiving in prison.

It is likely to be difficult to persuade a health care professional, particularly if they haven’t seen the person before, to see a prisoner. With no Medicare available, the prisoner wanting the visit or the person arranging the visit will usually have to pay the full fee for such a visit.

Usually access to the visiting GP is ‘triaged’. That means the prisoners that the nurses assess as having the most urgent and serious health problems will see the doctor first. This can often mean long delays in seeing the doctor if you have a less urgent problem. Therefore, if your condition worsens, you should tell the clinic as soon as possible.

NSW Justice Health has produced a brochure outlining arrangements for health and dental care in NSW prisons. You can find this brochure by following this link.

6E.1.1: Mental health care in NSW prisons and forensic facilities

Justice and Forensic Mental Health Network (the Network) delivers extensive custodial and forensic mental health services across correctional, community and inpatient settings.

Justice and Forensic Mental Health Network operates the following forensic mental health services:

  • The Forensic Hospital, Malabar – a high secure, 135 bed, mental health facility for male, female, adult and adolescent forensic and correctional patients and a limited number of high risk civil patients.
  • Long Bay Hospital – an 85 bed health facility inside Long Bay Correctional Centre, which contains a 40 bed Mental Health Unit for adult correctional patients.
  • Statewide Community and Court Liaison Service – which operates in 21 Local Courts across metropolitan and regional NSW.
  • Adolescent Community and Court Team – which operates in the Children’s Court.
  • Community Integration Team (CIT) – which provides assessment, referral, support, and treatment services to young people in the community.
  • Community Forensic Mental Health Service – for adult forensic patients in the community.
  • Mental Health Screening Units (40 beds for males and 10 beds for females) at Silverwater Correctional Complex in Sydney.
  • Ambulatory mental health services within correctional and detention centres.

The Network works closely with Local Health Districts (LHDs) to provide a range of integrated services to divert people away from custody and into community-based care, where appropriate, and to ensure continuity of care for patients transitioning back into the community.

The State’s three medium secure forensic units are operated by Hunter New England LHD, Western NSW LHD and Western Sydney LHD.

Medium secure mental health facilities in Local Health Districts (LHD’s) include:

  • Macquarie Unit Bloomfield Hospital, Western NSW LHD (20 beds),
  • Bunya Unit Cumberland Hospital, Western Sydney LHD (24 Beds);
  • Kestrel Unit Morisset Hospital, Hunter New England LHD (30 beds).

Forensic and custodial mental health services include:

  •  Adult and Adolescent Court Diversion Services
  • Specialist mental health services in all adult correctional centres and all juvenile justice centres
  • 135-bed high secure Forensic Hospital at Malabar
  • The Community Forensic Mental Health Service for adults and adolescents; and
  • Community Integration Team – assisting young people leaving custody.

Custodial mental health beds:

  • 40-bed male Mental Health Screening Unit, MRRC
  • 10-bed female Mental Health Screening Unit at Silverwater
  • 40-bed acute Mental Health Unit in Long Bay Hospital (men); &
  • 100-bed Hamden pod at Silverwater (a designated Mental Health accommodation area for men.

In total the Network provides healthcare in 32 Correctional Centres and 1 Transit Centre in NSW.

Forensic mental health services provide assessment, care and other services to people with mental illness who are, or have been, in contact with the criminal justice system. The provision of health care services is for forensic and correctional patients, and for civil patients who are a high risk of harm to others.

Forensic mental health services are underpinned by the same principles that underpin general mental health services with the addition of specific principles, legislation and processes that are applicable to forensic and correctional patients, including the Mental Health (Forensic Provisions) Act 1990 (NSW). The general principles include those such as the Charter for Mental Health Services in NSW. Forensic mental health services in NSW aim to adhere to the National Statement of Principles for Forensic Mental Health.

Many, but not all Justice Health clinics, have a mental health nurse attending. Psychiatrists also visit the clinics. You will be expected to talk to a Mental Health Nurse, if available, before you see a psychiatrist.

6E.1.2: Dental treatment in NSW prisons and forensic facilities

If you have problems with your teeth, call the Oral Health Hotline on the Common Auto Dial List 04#. This line is very busy so you may have to keep trying. An appointment with a dentist will be arranged but you may have to wait depending on the seriousness of your problem.

6E.2: Complaints about health care in NSW prisons and forensic facilities

If you are a prisoner or forensic patient in NSW, any complaints you have about the standard and quality of health care provided to you should be made either to:

If your complaint is about access to health care you could complain directly to:

For more about how to make a complaint, click here . To find out which body it is best to complain to, click here.

Complaints about conditions and treatment in prison or forensic facilities can also be made to an Official Visitor. For more about the Official Visitorclick here.

6E.2.1: How to make a complaint about your health care if you are in a NSW prison or forensic facility

The first thing to do if you are unhappy about your health care in prison is to ask to speak to the nurse in charge of the clinic at the prison.

If you still aren’t happy then you could write a letter outlining your concerns to:

Chief Executive
Justice Health
PO Box 150

Formal complaints can take a long time to be resolved. You could try talking to an Inquiry Officer at the Health Care Complaints Commission (HCCC) by dialling 05# on the Common Auto Dial List. Sometimes Inquiry Officers at the HCCC can contact Justice Health and help to sort things out more quickly.

If you still aren’t satisfied, then you can complain to the Health Care Complaints Commission (HCCC) . Your complaint must be in writing, so you can either use the HCCC complaints form, or write a letter to the Health Care Complaints Commission.

Health Care Complaints Commission
Locked Mail Bag 18

If you need help with writing down the complaint, contact an HCCC Inquiry Officer by dialling 05# on the Common Auto Dial List . The Inquiry Officer can write a letter of complaint for you to sign if there is some reason that you can’t write it on your own.

If your complaint is about the treatment and care received from a visiting GP or psychiatrist, including about diagnosis or medication prescribed, you should make it clear your complaint is about this. Visiting doctors and staff psychiatrists are likely to talk to Justice Health staff about your medical history. However, decisions about whether you are referred to a specialist or prescribed a particular medication are ultimately decisions made by the doctor, not the nursing staff employed by Justice Health. Justice Health nurses cannot prescribe medication.

If you are having trouble getting to see medical staff, or you think it has been too long for you to get an appointment with a specialist doctor, the NSW Ombudsman’s office might be able to help. (But remember, if your complaint is about the quality of care, or the actual medical treatment you have received, the Ombudsman won’t usually get involved.) You can call the NSW Ombudsman on the Common Auto Dial List 08#.

You can also write to the NSW Ombudsman’s office, just telling them your story in your own words. The address is:

NSW Ombudsman
Level 24, 580 George Street

If you are not sure whether to contact the HCCC or the Ombudsman, click here to find out more.

6E.2.2: Should you contact the Health Care Complaints Commission or the Ombudsman

The Health Care Complaints Commission (HCCC) cannot deal with complaints about general prison issues. It can deal with complaints about health care services provided to prisoners and forensic patients. For example, complaints about the quality of food provided, or concerns about hygiene issues around the preparation of food should be made to an Official Visitor or the NSW Ombudsman . Sometimes prisoners can’t get their medications on time because of lock-downs (times when prisoners have to remain in their cells). Complaints about this happening should be made to the NSW Ombudsman.

The NSW Ombudsman also deals with complaints about access to health services as opposed to the standard and quality of treatment and care.

If you are a patient at the Forensic Hospital at Long Bay, you should note that this Hospital is totally controlled by Justice Health and not Corrective Services NSW. If you have a complaint about the standard of health care at the Forensic Hospital at Long Bay, the HCCC can deal with your complaint. If you have a complaint about other matters not to do with the health care or treatment you receive, then the NSW Ombudsman is be the best place to complain.

If you are mistreated by a health professional (either physically, emotionally or through unwanted sexual conduct), then you should complain to the HCCC.

6E.3: The Official Visitor

If you have concerns about conditions or how you are treated in prison or a forensic facility, you can ask to see an Official Visitor. An Official Visitor will usually visit your prison or forensic facility at least once a month. The Official Visitors are appointed by the Minister for Corrective Services but are independent of Corrective Services NSW. They will try to fix your problem by speaking with senior prison staff.

There is a separate Official Visitors Scheme for NSW psychiatric hospitals and units This scheme visits the Forensic Hospital at Long Bay and other hospitals that house forensic patients such as Morisset and Cumberland Hospitals.

6E.4: Urine testing and other drug testing

If you are a forensic patient and you are granted leave, the Mental Health Review Tribunal can set conditions on your leave about the use or non-use of alcohol and other drugs, and can order drug testing and other medical tests to check that you have followed the conditions. This usually means you will have to have urine tests after periods of leave as well as having tests while in prison or hospital.

If you are a NSW prisoner serving a sentence or are on remand, you can be required to have a breathalyser test or a urine test if a prison officer has a reasonable suspicion that you have used drugs or alcohol in prison.

A prison officer above the rank of Assistant Superintendent can require a prisoner to have a urine test at any time. That is, they don’t need to have a ‘reasonable suspicion’ to make you have a urine test.

Updated January 30, 2015