We express concern that 'Corrections Health' now 'Justice Health' psychiatrists 'can' prescribe over the recommended dose, without clinical &/or peer review?
Prisoners can, and have died as a result of injectable anti-psychotics, and that this is a worry regarding Deaths in Custody, as well as being an extremely harrowing experience to undergo if it doesn't kill you.
Prisoners can, and have died as a result of injectable anti-psychotics, and that this is a worry regarding Deaths in Custody, as well as being an extremely harrowing experience to undergo if it doesn't kill you.
AUSTRALIA: NSW: The 2003 NSW Corrections Health Service (now Justice Health) Report on Mental Illness Among NSW Prisoners states that the 12 month prevalence of any psychiatric disorder in prison is 74%, compared to 22% in the general community, and while this includes substance disorder the high rate cannot be attributed to that alone.
Incidentally "Justice Health" may seem more 'just' that's why they changed their name "common government ploy" because they were not "correct" and even worse than hospitals outside the prison- about 10 times worse
So they weren't correct and they're certainly not just.
The twelve-month prevalence of psychosis in NSW inmates was thirty times higher than in the Australian community. The most common disorder was an anxiety disorder with the most common anxiety disorder being Post Traumatic (which can be very severe and disabling and indicates the horrors that many prisoners have experienced prior to and in jail).
One in twenty prisoners had attempted suicide in the twelve months prior to interview. This study only touches the surface of evaluation and statistics of the nitty-gritty of what's going on - it excluded many people, including those "too unwell" to be interviewed. It also reflects the attitude of the professional, but considering that we regard 'labelling' to be covered by the term 'psychiatric disability' we consider the report of great use.
This outrageously disproportionate situation arises from both prison conditions and the discriminatory nature of the "criminal justice system".
Injectable antipsychotics in prisons
This response was received from Justice Health
Re: Anti-psychotic medication
I write in response to your request for information dated 16th November 2004 regarding long acting depot anti-psychotics prison preparations.
There are certain clinical circumstances where certain anti-psychotics are required in the care of forensic patients. Their use is governed by the Mental Health Act and overseen by the Mental Health Review Tribunal.
In the case of patients discharged to the community under community treatment orders, the Mental Health Review Tribunal plays a similar role.
Justice Health aims to use the lowest possible dose and to minimise side effects on patients in all circumstances. There are quite a few preparations on the market and the dosage range of these preparations is outlined in MIMS. It would be 'uncommon' for Justice Health psychiatrists to exceed recommended dosage ranges without careful clinical consideration and peer review.
Many of our patients are now being placed on newer atypical anti-psychotic depot preparations like Risperdoi, Consta and hopefully use of this medication and the new generation of depot anti-psychotics will in the future minimise even further side effects and discomfort for patients.
It is very uncommon for force to be required to administer these medications. In an acute phase of illness where patients are very unwell and not able to cooperate injectable medications might be utilised but these tend to be short acting agents rather than depot preparations.
Generally depot preparations are only used in the maintenance phase of illness by which time the majority of patients are accepting of the requirement to take this medication.
I hope this information is helpful to you.
Yours sincerely
Dr Richard Matthews Chief Executive Officer 26 November 2004 **
________________________________________________________________
Justice Action has received many complaints about the use of injectable antipsychotics used in the NSW prisons and mental health facilities.
We express concern that "Corrections Health" now "Justice Health" psychiatrists can prescribe over the recommended dose, without clinical &/or peer review?
[Regarding forensic prisoners, we have received written confirmation from Justice Health that not just short acting but also depot antipsychotics can be and are administered using force, and that recommended dosages can be and are exceeded (which may occur without careful clinical consideration and peer review). This is a great concern, regardless of the frequency of such events, as we have been informed prior of a Death in Custody case, where a prisoner suffered Neuroleptic Malignant Syndrome, and according to staff died in a terrible manner following large doses of antipsychotics.]
So prisoners can, and have died as a result of injectable anti-psychotics, and that this is a worry regarding Deaths in Custody, as well as being an extremely harrowing experience to undergo if it doesn't kill you.
Atypical antipsychotics have their own problems, and over medication does not disappear just because an older drug is not used.
An example is the increased risk of diabetes, or effects on heart function, and many prisoners are already at risk of such diseases, due to conditions inside and also to conditions outside relating to discrimination and deprivation (eg Indigenous people).
What is being done about these effects on prisoners'? Are prisoners' given information about these effects? What danger signals should they watch out for? Can they report to Justice Health staff if they experience it?
Prisoners' have complained to Justice Action many times that injectable anti-psychotics are used as a non-medical tool, eg as punishment for disagreeing with a Correctional Officer, or as a convenience, and that these uses are in breach of International Rights Instruments.
How does the process of Correctional reporting to Health staff work? And what do they think they can do to improve the situation?
What are the procedural details on how Corrections information fits into a decision of forensic status? Why are prisoners' complaints showing us they are not receiving adequate information about the process and what medications are being administered to them?
Prisoners have a right to know these things and ask what is going wrong. Prisoners should be offered copies of their medical records and provided with them if they want them.
We question the "very uncommon" statement regarding use of force - and need statistics from Justice Health. Justice Action receives a fair number of incident complaints, and the difference doesn't make sense.
Why are short acting antipsychotics used with force anyway, why can't the use of force for depots be banned? We argue prisoner's consent should be sought and the prisoner should be worked with rather than against.
Prisoners should be allowed to work out plans for what actions to take in case of loss of capacity, and to communicate and discuss this with Health staff.
A Correctional environment should not prevent that, nor should it obstruct the carrying out of such a plan. This is a right and it is reasonable. These provisions should allow prisoners to access a psychiatrist in an emergency, eg to express concern that they are deteriorating, and to give input into their treatment so as to prevent the use of force or high doses.
Prisoners house at the HRMU High Risk Management Unit or in other segregation units at all jails end up with mental illness.
The transfer of Juveniles to the Department of Corrective Services from Kariong and the use of isolation were reported to be one way of preventing hostility at the centre?
But prisoners who are isolated for prolonged periods end up with mental illness. They can self-harm or even commit suicide.
Furthermore, it can easily be predicted that those placed in isolation will suffer mental illness. These are not necessarily forensic patients but they end up being mentally ill and treated like they're forensic patients - after prolonged periods of isolation?
So you take those prisoners you don't like that cause all the trouble and give them a mental illness as a way to change their offending behaviour. Brilliant?
After a prolonged period of isolation you take them to the long bay prison hospital and they're forced onto medication for the rest of their life as a way of control.
Under the heading prisoners programs this must rate as a complete failure in terms of solving problems like lack of education, social skills or life skills.
Related:
A TOTAL ABUSE OF POWER
We the prisoners at the High Risk Management Unit at Goulburn Correctional Centre would like to ask you for help in receiving equal treatment and opportunities as other prisoners throughout the system. As we are told that we are not in a segregation unit but we are treated as though we are in one.
Firstly we are being housed in a segregation type environment and yet we are being told that we are not in segregation but we are on normal discipline status, this is in regards to 9 unit and 8 unit of the HRMU. This is totally false, we are not being housed as normal discipline prisoners, but we are being housed as segregation prisoners and in some cases prisoners are being housed in 7 unit which is officially called and used as a segregation and those prisoners are being told that they are not in segregation.
More:
http://www.geocities.com/gregskables/archive3/2003c24
EDITORIAL: Justice Denied In NSW Corrective Services
There used to be a (VJ) or Visiting Justice who would go into the prison and judge any claim or accusation that was made by any prisoner or prison guard. If it were found that a prisoner had offended then punishment was metered out.
Taken into account were any relevant evidence or proof of and alleged incident and the type and duration of any such punishment that would be given to the prisoner as a result of being found guilty of some type of internal prison offence. Whether that is assault, contraband, or gang related activity etc.
The reason for a VJ meant that the wide ranging discretion that the commissioner has in relation to the "Good order and security of the prison" could not be conducted on false premise say because some politician, police or prison guard took offence to a certain prisoner who was unpopular, either politically or personally.
More: http://www.geocities.com/nswac14/archive04/2004a58.html
UK solitary confinement
Serious brutality against prisoners is now routine in segregation in gaols like Full Sutton, Frankland and Long Lartin, and all levels of staff - screws, governors, doctors, boards of visitors etc - collude and co-operate with the sadists directly inflicting the violence. The conspiracy of silence extends from the Home Office and Prison Service to middle class prison reform organisations who accept that exceptional measures are sometimes justified when dealing with 'control problem' prisoners.
More: http://www.sydney.indymedia.org.au/front.php3?article_id=49266&group=webcast
US: solitary confinement
DEATH IN THE BOX
By the time Jessica Lee Roger was discovered on the floor of her prison cell on Aug. 17, 2002, it was too late. In the 24 minutes since guards had last checked her, she had tied a bed sheet around her neck and, after many attempts over three years in prison, finally strangled herself. When word of Roger's suicide spread through the cellblocks of the Bedford Hills Correctional Facility that sultry weekend, two correction officers cried.
More: http://www.geocities.com/nswac14/archive1/DITB.pdf
Crime and Punishment
Prisons, by their nature and the communities they house, suffer more acutely from the social exclusion that characterises the underprivileged parts of Australian society. Without the exacerbation of a custodial experience, these characteristics alone militate against the successful reintegration of prisoners back into the community.
More: http://www.sydney.indymedia.org.au/front.php3?article_id=49267&group=webcast
Incidentally "Justice Health" may seem more 'just' that's why they changed their name "common government ploy" because they were not "correct" and even worse than hospitals outside the prison- about 10 times worse
So they weren't correct and they're certainly not just.
The twelve-month prevalence of psychosis in NSW inmates was thirty times higher than in the Australian community. The most common disorder was an anxiety disorder with the most common anxiety disorder being Post Traumatic (which can be very severe and disabling and indicates the horrors that many prisoners have experienced prior to and in jail).
One in twenty prisoners had attempted suicide in the twelve months prior to interview. This study only touches the surface of evaluation and statistics of the nitty-gritty of what's going on - it excluded many people, including those "too unwell" to be interviewed. It also reflects the attitude of the professional, but considering that we regard 'labelling' to be covered by the term 'psychiatric disability' we consider the report of great use.
This outrageously disproportionate situation arises from both prison conditions and the discriminatory nature of the "criminal justice system".
Injectable antipsychotics in prisons
This response was received from Justice Health
Re: Anti-psychotic medication
I write in response to your request for information dated 16th November 2004 regarding long acting depot anti-psychotics prison preparations.
There are certain clinical circumstances where certain anti-psychotics are required in the care of forensic patients. Their use is governed by the Mental Health Act and overseen by the Mental Health Review Tribunal.
In the case of patients discharged to the community under community treatment orders, the Mental Health Review Tribunal plays a similar role.
Justice Health aims to use the lowest possible dose and to minimise side effects on patients in all circumstances. There are quite a few preparations on the market and the dosage range of these preparations is outlined in MIMS. It would be 'uncommon' for Justice Health psychiatrists to exceed recommended dosage ranges without careful clinical consideration and peer review.
Many of our patients are now being placed on newer atypical anti-psychotic depot preparations like Risperdoi, Consta and hopefully use of this medication and the new generation of depot anti-psychotics will in the future minimise even further side effects and discomfort for patients.
It is very uncommon for force to be required to administer these medications. In an acute phase of illness where patients are very unwell and not able to cooperate injectable medications might be utilised but these tend to be short acting agents rather than depot preparations.
Generally depot preparations are only used in the maintenance phase of illness by which time the majority of patients are accepting of the requirement to take this medication.
I hope this information is helpful to you.
Yours sincerely
Dr Richard Matthews Chief Executive Officer 26 November 2004 **
________________________________________________________________
Justice Action has received many complaints about the use of injectable antipsychotics used in the NSW prisons and mental health facilities.
We express concern that "Corrections Health" now "Justice Health" psychiatrists can prescribe over the recommended dose, without clinical &/or peer review?
[Regarding forensic prisoners, we have received written confirmation from Justice Health that not just short acting but also depot antipsychotics can be and are administered using force, and that recommended dosages can be and are exceeded (which may occur without careful clinical consideration and peer review). This is a great concern, regardless of the frequency of such events, as we have been informed prior of a Death in Custody case, where a prisoner suffered Neuroleptic Malignant Syndrome, and according to staff died in a terrible manner following large doses of antipsychotics.]
So prisoners can, and have died as a result of injectable anti-psychotics, and that this is a worry regarding Deaths in Custody, as well as being an extremely harrowing experience to undergo if it doesn't kill you.
Atypical antipsychotics have their own problems, and over medication does not disappear just because an older drug is not used.
An example is the increased risk of diabetes, or effects on heart function, and many prisoners are already at risk of such diseases, due to conditions inside and also to conditions outside relating to discrimination and deprivation (eg Indigenous people).
What is being done about these effects on prisoners'? Are prisoners' given information about these effects? What danger signals should they watch out for? Can they report to Justice Health staff if they experience it?
Prisoners' have complained to Justice Action many times that injectable anti-psychotics are used as a non-medical tool, eg as punishment for disagreeing with a Correctional Officer, or as a convenience, and that these uses are in breach of International Rights Instruments.
How does the process of Correctional reporting to Health staff work? And what do they think they can do to improve the situation?
What are the procedural details on how Corrections information fits into a decision of forensic status? Why are prisoners' complaints showing us they are not receiving adequate information about the process and what medications are being administered to them?
Prisoners have a right to know these things and ask what is going wrong. Prisoners should be offered copies of their medical records and provided with them if they want them.
We question the "very uncommon" statement regarding use of force - and need statistics from Justice Health. Justice Action receives a fair number of incident complaints, and the difference doesn't make sense.
Why are short acting antipsychotics used with force anyway, why can't the use of force for depots be banned? We argue prisoner's consent should be sought and the prisoner should be worked with rather than against.
Prisoners should be allowed to work out plans for what actions to take in case of loss of capacity, and to communicate and discuss this with Health staff.
A Correctional environment should not prevent that, nor should it obstruct the carrying out of such a plan. This is a right and it is reasonable. These provisions should allow prisoners to access a psychiatrist in an emergency, eg to express concern that they are deteriorating, and to give input into their treatment so as to prevent the use of force or high doses.
Prisoners house at the HRMU High Risk Management Unit or in other segregation units at all jails end up with mental illness.
The transfer of Juveniles to the Department of Corrective Services from Kariong and the use of isolation were reported to be one way of preventing hostility at the centre?
But prisoners who are isolated for prolonged periods end up with mental illness. They can self-harm or even commit suicide.
Furthermore, it can easily be predicted that those placed in isolation will suffer mental illness. These are not necessarily forensic patients but they end up being mentally ill and treated like they're forensic patients - after prolonged periods of isolation?
So you take those prisoners you don't like that cause all the trouble and give them a mental illness as a way to change their offending behaviour. Brilliant?
After a prolonged period of isolation you take them to the long bay prison hospital and they're forced onto medication for the rest of their life as a way of control.
Under the heading prisoners programs this must rate as a complete failure in terms of solving problems like lack of education, social skills or life skills.
Related:
A TOTAL ABUSE OF POWER
We the prisoners at the High Risk Management Unit at Goulburn Correctional Centre would like to ask you for help in receiving equal treatment and opportunities as other prisoners throughout the system. As we are told that we are not in a segregation unit but we are treated as though we are in one.
Firstly we are being housed in a segregation type environment and yet we are being told that we are not in segregation but we are on normal discipline status, this is in regards to 9 unit and 8 unit of the HRMU. This is totally false, we are not being housed as normal discipline prisoners, but we are being housed as segregation prisoners and in some cases prisoners are being housed in 7 unit which is officially called and used as a segregation and those prisoners are being told that they are not in segregation.
More:
http://www.geocities.com/gregskables/archive3/2003c24 EDITORIAL: Justice Denied In NSW Corrective Services
There used to be a (VJ) or Visiting Justice who would go into the prison and judge any claim or accusation that was made by any prisoner or prison guard. If it were found that a prisoner had offended then punishment was metered out.
Taken into account were any relevant evidence or proof of and alleged incident and the type and duration of any such punishment that would be given to the prisoner as a result of being found guilty of some type of internal prison offence. Whether that is assault, contraband, or gang related activity etc.
The reason for a VJ meant that the wide ranging discretion that the commissioner has in relation to the "Good order and security of the prison" could not be conducted on false premise say because some politician, police or prison guard took offence to a certain prisoner who was unpopular, either politically or personally.
More:
http://www.geocities.com/nswac14/archive04/2004a58.html UK solitary confinement
Serious brutality against prisoners is now routine in segregation in gaols like Full Sutton, Frankland and Long Lartin, and all levels of staff - screws, governors, doctors, boards of visitors etc - collude and co-operate with the sadists directly inflicting the violence. The conspiracy of silence extends from the Home Office and Prison Service to middle class prison reform organisations who accept that exceptional measures are sometimes justified when dealing with 'control problem' prisoners.
More:
http://www.sydney.indymedia.org.au/front.php3?article_id=49266&group=webcast US: solitary confinement
DEATH IN THE BOX
By the time Jessica Lee Roger was discovered on the floor of her prison cell on Aug. 17, 2002, it was too late. In the 24 minutes since guards had last checked her, she had tied a bed sheet around her neck and, after many attempts over three years in prison, finally strangled herself. When word of Roger's suicide spread through the cellblocks of the Bedford Hills Correctional Facility that sultry weekend, two correction officers cried.
More:
http://www.geocities.com/nswac14/archive1/DITB.pdf Crime and Punishment
Prisons, by their nature and the communities they house, suffer more acutely from the social exclusion that characterises the underprivileged parts of Australian society. Without the exacerbation of a custodial experience, these characteristics alone militate against the successful reintegration of prisoners back into the community.
More:
http://www.sydney.indymedia.org.au/front.php3?article_id=49267&group=webcast 
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