The issue of mental health treatment in prisons was a largely “hidden problem” from the public, he said, but was a frequently discussed issue amongst psychiatrists in New Zealand and Australia.
“It’s certainly inequitable and potentially a breach of their human rights,” Cavney said.
“There are a lot of people who we know are unwell and need to be in hospital but can’t immediately be admitted into a forensic acute ward. So that leads to sick people staying in prison for longer.
“They can be locked down in isolation for quite a long time over the course of a day, so it’s quite a restrictive and untherapeutic way of managing people who are acutely unwell.”
Health NZ said within the prison environment, prisoners were able to access some outpatient mental health care provided by forensic services, however, it was necessary to operate a waitlist for inpatient care with the demand exceeding supply.
The system operates on with those deemed to be most severely unwell being the first admitted to beds.
Health NZ Mental Health & Addictions Service Enhancement national director Phil Grady said managing the availability of acute and secure forensic inpatient beds was a priority.
“Health NZ is actively working together with Corrections to improve our systems and delivery of care for mentally unwell prisoners. We recognise this is a high needs group,” Grady said.
Cavney said people awaiting trial or sentencing who needed mental health treatment were spending longer periods of time in prison, but if those same people were in a community setting, they would probably have access to an inpatient bed faster.
In prison, Cavney explained, the Mental Health Act could not be applied, which meant treatment of prisoners who had been identified by a clinician as needing inpatient care could not be enforced. This meant inmates could refuse mental health treatment and likely would become more unwell, he said.
The problem was also exacerbated by prisoners remanded in custody who could not be moved to highly secured mental health facilities because of the risk of escape, Cavney said.
Grady said it was also important to prevent the criminalisation of mental health needs and to find alternative venues for care delivery that were community and recovery-based.
Within Corrections, the chief mental health and addictions officer, Emma Gardner, said the department did not decide who was in custody or in a mental health facility.
“Increasingly, Corrections staff are required to manage some of New Zealand’s most unwell people in a custodial environment, including, at times, people waiting for a bed in a dedicated forensic mental health facility outside prison.
“This can be extremely challenging for our frontline staff who do an incredible job working with often volatile and vulnerable people.”
Beds in Auckland’s Mason Clinic were mostly limited to those prisoners who had been acquitted of serious crimes on the grounds of insanity or people who had been deemed unfit to stand trial.
Of the 182 people added to the wait list last year, 82 were admitted to the Mason Clinic, 34 were diverted from custody and admitted to a local general mental health inpatient unit, and 66 were removed from the wait list after responding to treatment or for other reasons.
The high demand for inpatient beds was also strained further by the disproportionately high number of prisons in the northern region.
Forensic psychiatry services in the northern region – which covers Auckland to all the way up north – are the largest in New Zealand and provide care for 40% of the national population. The region includes New Zealand’s largest remand prison, largest prison for women and the only maximum-security prison in the country.
Cavney said the Auckland Regional Forensic Psychiatric Service would try to identify people early who might be suitable for a diversion into a general mental health unit in support of a bail application to that address after they were remanded in custody.
Judicial matters, such as delays in court proceedings, perceptions about the lesser security of psychiatric units compared to prison, or a lack of a general mental health unit bed could impact where people with mental illnesses were bailed to, Cavney added. The default was often that they remained in prison, he said.
In February, the Mason Clinic opened its new $162m E Tū Wairua Hinengaro unit, a multi-storey building with a 60-bed capacity.
Grady said while the facilities within the new unit had enhanced the quality of care, the new facility did not add additional bed capacity for the forensic service and was a replacement for the old facility which was no longer fit for purpose.
The previous ageing units had air quality and weather-tightness issues.
Gardner said prison-based services were not designed to support people with serious mental illness, but Corrections was being proactive in ensuring people in prison had access to the specialist mental health support they needed.
She said a range of work was underway to improve mental health support in prisons and Corrections had “significantly invested in the growth of mental health teams”.
“There isn’t one simple change to make that will address systemic issues.”
In Budget 2025, the Government invested $51m over four years in specialist forensic mental health services to open more beds in the Midland region.
Dr Hiran Thabrew says delays to treatment for prisoners would likely produce worse long term outcomes. Photo / RNZ / Cole Eastham-Farrelly
RANZCP Tū Te Akaaka Roa NZ national office chair Dr Hiran Thabrew said everyone deserved access to safe, equitable and effective mental health care, no matter their background or circumstances.
He said delays to treatment were likely to lead to greater distress for prisoners with mental health issues, longer duration and cost of treatment and worse long-term outcomes.
“We’re calling on all parties to commit to increasing funding for 20 additional subspecialty psychiatry training runs in key areas of unmet need like forensic psychiatry, along with other mental health resources ahead of this year’s election.”
In Australia, the shortage was even more severe, with people who were found unfit to stand trial or legally insane after proceedings still being held in prison under custodial orders because of the absence of forensic inpatient beds for indefinite periods.
“There are disproportionately high rates of mental illness in the prison setting compared to the community,” Cavney said.
“Internationally, it’s been recorded that prisons have become the new revolving door for mental health patients.”
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