Increase in services for forensic mental health

Media Release

11 April 2007

Increase in services for forensic mental health patients

The Ministry of Health notes the increase in forensic mental health services provision across the country, as shown in the Census of Forensic Mental Health Services, carried out in 2005.

In this census there were 236 secure and non-secure inpatient beds across all five forensic service regions. This compares to 206 in 1999, an increase of 30 beds.

Director of Mental Health Dr David Chaplow says the increase reflects the growth in service provision need, which was largely a result of an increased prison muster. The Ministry of Health is committed to monitoring this need, and providing resources for forensic services in accordance with demand as it arises.

Along with these additional beds, there has been an increase in prison liaison services, with over 22 prison liaison full-time equivalent (FTE) employees established nationwide since 1999. Prison liaison services are serving on average 5 percent of prisoners. The Ministry of Health would like to see an increase in the percentage of prisoners receiving forensic services, as epidemiological studies show a greater need than 5 percent exists. Since 1999 there has been an increased emphasis on the transfer of community-based forensic service users to general adult mental health services, where practically possible.

Dr Chaplow says this is good news, and shows that community-based care services are doing an effective job in providing care for patients.

Despite this, the annual prison population is set to increase within the next few years from approximately 7712 in June 2007, to approximately 8685 in June 2010. Regional forensic services? capacity looks set to be further stretched because of this. A recent example is the opening of the new Spring Hill prison near Meremere, which will place pressure on forensic services in the Waikato region. The Ministry is currently updating the 2001 Forensic Framework (Services for People with Mental Illness in the Justice System 2001) to take account of this 2005 Census. The updated review reflects new issues that have emerged since 2001, which include the increase of female service users, service issues around youth, and the future demand on forensic services, particularly from growth in prison numbers. Future forecasts for FTEs and service requirements for the next five years will also be included. Key DHBs, who include those providing regional forensic services and funders, will be consulted before mid-2007 for their views on service direction and planning for this timeframe. The Census of Forensic Mental Health Services 2005 can be viewed at www.moh.govt.nz.

Additional information:

Background to this Census The National Study of Psychiatric Morbidity in New Zealand Prisons (Department of Corrections 1999) was produced after the Ministries of Justice and Health sought more information on mental illness in the prison population. It found that, in comparison with the general population, a disproportionately high number of prisoners have mental illness. While the National Study was being undertaken, the Ministry of Health began developing a framework for forensic mental health, Services for People with Mental Illness in the Justice System (Ministry of Health 2001a). As part of the development process, a census and qualitative survey of forensic services (as at September 1999) was completed. This 2005 Census updates the data found in the 1999 Census.

Since the framework was developed in 2001 a number of changes have occurred within the wider environment of forensic services, including the following:

· The National Secure Unit at Lake Alice Hospital has closed and replacement beds have been located within regional forensic inpatient units. · Legislative arrangements have changed, with the replacement of part 7 of the Criminal Justice Act 1985 by the Criminal Procedure (Mentally Impaired Persons) Act 2003, and with the enactment of the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003. · New community services have been developed for people with intellectual disability and a history of offending. · Intersectoral initiatives are occurring or are in development for meeting the mental health needs of children and young people in the youth justice system (under the Children, Young Persons and their Families Act 1989). · Prison musters have increased, and new prisons have been (and are being) built.

As a result of these environmental changes, there have been a number of changes to the configuration of forensic services within New Zealand.

In October 2005 a new census of forensic services was carried out. This census had wider coverage than the 1999 census, and information was collected on:

· forensic inpatients and community-based forensic service users at all regional forensic services, and Hauora Waikato, as at 10 October 2005 · prison liaison service users as at census date (10 October 2005), and prison liaison service activity for the month from 10 October to 10 November 2005 · court liaison service activity for the month from 10 October to 10 November 2005, and court reports prepared in the month from 10 October to 10 November 2005 · bed numbers and staffing levels at all regional forensic services, and Hauora Waikato.

Admission length In 2005 the length of current admission was less than one year for 92 (43%) forensic inpatients, the largest single group in this category, as well as for 31 (19%) community-based forensic service users. The largest group of community-based forensic service users (53, or 32%) had a length of current admission of two to four years.

Twenty inpatients (10%) and 26 (16%) community forensic service users had long-term admissions of six or more years, while 47% (102) of inpatients and 65% (107) of community forensic service users had current admissions in the range of one to six years. These figures are generally comparable to 1999 results, allowing for missing data at that time.

Diagnoses and Index Offences As in the 1999 review, schizophrenia was the most common diagnosis among inpatients (157, or 71%) and community forensic service users (121, or 73%) in 2005. Each primary diagnosis for forensic inpatients occurred in roughly the same proportions in 1999 and 2005. However, there was an increase in the proportion of community-based forensic users with a primary diagnosis of schizophrenia from 48% to 73%. This increase was due to lower numbers of community-based forensic service users with a primary diagnosis of bipolar affective disorder, personality disorder, substance abuse and no diagnosis. The actual number of community-based forensic service users with a primary diagnosis of schizophrenia was in fact stable from 1999 (123) to 2005 (121).

In 1999 violence or the threat of violence was the index offence for 69% of forensic inpatients and 52% of community forensic service users for which this data was available. Combining these two groups, violence or the threat of violence accounted for 58% of index offences. The next most common index offences were willful damage/trespass (11%) and sexual offences (8%).

Similarly, violent offences were the most common category of index offence among inpatient and community forensic service users in 2005 (225 or 59%). The next most frequent category was sexual offences, which accounted for 34 (9%) of index offences, followed by offences against a person (30 or 8%).

Gender and Age At the time of the 2005 census, 184 (86%) people in forensic inpatient facilities were men and 31 (14%) were women. Comparison with 1999 information shows that the number of women inpatients had nearly doubled since 1999 (from 15 to 31), making up 14% of inpatients in 2005 as compared with 8% in 1999.

Of the 165 community forensic service users in 2005, 89% (147) were male and 11% (18) were female. The number of female community-based forensic service users has dropped since 1999, when there were 27 such users, but has stayed constant in percentage terms.

In October 2005 age range patterns for both inpatient and community forensic service user groups were quite similar. Eighty-seven percent (186) of inpatients and 92% (151) of community forensic service users were 25 years old and over. Fifty-two percent (112) of forensic inpatients and 61% (101) of forensic community forensic service users in 2005 were over the age of 35 years.

What types of forensic services are provided? Forensic mental health services were first established in New Zealand as a response to the issues raised in the Mason Report, which presented the findings of the Committee of Inquiry into Procedures Used in Certain Psychiatric Hospitals in relation to Admissions, Discharge or Release on Leave of Certain Classes of Patients 1989 (Mason 1988). Regional forensic services were established in Auckland, Wellington, Wanganui, Hamilton, Christchurch and Dunedin. These services were in addition to the National Secure Unit at Lake Alice Hospital. The role of these regional services was to assess, treat and rehabilitate people with a mental illness who had, or were alleged to have, committed a crime and those who were likely to offend. The following forensic inpatient facilities exist in New Zealand:

· Mason Clinic, Auckland; 84 beds; Auckland Regional Forensic Service (RFS) · Henry Rongomau-Bennett Centre, Hamilton; 40 beds; Waikato RFS · Stanford House, Wanganui; 10 beds; Central RFS · Ratonga-Rua-o-Porirua, Porirua; 40 beds; Central RFS · Hillmorton Hospital, Christchurch; 34 beds; Canterbury RFS · Wakari Hospital, Dunedin; 13 beds; Otago/Southland RFS.

Hauora Waikato also provides 15 ?step-down? inpatient beds for forensic patients who are being transferred out of secure care.

ENDS

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