The Victorian Auditor General's 94 page report on
Mental Health Strategies for the Justice System [
PDF], cited in the forthcoming book by Bonython & Arnold, comments
Good mental health is one of the foundations of a good life and a healthy society. The World Health Organisation broadly defines mental health as 'a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community'.
Almost 50 per cent of people aged 16 to 85 years will experience one or more mental illnesses—such as anxiety, mood and substance-use disorders—in their lifetime.
These illnesses can have significant impacts on individuals and their quality of life, including impairing their mental functioning and capacity to maintain relationships. They can also cause a person to come into contact with the criminal justice system. Rates of mental illness among people interacting with police, the courts and the corrections agencies are much higher than in the community generally.
A range of criminal justice agencies will often have to manage people with a mental illness:
Victoria Police provides initial response to incidents involving people with a mental illness. It intervenes by responding to incidents, and where necessary arresting and managing people with a mental illness in police cells.
The Magistrates' Court sentences offenders—including those with a mental illness—and aims to divert them from the criminal justice system where appropriate.
The Department of Justice (DOJ), through Corrections Victoria and Justice Health, manages and treats prisoners with a mental illness while incarcerated, while on parole, and on corrections orders.
In addition, the Department of Health (DH) sets priorities and funds mental health services that treat and manage people in contact with the criminal justice system.
While these agencies operate independently, they rely on each other when dealing with people with a mental illness. Better practice research indicates that joint planning and coordination is required where policy issues span the responsibilities of more than one agency, where agencies' responsibilities are interdependent, or where coordinating services can reduce costs and increase quality for end users.
This audit examined the effectiveness of planning and coordination for mental health across Victoria's criminal justice system, as the foundation for effective responses to people with a mental illness.
The Auditor General concludes -
The increasing incidence of people living with a mental illness in the community means that justice and health agencies are experiencing significant challenges. There are increasing interactions between people with a mental illness and agencies within the criminal justice system, and a lack of capacity to adequately respond to and manage these needs. This is particularly evident for Victoria Police and for Corrections Victoria.
Justice and health agencies recognise the importance of addressing mental health issues within the criminal justice system. All have implemented initiatives that aim to improve outcomes, but significant gaps remain. In the face of the increasing incidence of people with a mental illness interacting with the criminal justice system, a whole‑of‑system approach is required.
There is currently no overarching strategy or leadership for mental health and the justice system that focuses on improving outcomes for people with a mental illness. Where plans do exist, they are limited to agencies' own areas of responsibility, or only address parts of the justice system.
While there is evidence of agencies working together, this is neither uniform nor sufficiently coordinated across the justice system to address mental illness effectively. Further collaboration and coordination would likely enhance the overall outcomes for people with a mental illness.
Responsibility for coordinating the agencies is unclear, and there is a lack of accountability for the success or failure of responses across the criminal justice system. This is likely to further limit the effectiveness of coordination, collaboration and planning, as actions rely on individual agencies, their relationships and their ability to take a system-wide perspective.
The lack of effective planning and collaboration is inconsistent with several major strategic statements from the health and justice portfolios since 2009. These identified that justice, mental health, disability and other services such as housing, must work closely together if better outcomes are to be achieved for people with a mental illness coming into contact with the justice system.
The Findings in the report are -
Police response and arrest interventions
Victoria Police performs a critical role responding to people with a mental illness. Its role is at the 'front end', managing incidents caused by personal crisis, behaviour suggestive of mental disorder, or the effects of alcohol and other drugs.
The nature of Victoria Police's role in responding to people with a mental illness means that it routinely interacts with the health system, hospitals and DH. As such, both it and DH need to effectively collaborate and plan to maximise outcomes for people with a mental illness.
Until recently these agencies have focused planning in their own areas of responsibility. However, they are now working towards a joint plan to develop effective responses to mental illness. This has the potential to improve outcomes for people with a mental illness, whose interaction with mental health services results from their contact with police.
The level of inter-dependence between Victoria Police and DH necessitates effective collaboration and coordination. Since 2006, both agencies have sought to engage around mental illness, but have found it difficult to resolve issues and strategically collaborate. However, since 2012 Victoria Police and DH have both taken steps to strengthen their strategic engagement, and are working towards an agreed framework to oversee and address areas of inter-dependence.
Victoria Police and DH have longstanding mechanisms to support local communication and coordination between police, ambulance, area mental health services (AMHS) and hospital emergency departments. However, Victoria Police and DH will need to devote ongoing attention to ensure emergency services liaison committees (ESLC) are effectively maintaining local coordination.
Courts-based interventions
The Magistrates' Court hears criminal charges brought by police, makes findings in relation to guilt and makes sentencing orders. Courts may also obtain mental health assessments in considering criminal cases, particularly where an accused's mental illness may satisfy the criteria under relevant legislation.
The Magistrates' Court has successfully piloted specialist courts and programs to divert offenders with a mental illness to treatment, and address the causes of their offending. The specialist courts and programs play a key role by reducing rates of imprisonment.
However, there is no current plan guiding the development of the Magistrates' Court's specialist courts and support programs for people with a mental illness - including a framework describing the role these initiatives could play if they were extended beyond their current pilot locations to operate more widely across the Magistrates' Court's 12 major regional locations.
Prior to July 2014, DOJ provided policy, project and program management support, and led inter-agency communication around the Magistrates' Court's programs. DOJ's support enabled development of the Magistrates' Court's specialist courts and support programs for mental illness. From 1 July 2014, Court Services Victoria (CSV) has taken over responsibility for the Magistrates' Court's administrative and operating support, and management of specialist courts and support programs.
There is no agency-level forum in which DOJ, CSV, Victoria Police, DH and the Department of Human Services (DHS) are able to discuss strategic issues aimed at reducing offending and improving recovery of people with a mental illness in the criminal justice system.
Police custody and prison-based interventions
Holding offenders in custody provides an opportunity to both identify and treat mental health issues. When detained in police cells, individuals are in the legal custody of the Chief Commissioner of Police and Victoria Police provides health services as part of its custodial responsibility. Prison health services provide voluntary psychiatric consulting, nursing and inpatient treatment for prisoners with a mental illness. Under the Mental Health Act 2014 compulsory mental health treatment cannot be provided in prisons.
As offenders frequently move between police cells and prisons, effectively addressing their mental illness is complex. It requires effective collaboration between Victoria Police, DOJ, DH and other corrections service providers. However, there is no integrated plan for managing offenders with a mental illness who come into contact with these agencies. Previous plans to appoint a lead provider of health services across police, corrections and courts did not progress.
Justice Health and DH are now undertaking separate, but coordinated planning for prison mental health and wider mental health services. Justice Health is preparing for an additional 75 mental health beds for men in 2017. This planning comes as indicators of under-capacity within prison and compulsory mental health facilities have been apparent for several years and have now become extreme.
DOJ and DH have arrangements to communicate around mental health at an agency level. In particular, the agencies have well-established communication around mental health through the multi-agency Justice Health Joint Management Committee.
This coordination has helped Justice Health and DH to work closely from the inception of their inter-related planning projects. However, DOJ and DH have not clarified arrangements to ensure that decisions arising from each agency's planning are coordinated and address the current delays for prisoners with a severe mental illness requiring treatment.
Community supervision and prison transition interventions
Managing prisoners with a mental illness after release from prison, or offenders on community corrections orders, is challenging. Yet it can reduce the risk of reoffending. However, it requires the offender to actively engage in treatment or other programs, and for multiple agencies to work together.
There is, however, insufficient coordination of planning among the key agencies to support offenders with a mental illness released from prison. DOJ, DH and DHS operate and plan various support and housing programs. While the agencies are starting to work together, planning is not informed by a consistent framework of objectives, or of analysis of current and future demand.
Corrections Victoria, DH and DHS do not maintain regular agency-level contact around programs for community supervision and transition from prison. Consequently, this increases the risk that the agencies will miss opportunities to improve programs and services for people with a mental illness, or they could be unaware of changes that affect their ability to fulfil their accountabilities. This is particularly the case as Corrections Victoria, DH and DHS are involved in separate reforms that affect programs relevant to people with a mental illness.
The Auditor General makes the following recommendations
That Victoria Police and the Department of Health:
enhance bilateral arrangements to improve collaboration and coordination between the two agencies
improve governance weakness around local service coordination with the aim of improving accountability
update their joint protocol to reflect recent legislative changes.
That Court Services Victoria:
establishes a planning framework for the Magistrates' Court's specialist courts and support programs that considers ways to maximise their role and outcomes for offenders with a mental illness across the state
establishes strategic relationships with justice, health and human services agencies to coordinate development of its specialist courts and support programs for people with a mental illness.
That Court Services Victoria, the Department of Justice and the Department of Human Services:
review the provision of housing services to identify potential efficiencies and opportunities to improve effectiveness.
That the Department of Justice and the Department of Health:
prepare a joint plan for mental health facilities inside and outside prisons to guide future funding bids.
That the Department of Justice:
amends the terms of reference of the Justice Health Joint Management Committee to reflect its role as a forum for agency communication and coordination.
That Victoria Police:
monitors and reports the time that prisoners with a mental illness are held in police cells before transfer to the prison system.
That the departments of Justice, Health and Human Services:
establish arrangements to improve coordination, collaboration and planning across the three agencies
review the range of post-release and community correction programs to identify opportunities for improved effectiveness and efficiency.
The report notes that "two recommendations do not appear in the body of the report - they are directed at the criminal justice system as a whole"
That the Department of Justice, Department of Health, Department of Human Services, Victoria Police and Court Services Victoria:
-
jointly contribute to the development of a strategy that includes processes for coordination, collaboration, apportioning responsibility and accountability, and monitoring system-wide performance
- provide advice to government about agency roles and responsibilities for system-wide planning, responses and performance monitoring.
