Manawatū Prison fails to adequately address mental health needs - inspector

Prisoners seeking mental health support at a prison south of Palmerston North were waiting up to three months to see a clinician, inspectors say.

The inspection at Manawatū Prison, conducted by the Office of the Inspectorate during April 2023, is the first one to check an entire unit since the end of Covid-19 restrictions.

The report found the prison's resources and support systems struggled to adequately address mental health needs.

Chief Inspector Janis Adair said despite some progress since 2019, the unit had persistent gaps in mental health support.

"A Clinical Nurse Specialist (Mental Health) [was] appointed approximately two months before our inspection," Adair said.

"The Clinical Inspector's review of 43 health files from across the six-month review period showed that prior to the Clinical Nurse Specialist starting, not all requests for mental health assistance had been followed up by a mental health clinician due to the limited support available at the time."

The report from the prison's watchdog revealed delays in accessing mental health clinicians, with prisoners facing waitlists of two to three months for assistance.

While a clinician was available to support prisoners with mild to moderate mental health needs, limited interview and therapy spaces further hampered efforts to provide timely care, Adair said.

The inspection found prisoners were having challenges trying to manage their mental health.

Some men found it "hard to cope", the report said.

The prison unit also lacked an Intervention and Support Unit (ISU) for at-risk prisoners, raising safety concerns, particularly regarding those prone to self-harm.

While prison staff made commendable efforts to manage such cases, the lack of specialised resources posed ongoing challenges, Adair said.

"The design of the site, by virtue of the date it was built, posed a constant challenge despite ongoing remedial and maintenance work.

"The site continues not to have an Intervention and Support Unit, which is a significant limitation, though I acknowledge the best efforts of staff to manage those who are at risk of self-harm."

Prisoners considered at-risk were being transferred to other prison units in the country, the report found.

"The health centre manager told us there were sometimes challenges with completing at-risk assessments and that health staff had to call her for confirmation of referrals to Whanganui Prison.

"Moreover, due to the limited numbers of custodial staff available, there were sometimes difficulties in arranging transfers for at-risk prisoners."

Staff burn-out

At the time the inspection took place, Manawatū Prison housed 145 remand and 75 sentenced prisoners, a total of 220 men.

Adair said staffing issues were impacting prisoner's management.

"[At the time of the inspection] the site was operating at a reduced staffing level and with a high proportion of remand prisoners which meant it was difficult for staff and other stakeholders to prioritise improving outcomes for prisoners.

"Shortages of custodial staff, both at the site and nationwide, were of concern to many staff."

The inspectorate said the staff shortage nationwide was increasing the workload and 30 percent of the staff had less than three years' experience.

"Custodial staff we spoke with were positive about the idea of new staff starting, but several pointed out that, short-term, new staff increased their workload as they needed training and support."

Despite overall high morale from custodial staff, overtime and burnout were impacting the unit, she said.

"Several custodial staff told us 'a lot' of custodial staff were doing overtime to keep the site running, and that the constant 12-hour shifts left staff tired and burned out, even on their days off.

"They said there had been some eight and 10-hour shifts, but these were no longer available, which was a source of frustration."

Real progress made - Prison watchdog

Adair said, despite the challenges, the prison was doing far better than its last inspection.

"During this inspection, I found that Manawatū Prison's leaders were generally visible, accessible and consistent. This was contributing to improved staff morale.

"It is pleasing to note that since our last follow-up inspection of Manawatū Prison in 2019, and the more recent inspection in 2021 by the Chief Ombudsman, the site has made real progress on a number of fronts."

Highlighting the progress was necessary to influence other institutions to follow the same path, she said.

"For the first time in a prison inspection report, I have chosen to highlight some areas of notable positive practice.

"Firstly, and importantly, to recognise the efforts of staff. Secondly, in the hope that other prison directors will look to these areas of good practice and consider implementing them at their sites."

In the report, Adair highlighted the prison's efforts to keep holding prisoners' welfare groups.

"Since late 2022, the site has been holding regular prison forums, which give the men an opportunity to raise issues or concerns directly with senior leaders.

"These forums have proved to be a positive initiative and I urge other sites to explore how they may best introduce something similar."

The prison had repurposed its gym for a short course on scaffolding due to staff shortage, she said.

"This was a creative response that gave both remand and sentenced prisoners a constructive activity."

In the report, Adair also mentioned, at the time of the inspection, prisoners were not required to share cells.

"I know they welcomed having some personal space.

"Whilst I acknowledge that this is not always possible at other sites, I do urge the Department [of Corrections] to consider, where possible, providing this."

'Important concerns over mental health in prisons' - Doctor

Former public health leader Dr Erik Monasterio said the report raised important concerns regarding mental health management in prisons.

Prisoners on remand were unable to access vital mental health services, which exacerbated psychological distress, Dr Monasterio said.

"The striking aspect of the Manawatū Prison from the report is that it has got a high remand population, and people who are held on remand do not have, in general, access to any therapeutic intervention.

"So, with a limited access to improving mental health services, those who have psychological distress are unlikely to be able to access that support, which obviously is not going to be helpful for those prisoners."

The lack of ISUs was concerning too, Dr Monasterio said.

"The absence of [ISUs] means that the level of concern about detaining people with high psychiatric needs is not occurring in Manawatū Prison. But it's noteworthy that [prisoners with acute mental health disorders] are sent to Wanganui prison.

"The questions then is how often that's occurring, and how long are prisoners needing to wait to access psychiatric care once transferred."

In general, the review was positive, he said.

"That review seems to be positive in many ways, because it highlights improvement in many important areas for the management of prisoners.

"In particular, I think it's helpful that leadership staff are better integrated with general staff, which often means that you can get to know prisoners better and manage them better."

'Making continuous improvements' - Department of Corrections

Corrections Chief Custodial Officer Neil Beales said he was happy with the report.

"I am immensely proud of our staff throughout the country during the pandemic, who worked conscientiously and professionally throughout difficult times, to ensure the safety of their colleagues, prisoners and the public."

Corrections was making a concerted effort to recruit, retain and train frontline custodial staff, Beales said.

"This includes launching its recruitment campaign, strengthening recruitment processes, improving onboarding processes, implementing new rosters which provide staff with better work/life balance and help them to avoid fatigue and continuously working to improve staff safety."

"As of 19 January 2024, we have received 18,662 applications since 1 October 2022, with 1097 recruited into Corrections Officer roles."

In relation to the mental health findings, Beales said while prison services were not designed to support people with severe mental health issues, Corrections took its duty of care very seriously.

"In recent years, we've seen our role significantly expand as staff manage a growing number of people, including defendants remanded in custody, with complex mental health needs.

In all prisons, appointed mental health services may or may not have a waitlist, depending on the demand, he said.

"However, individuals who are assessed as having mental health needs requiring immediate support will be prioritised, and those considered to be at risk of suicide or self-harm will be supported in an Intervention and Support Unit."

The Central Regional Forensic Adult Mental Health Service was currently inside Manawatū Prison one day per week and ran a consultant psychiatrist and mental health nurse clinic, he said.

"Corrections funds one [full-time employee] Improving Mental Health clinician at Manawatū Prison, contracted to provide 15 hours face to face time per week. A Clinical Nurse Specialist (Mental Health) also works on site four days a week."

While the prison did not have ISUs, the health team was trained in completing mental health assessments, Beales said.

"And at-risk prisoners are transferred to the Intervention and Support Unit at Whanganui Prison. There is good communication between the health centre managers which ensures all at-risk prisoner transfers are managed safely."

He acknowledged the report was important for the prisons' development.

"Independent scrutiny such as this helps to focus our work on the right areas and ensure we are making continuous improvements."