Abstract
In December 1999, a discussion paper ‘Towards a National Approach to Forensic Mental Health’, was issued by the Australian Health Minister's Advisory Council National Mental Health Working Group (AHMAC). It arose out of a workshop held in Queensland in 1996 and convened by AHMAC. This reviewer was one of those in attendance.
The document described the status of the then existing services around Australia, identified the issues facing delivery of forensic mental health services and finished with a proposal articulating Guiding Principles, Rights and Responsibilities, and a suggested model for a forensic mental health system. This model recognised that Australia has a diverse population and needs and such diversities need to be both understood and reflected in planning such services. Further developments since the issue of the discussion paper have included a forensic policy and planning day in Sydney in 2000 involving a more restricted group representing state and territory health departments. Both the First and Second National Mental Health Plans have identified the special importance of the forensic population and its need to access equivalent services compared with those available to the wider community. There is therefore an imperative for promulgating, advancing and, hopefully, implementing these important principles, ideally during the lifespan of the Second National Mental Health Plan (1998–2003).
Prison forensic mental health is, in this reviewer's opinion, the cornerstone of a forensic mental health service. It plays as pivotal a role as a hospital within a health care system. Mental health professionals therefore can learn a great deal from Psychiatric Services in Jails and Prisons (a taskforce report of the American Psychiatric Association and chaired by Dr Henry Weinstein with, among its distinguished consultants, Dr Henry Steadman). First published in 1989, it has, according to the preface of the second edition, ‘lighted the way for those seeking to navigate the perilous shoals providing psychiatric services in jails and prisons’. The preface continues ‘in the succeeding decade, American jails and prisons have seen many changes including considerable litigation, the development of consumer groups, dramatic increases in census, and the creation of exemplary programmes’. Australian jails, similarly, have experienced a significant rise in population, reflecting an increasingly punitive community view of criminality, and the willingness of politicians, of all persuasions, to play the ‘deviance’ card in the law and order debate. To date, we have not experienced undue litigation regarding the quality and functions of our jails (perhaps if we had, more rapid and desirable changes to our correctional system would occur, with, perhaps, visible evidence of ‘some exemplary programmes’). Similarly, the influence of consumer groups for correctional and forensic populations (such as there are) in this country has been muted and lacks any real authority. What we have seen is the advent of American-style private jails about which there has been a surprising lack of community debate.
This taskforce report is divided into three sections – ‘Principles governing the delivery of psychiatric services in jails and prisons’, ‘Guidelines in psychiatric services in jails and prisons’ and ‘Special applications of the principles and guidelines’. This latter section deals with substance abuse, disorders, co-occurring disorders, HIV/AIDS, women, youth and adult correctional facilities, geriatrics and related issues and mental retardation/ developmental disability.
All sections of the book are clearly and succinctly written. The contents reflect the wide experience of the taskforce members. Understandably, it is in an American context but, nonetheless, has wide applicability. A short reading list in included at the end of the book. This, though useful, is limited by its exclusively American content. I would have liked to see mention of Conacher's book Management of the mentally disordered offender in prison [1] on that list, but this, while North American, is Canadian rather than American which may account for its noninclusion. This, however, is a small criticism and does not detract from the excellence of this slim and easy to read (and digest) volume. I would regard it as essential reading for any practitioner in the forensic mental health field and also forensic mental health administrators and policy makers. Criminologists, jail managers and (dare I say it) politicians could also learn a good deal from it.