The former head of Canterbury DHB’s mental health service says the Government is ignoring the gravity of the country’s mental health crisis, particularly when it comes to those who have committed a crime.
On March 13, 2020 an editorial in the New Zealand Medical Journal came out swinging.
“Mentally ill people in our prisons are suffering human rights violations,” the title read.
“Successive governments have ignored the effect that rapid growth in the prison population has had on health and equity in Aotearoa New Zealand.
“The clinical directors from all the regional forensic services consider this an unacceptable health equity and human rights crisis, requiring an urgent government response.”
One of those authors was Erik Monasterio, who at the time was the clinical director and director of Area Mental Health Service, Canterbury Regional Forensic Service.
The article went on to describe how growth in the prison population had far exceeded resources to manage the wide and complex range of health problems common for this population.
“It leaves prisoners with acute health needs far worse off than the rest of the population, especially those suffering from serious mental illness. The growth has contributed to a serious – arguably scandalous – mental health crisis with few options for relief in sight.”
It advocated for a specialised mental health court, similar to those in place in some Australian states and other parts of the world, where low-level offenders with mental health problems were treated, rather than put behind bars.
Unfortunately, the editorial did not pack the punch it should have – with the country on the brink of its first level four lockdown, the news cycle and politicians gave it no mind.
Last year during an RNZ investigation it was highlighted when Monasterio expressed the same concerns.
He told Newsroom a year on again, nothing had changed.
“There does not want to be the acknowledgement of the extent of the problem – little less looking at solutions for it.” – Erik Monasterio
“There have been some discussions, and, it is my understanding, some consideration to those. But as time goes on … the health crisis is getting worse and worse, and once the general health crisis gets worse, you know, the sensitivity to people with serious mental disorders who also offend goes down the scale.
“They fail to capture the advocacy voice, because seemingly, people who suffer from medical conditions are more worthy of that discussion.”
After working for the DHB for almost 27 years, he quit in 2021, despondent his job was not improving the quality and access of care for people with a serious mental illness.
“I was part of a system that was becoming increasingly more irresponsible for the care of people. So my opinion was, if I could not satisfactorily lead and make an impact, a positive impact, then my only decision to make was to leave.”
He said in the past five years the situation for the mentally ill had become the worst he had seen.
“My overall impression is that there is a failure to appreciate the nature and severity of the issue. Because you don’t hear progressed discussion in relation to establishing mental health courts or good diversionary programmes, to ensure that people with serious mental illness are not unnecessarily incarcerated.
“My view is that it’s just such a difficult issue and we’ve gone so significantly backwards in the last five years, that even at that governmental level, there does not want to be the acknowledgement of the extent of the problem – little less looking at solutions for it.”
The argument for a mental health court
Monasterio said a lack of beds in inpatient mental health facilities coupled with a staffing shortage meant mentally unwell people continued to be placed in custodial and prison environments rather than in specialised mental health care services.
His question now is how can that trend at the very least be stopped or, ideally, reversed?
“One of the considerations is the introduction of mental health courts, and they’ve been around for some time, particularly in the UK, the US, parts of Australia and in Canada.
“The evidence from those mental health courts is that they do decrease the rate of recidivism or reoffending for people with mental disorders associated with violence, and they do divert people away from a criminal justice system to a health system, which is where they should be if they have a major mental disorder.”
He said a pilot should be established as a starting point.
“Which generally require specially trained judges, representation from police, mental health services – particularly multidisciplinary teams, and specialists in the assessment of drug and alcohol treatment.”
“It would be ideal for New Zealand to introduce pilot mental health courts to identify particularly at the point of reception to custody, those who present with high risk of offending and have serious mental health issues, and therefore can be diverted into mental health services and away from prisons.”
“The notion of a mental health court would probably run into those volume issues, because of the nature of the mental health challenge in our community full stop.” – Shaun Robinson
He said beyond that, the general court system needed to be more flexible when it came to offenders with a mental illness.
“New Zealand also has very limited availability or diversionary options, that is somebody presenting to court who has mental health illness symptoms, and the offending may not be at the severe end of the spectrum.
“So that doesn’t require a complex mental health court. Rather it requires flexibility and availability of diverting people for relatively minor charges to specialist mental health services, to drag them away from the criminal justice and the legal system.”
Three years ago Auckland District Court launched the Criminal Procedure (Mentally Impaired Persons) (CPMIP) specific court, dedicated exclusively to cases where issues of fitness to stand trial or insanity had been raised.
Justice Minister Kiri Allan said she was not aware of any plans to expand this court to other locations.
She did not answer questions asking if work had been done since Monasterio’s article was published to progress a pilot, or if it was something she would like to get on the work programme.
In 2021 a research paper analysing the first year of the CPMIP court noted that though it appeared to be a beneficial operation, there was still an urgent need to consider other approaches.
“In particular, we believe that the creation of a dedicated mental health court would signal a serious commitment to achieving equity for this highly vulnerable cohort while filling a significant gap in existing court services,” the conclusion read.
A discussion to be had
Changing Minds chief executive Kevin Harper said setting up a specialised court was a discussion worth having.
“It’s understanding why is it being created … and what would be the unintended impacts, particularly in terms of prejudice and discrimination and self-stigma.
“What would it mean if you’ve been through a mental health court, do you end up with another label? Is that label unhelpful? With a lot of people if you come out of prison you’re carrying a label that has an impact on your mental well-being in general.”
Recently reported figures showed the scale of prisoners’ mental health needs, with nearly every prisoner in need of help.
Mental Health Foundation chief executive Shaun Robinson pointed to this problem of sheer volume.
“The notion of a mental health court would probably run into those volume issues, because of the nature of the mental health challenge in our community full stop.
“What I think is very important is that the courts do really take a strong heed of mental health challenges, not as a reason to not hold people accountable for their actions, but as a rehabilitation and sort of restoration model.”