Crisis care units are under pressure to meet demand
Crisis care units (CCU) across Western Australian prisons are under significant pressure to meet increasing demand. This is due to a variety of factors including outdated infrastructure, population increases, and a growing number of people in custody who are at risk of suicide and self-harm. This has led to periods where some CCUs have been full and, on occasion over-capacity, resulting in prisoners sharing cells. This has placed additional pressure on clinical staff to discharge people in custody from a CCU placement as soon as possible to free up beds.
Some people in custody were also spending long periods of time in the CCU, a few of whom could not be relocated due to a lack of alternative placement options. Long periods in crisis care, traditionally a short-term placement option, can be detrimental to personal wellbeing given the environment’s short-term placement design. Overall, the lack of policy governing the intended purpose and use of crisis care has likely contributed towards ad hoc or site-specific arrangements which, in turn, can led to inconsistent and poor treatment of people in custody.
Experience for people in crisis care described as ‘bleak’
Placement and treatment for people in the CCU was found to be mainly based on suicide prevention rather than therapeutic support. Experts our office consulted for previous inspections found some CCUs were untherapeutic and not fit for purpose. We found the experience of prisoners in crisis care was one of isolation and loneliness and likely exacerbated, rather than improved, mental health outcomes.
Staffing, both custodial and non-custodial, in CCUs was also problematic. While support was available, it was limited due to critical shortages in mental health, psychological health services and psychiatry. Cultural mental health support was also limited and placed a greater burden on prison support staff to provide counselling, despite having no formal training. Custodial staffing in some CCUs was poor and reduced opportunities for people in custody to receive appropriate time out of cell.
Crisis care infrastructure does not support psychological wellbeing
The physical design of CCUs did not support psychological wellbeing of prisoners. CCUs were found to be outdated and prioritised security over therapeutic principles. The units were generally noisy, and they lacked stimulation, colour, and natural lighting, which can ultimately affect prisoner mood and wellbeing. Only Bandyup and Melaleuca women’s prisons provided some therapeutic features with the inclusion of colour and artwork in dayrooms. Most recreation yards within CCUs did not provide people in custody with access to green spaces or leisure items.