Almost half of the prison population is mentally ill, but experts say psychiatric services in Australian jails are so underfunded inmates often don't receive treatment unless they are suicidal.
Lawyers and academics believe the neglect of health services in prison is not only a violation of human rights but is creating a complex and expensive social problem that future generations will have to deal with.
A 2018 report into the health of Australia's prisoners found 40 per cent of jail entrants have a mental health condition and nearly a quarter (23 per cent) are on psychiatric medication.
Under-resourced staff are forced to prioritise care for the growing number (5 per cent) of inmates at risk of suicide or self-harm.
Stuart Kinner, who heads the justice health unit at the University of Melbourne and sits on the federal government's National Prisoner Health Information Committee, said a failure to address the issue was creating a snowball effect and the consequences would be hard to reverse.
"What we are doing is basically cost shifting," Professor Kinner said.
"We're avoiding spending a little bit of money now to provide adequate health care in prisons and shifting the very substantial cost to other buckets of money at the state and Commonwealth level where we pick up the pieces of those failures.
"People who have ongoing, significant mental health problems have worse outcomes after incarceration.
"Higher rates of reoffending and re-incarceration, higher rates of death due to suicide and overdose, higher rates of significant non-fatal health problems that cost the state a lot of money in emergency department presentations.
"It really begs the question — what's the point?"
Society's shameful secret
The majority of the clients Gold Coast criminal defence lawyer Vered Turner represents are referred to her by Legal Aid.
She said while prisons were supposed to rehabilitate criminals, poor conditions in Queensland's "overcrowded" jails were exacerbating mental illness.
"I have a client who has been waiting nine months to see someone," Ms Turner said.
"He is extremely depressed and deteriorating but he's not suicidal so he's put at the bottom of the list.
"At the moment it is taking months to get an appointment with a psychologist, let alone a psychiatrist.
"How can they reintegrate into society? They won't be able to get jobs."
Human rights lawyer Matilda Alexander heads Queensland Advocacy Incorporated, an organisation that provides a free mental health legal service.
She said the public would be shocked to learn of Australia's "two-tier system" that excluded prisoners from accessing Medicare subsidies.
"This has been an issue for a very long time," she said.
"It is a shameful indictment on our society that people with disability and people with mental health concerns are disproportionately represented in the prison population.
"It is our responsibility to not further deprive incarcerated people of the medical help that they need."
Duty of care
According to the Queensland Forensic Mental Health Service the rates of mental disorder and trauma among prisoners are "magnitudes higher than they are for the community".
The latest data from Queensland Health, which is responsible for managing mental health services in Queensland prisons, revealed 3,763 mental health referrals were received in the 12 months to September 2022.
The Queensland prison population at that time was 9,493.
Queensland Health said it was "not feasible" to provide information about how long prisoners wait for an appointment with a mental health professional.
"Prisoners only see a psychiatrist or specialist prison mental health services for complex mental health conditions," a spokesperson said.
"Just like [the] general population, a prisoner requiring care is triaged based on the level of clinical urgency."
Professor Kinner said because services were delivered on an ad hoc basis, he was sceptical about whether the government even knew how long the waitlists are.
"I remain to be persuaded that good data on that actually exists," Professor Kinner said.
In a submission to Queensland's 2022 parliamentary inquiry into mental health outcomes, the Australian Psychological Society advised that there was "almost no individualised, tailored psychological treatment in correctional facilities".
They argued it not only posed a "duty of care issue" but represented a "lost opportunity" to address the underlying issues likely to contribute to offending.
A recent study led by the Queensland Centre for Mental Health Research attempted to map Australia's prison mental health service workforce.
Australia's standard guidelines for corrections endorse the United Nations rules for the treatment of prisoners, known as the Nelson Mandela rules, which stipulate that "prisoners should enjoy the same standards of health care that are available in the community".
To mirror the level of care available to the public, clinicians determined 11 full-time specialist mental health workers for every 550 prisoners would be required.
The study revealed New South Wales had enough funding to cover just 0.83 full-time positions for every 550 prisoners, Queensland had 3.98, Tasmania had 2.03, Western Australia had 2.29 and the Northern Territory had 4.29.
The ACT was the only jurisdiction to satisfy the minimum requirement with 15.22 funded positions, and data was not made publicly available for both Victoria or South Australia.
The authors said services were "significantly under-resourced" and that a potential solution to funding challenges would be ending "the discriminatory exclusion of people in Australian prisons from Medicare-subsidised mental health services".
"That funding mechanism, that was put in place by the federal government in recognition of the need for an increased investment in mental health services, is uniquely withheld from the group with the highest need for those services," Professor Kinner said.
"That really showed without any doubt that the funding for mental health services in prisons is woefully inadequate, not just in Queensland but around the country.
"It's a human rights issue, first and foremost."
