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A Mixed Methods Study of Staff and Male Prisoner Patient Experiences of Prison Based Mental Health Services

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A Mixed Methods Study of Staff and Male Prisoner Patient Experiences of Prison Based Mental Health Services School of Occupational Therapy and Social Work Faculty of Health Sciences Stories and Stats: A Mixed Methods Study of Staff and Male Prisoner Patient Experiences of Prison Based Mental Health Services Kate Hancock This thesis is presented for the Degree of Doctor of Philosophy of Curtin University of Technology November 2009 Declaration “To the best of my knowledge and belief this thesis contains no material previously published by any other person except where due acknowledgment has been made. This thesis contains no material which has been accepted for the award of any other degree or diploma in any university.” Signed Kate Hancock Date: 07/05/2010 i Hope is the thing with feathers That perches in the Soul, And never sings the tune without the words, And never stops at all, And sweetest in the gale is heard;… Emily Dickson 1830-1886 (Complete Poems, 1924) ii Acknowledgements First and foremost I would like to extend a big thanks to the staff and prisoner patients who freely shared their time, emotions, and perspectives on this important topic. The project would not, of course, have been possible without their involvement, or the support of the Department of Corrective Services. I am very appreciative for the guidance of my supervisor, Associate Professor Angela Fielding, who provided me with academic and personal support during the course of this project. I felt a connection with Angela from the very inception and this motivated me to enrol at Curtin University. I would like to thank her for sticking with me when the going got tough, for her critical eye towards the end, and for her care and space when my life suddenly changed in late 2008. I would also like to thank my co-supervisor Mark Liddiard for his feedback on early and late drafts despite my laughter and tears, Professor Fran Crawford for her guidance, and to Jenny Lalore for her assistance and patience helping me with reams and reams of quantitative data. I would like to acknowledge that this research was made viable through a Curtin Postgraduate Research Scholarship. I am grateful for the financial support extended to me by Curtin University. Reimbursement of research-related expenses allowed me to travel, purchase texts and so forth, during my candidature. I am indebted to my colleagues at the Department of Corrective Services – Dr Shona Hyde, Dr Hilde Tubex, Anne Highfield, Samantha Kelly, Vicki Caudwell, Anastasia Lauren, Dr Edward Wilson, Chris McDavitt, Naomi Carter, Vicki Williams and Dr Monica Cass-O’shea. I would like to thank them for their encouragement, unwavering support, proofreading and constructive feedback, and for innately knowing when I really did, and really did not, want to talk about my thesis. Thank you The sheer intensity of the ‘PhD process has meant that many people ‘outside’ of the academic and professional domain have provided unfailing support and encouragement. As I learned, undertaking a PhD is a long and arduous journey of academic and personal discovery. My remarkable friends (Fi, Ed, Renee (WW), Dione, Damo, Queen Amy, Princess Tara, Leon, Kristie, Perfect Brooke, Lady Em, Dr Josie Jo, Nick and Linda, Raphy, Alex, Marzia, Andy and Jess, Andy and Ann, Chez and Rob, Erin, Trish, Justin, Jaime, Jane, Kian, Hannah, Luke, Madam, Stuart, Marissa, Matty and Jo, Malone, Steve and Nath, Max, Aneka, and Will), and wonderful family (Jane, Ben, Dad, Mum, Alina and my Gran) have in many ways walked this odyssey with me and I am ever grateful for their steadfast conviction and belief in my abilities, their love, and their unconditional support throughout my many highs and lows. This love and support underlies most of what I do. I thank you all. For the people I have named and those who remain unnamed, you have been the lighthouses that make for a safe journey in rough seas; The desire to enter into the world around you and having no idea how to do it, the fear of observing too coldly, too distractedly, too raggedly, the rage of cowardice, the insight that is always arriving late, as defiant hindsight, a sense of utter uselessness of writing anything and yet the burning desire to write something, are the stopping places along the way. At the end of the voyage, if you are lucky you catch a glimpse of the lighthouse, and you are grateful. Life after all is bountiful (Behar, 1996, 3). Katiy Hancock (2010) iii Caveats In this report a summary and description is provided of the results of the interviews and survey data collection. Stakeholders and prisoners articulated various views, perceptions, concerns and understandings of a range of matters concerning mental illness and mental health service provision in prisons across Western Australia. These are reported as the perceptions and views held by these individuals. Any analysis of these findings is the responsibility of the researcher. iv Abstract One consequence of the deinstitutionalisation of psychiatric care and increase in community care is the rising number of mentally ill people in prison populations where there are insufficient mental health professionals and services to address the treatment and rehabilitation needs of psychiatrically unwell prisoner patients. People with mental illness are over-represented in prison populations, and the provision of mental health services is a difficult task in an environment where discipline and safety take precedence over health treatment. This research investigated attitudes, perceptions, and experiences of prisoners, health professionals, and correctional staff in relation to mental illness and mental health service provison across eight prisons in Western Australia. The research aimed to gain a deeper understanding of experiences within prisons. Perceptions, attitudes and experiences of participants were explored using a mixed methods approach; both qualitative and quantitative methods were employed to gather information in a ‘two phase sequential design’ (QUAL/QUAN) (Creswell and Plano Clark 2007). The Phase One key informant interviews (n=17), and the key themes identified in the literature review, informed the development of the Phase Two quantitative survey questionnaires (n=168). These Phases acted as two different ways of exploring the research questions. Health professionals in prisons suffer from a systemic lack of recognition, support and leadership from both the health and justice spectrums and report they are merely ‘crisis managing’ prisoners. In addition, correctional staff are seriously undertrained to manage and care for mentally ill individuals and experience role conflict due to the changing demands of the prison officer role. Prisoner patients have varied experiences of incarceration and attitudes towards current mental health services that are dependent on a range of factors including the prison location, ability to form positive and therapeutic relationships, diagnosis, level of bullying and harassment, and isolation. There is a need to develop multifaceted and team approached services that are personalised to the individual needs of the mentally ill. Moreover, there is a need to develop a correctional approach to health and mental health care delivery as the present reliance on a community medical model is ineffective. This research provides unique insight into the prison mental health experience through the voices of those who live and work in this complex setting and will inform future health and correctional policies. v Table of Contents Table of Contents Declaration ............................................................................................................................................. i Acknowledgements ............................................................................................................................... iii Caveats ................................................................................................................................................. iv Abstract ................................................................................................................................................. v Table of Contents .................................................................................................................................. 1 List of Figures ....................................................................................................................................... 8 List of Tables ......................................................................................................................................... 9 List of Abbreviations, Terms and Acronyms ....................................................................................... 10 CHAPTER ONE: AN INTRODUCTION TO THE RESEARCH ........................................................ 11 Introduction ......................................................................................................................................... 11 Researcher’s Positioning .................................................................................................................... 12 Research Background ......................................................................................................................... 14 Research Overview .............................................................................................................................. 17 Significance of this Research ................................................................................................................................. 17 Research Questions and Objectives
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