Improving mental health in prisons.

‘I am able to separate the person from his behaviour’ – clinical nurse specialist Jacqueline Bell-Walsh brings a range of skills to her new role. When Jacqueline Bell-Walsh was appointed the first in-reach mental health clinician to pilot a new programme at Spring Hill Corrections Facility in the Waikato town of Te Kauwhata, it was an opportunity to use the very best of her skills. Bell-Walsh began her nursing training at Carrington Hospital in the late 1970s and, for 10 years, worked in the acute admission and alcohol and drug addiction areas. Later, she moved to the Probation Service and worked for 18 years as a probation officer, while also maintaining her nursing registration. This was until changes in legislation meant nurses had to demonstrate maintained competencies. “In 2010, I did a return-to-nursing course at the Waikato Institute of Technology and began working at the inpatient mental health unit at Waikato District Health Board [DHB]. During the three years I spent there, I became an associate clinical nurse manager of the admission unit. I was then seconded to the Corrections Department as a clinical nurse specialist [CNS] to pilot the new primary health care [PHC] mental health in-reach role in the Waikato region. This job seemed to be tailormade for me, as it brought together my mental health nursing and Corrections experience. Being able to combine these skills is giving me a huge amount of job satisfaction.” Over the course of her career, Bell-Walsh says she has tried to get away from the prison environment but she recognises she has a real heart for offenders. “I have a non-judgemental attitude towards prisoners and always find something positive to say about everybody. I am able to separate the person from his/her behaviour, which was something instilled in me during my years at the Carrington Hospital nursing school. “Behaviour does not define a person. If you call someone a criminal, that may be the only way you look at them, so it’s best never to label people.” Bell-Walsh spent the first months supporting the development of the programme at Spring Hill and, once implemented, offered to run it at Waikeria Prison. This made sense, as it is common to transfer prisoners between the two facilities. She is now based three days a week at Spring Hill and two days a week at Waikeria Prison. The in-reach pilot was originally for a year, but was recently extended for another 12 months. The programme is also being piloted by a CNS at Christchurch Men’s Prison and by an occupational heath therapist at Auckland Region Women’s Corrections Facility. The aim is to develop a PHC mental health programme that meets the needs of prisoners with mild to moderate mental health issues, ie those who do not qualify for help through forensic services. “We know about 20 per cent of the general population has mental health issues, but at least a third of prisoners do,” said Bell-Walsh. “All male prisoners aged over 18 undergo mental health screening by a registered nurse within the first seven days after their arrival in prison. Prisoners are referred to DHB-run forensic services if they screen as positive for moderate to severe mental health issues, but this only accounts for eight per cent of prisoners. That leaves about 25 per cent suffering a variety of mental health issues, primarily depression and anxiety.” In addition, Bell-Walsh says, research indicates 60 per cent of prisoners may have a personality disorder and 89 per cent have substance abuse issues. All prisons have a nurse-led health centre focused on meeting the full range of prisoners’ health needs. Clinic nurses have been trained to identify and support patients with mental health presentations, but some lack confidence in this area. “A key aspect of my role is to further develop nurses’ clinical knowledge and confidence in managing mental disorders. I am able to reinforce best practice and support care planning by working alongside clinic and custodial staff, and this has been rewarding.”