Up to 20 prisoners with severe mental illness are living in "inhumane" conditions that breach human rights because the state's only mental health hospital for inmates is perpetually full, advocates say.
Frankland Centre is a 30-bed forensic hospital on Graylands Campus, providing inpatient mental health care to remand and sentenced prisoners.
But even as demand soars, one of its beds has been empty, while department data shows others are full of people not actually convicted of crimes but held in custody under a controversial WA law that allows indefinite definition.
Mental Health Advocate Sheila Rajan, who sees the inmates when they arrive at the Frankland Centre, said she felt angry that the system had failed them.
"… We have not done the right thing by people who have a sickness that needs treatment," she said.
A staff member of the facility, who asked to remain anonymous to protect their employment, said one of the 30 beds was empty last week because there was not enough staff to safely care for another acute patient.
"It's heartbreaking," the worker said.
"You hear news stories about suicides in prison and with people not being cared for properly — that's going to cause more trauma for them while they're waiting for a bed.
"I'm worried about the people that are waiting, and they are potentially in solitary confinement."
Waitlist not that long, government says
WA Health said the bed was not empty due to staff shortages but "for the safety, wellbeing and clinical needs of consumers and staff and due to an admission earlier in the week."
It said there were currently five people on the waitlist, but advocates say it fluctuated to numbers of up to 20 on any particular day.
WA Inspector of Custodial Services Eamon Ryan said there had been an average waitlist of between 10 and 15 so far in 2022.
He said prisoners who needed long-term hospital treatment were increasingly being taken to emergency rooms because there were no beds available at the Frankland Centre.
"They're seen, stabilised for maybe a period of 12–24 hours, and then returned back to the prison to the same environment," Mr Ryan said.
"It's a bandaid."
Some prisoners isolated
He said the patients that would normally be transferred to the Frankland Centre were experiencing serious mental health conditions, including extreme psychosis.
Mr Ryan said, in prison, they were often isolated under observation in cells where they could not self-harm.
He said the majority of their care was provided by custodial officers who were not trained as mental health workers.
"Essentially, their task is to keep them alive," Mr Ryan said.
"It's just a fundamental breach of human rights. It's inhumane."
Mr Ryan said that although there were 29 dedicated mental health beds at Bandyup Women's Prisons and a new 34-bed facility being built at Casuarina, they were not equipped to provide appropriate treatment in the most severe of cases, which were categorised as "P1s".
The Department of Justice said the most acute patients needed to be referred to the Frankland Centre, sometimes for involuntary treatment, which the department was not legally allowed to provide.
"When there is no bed available at the Frankland Centre, a patient may be transferred to a tertiary hospital's emergency department as a short-term solution," a department spokesperson said.
For those who had to stay in prison because the centre was full, the spokesperson said careful consideration was given to ensure the safety of people who were considered a danger to themselves or others.
He said mental health nursing was provided seven days a week, with staff assessing, treating and caring for patients in specialist units.
"Vulnerable prisoners remain under observation with access to health staff at all times," the spokesperson said.
Controversial law creates bottleneck
In the past four years, an increasing number of beds at the Frankland Centre have been filled by people detained under the Mentally Impaired Accused Act.
The act allows the indefinite detention of people who are accused — not convicted — of crimes but remain in custody because they were unfit to stand trial or be held criminally responsible.
Unlike people serving jail sentences who might receive temporary treatment at the centre, patients on custody orders could remain there indefinitely until a board decides they are fit to stand trial or live in the community.
"The laws govern how long they need to be there," Ms Rajan said.
"They have mental illnesses that require treatment. They need to be in a hospital. They should not be in a prison, so it is absolutely appropriate that they are referred.
"The problem is that we haven't got enough beds."
In June, there were 28 beds filled by patients on custody orders, more than triple the number in 2017, reducing access for prisoners in jail.
By the time a bed became available, she said their mental illness had often intensified due to trauma.
Ms Rajan said to make room, patients were sometimes being discharged from the Frankland Centre before they were well enough
The number of prisoners in WA has tripled since the Mount Claremont facility opened in 1994.
Ms Rajan said such a disparity between services and demands would not occur for patients with physical ailments.
"If you had someone with diabetes, and you were not treating it … you'd be negligent," Ms Rajan said.
Plans for Graylands expansion
She said people could not be "compelled" to do treatment if they were in prison, so some inmates who would otherwise be considered unfit to make that choice remained untreated.
Creating more beds for prisoners is under consideration as part of the Graylands Reconfiguration and Forensic Taskforce, but those close to the project say construction is years away.
WA Health said it was a "long-term project that would deliver significant benefits to the WA community."
