Regional Forensic Services in New Zealand were established after the Mason Report in 1988. In 1997, the Central Regional Health Authority carried out a review of the 2 Regional Forensic Services in the central region. This review was chaired by Dr Phil Brinded of the Canterbury Regional Forensic Service. The principal conclusion from this review was that a single regional forensic mental health service be contracted to provide for the regional responsibilities within the central region. A number of key advantages from this structure were highlighted. Consequently, the Central Regional Health Authority put out a Request for Proposal for the provision of regional forensic services and this contract was awarded to the Wellington Regional Forensic Service. The Central Regional Forensic Mental Health Service was established.
The Central Regional Forensic Mental Health Service has 28 regional secure beds (Purehurehu and Rangipapa) and 16 step down beds incorporated into the Inpatient Rehabilitation Service Tawhirimatea and Tane Mahuta) at Ratonga Rua-o-Porirua. The Central Regional Forensic Mental Health Service also has forensic community teams established in Wanganui, Palmerston North, Hawke's Bay, Wellington/Hutt Valley/Porirua, Wairarapa and Gisborne. These teams are multidisciplinary based with their principal role to cover all prisons and courts in the region and provide consultation and liaison services to local mental health services.
As well as the Central Regional Forensic Mental Health Service, Wanganui DHB through Stanford House provides 10 Forensic Extended Care beds. These are the beds for the Central region that were allocated from the closure of the National Secure Unit at Lake Alice Hospital. They are accessed by the Central Regional Forensic Mental Health Service.
In summary, the specific service provision of the Central Regional Forensic Service is in four areas.
• Inpatients setting
Within the courts, the principal role of the Forensic Service is to provide triage, consultation, liaison and advice. Principally this is the role of the justice liaison staff who assess people being processed through the court system, to identify those who have mental health problems, and who may need to be diverted into the mental health system. In identifying those with mental health problems or possible mental health problems, many or most will be diverted to or assessed in general mental health settings.
The provision of advice to the court operates at a number of levels, both at an informal and formal level. Informal verbal advice is provided to a variety of criminal justice agencies including advocates, the judiciary, police, probation service and corrections staff. More formal advice is provided to the courts through reports under Sections 38, 35, 25 and 23 of Criminal Procedure (Mentally Impaired Persons) Act 2003, and Section 333 of the Children, Young Persons & Their Families Act, 1989.
In a prison setting there are 4 levels of input:
• Consultation and liaison with prison staff and assistance with behavioural/management plans
• Assessment and ongoing treatment of inmates who have a mental health illness/mental health issues
• Transfer to hospital at Ratonga Rua o Porirua, for those inmates whose mental illness requires hospital treatment
• The provision of reports and oral evidence as necessary to the Parole Board
In the prison setting the service provided is similar to that of a general community mental health service. The findings of the National Epidemiology Study in Prisons (1999) which indicated that 10% of the prison population have significant mental health issues impacts on and informs service delivery. In the Central Region there are 6 prisons (Hawke's Bay, Wanganui, Manawatu and 3 in the Hutt/Wellington, including a women's prison). The growth in prisoner numbers in the central region has been very significant.
The inpatient arm of the Central Regional Forensic Mental Health Service is in a range of settings.
1. Acute Mental Health Services: For those in prison, the Central Regional Forensic Mental Health Service provides the acute inpatient service. This is for inmates transferred under Section 45 or 46 of the Mental Health Act, 1992 who require mental health care and treatment in a secure setting. After their inpatient treatment they are transferred back to prison.
2. Assessment: The regional secure units provide facilities for inpatient assessment principally under the Criminal Procedure (Mentally Impaired Persons) Act 2003.
3. Special Patients: Those found Insane or Unfit to Stand Trial and who are made Special Patients by the courts are managed by the Central Regional Forensic Mental Health Service. Special Patients' "journey" through secure settings and to the community is typically over a long period of time.
4. The court also has an additional sentencing option whereby a person can be sentenced to a term of imprisonment and to receive treatment in hospital, and their time in hospital counts as part of the prison sentence. In these circumstances, the person is also a Special Patient. When the person no longer needs to be in hospital, the Service must arrange a transfer to prison to complete their sentence.
5. Rehabilitation: The Central Regional Forensic Mental Health Service has 16 "step-down" beds in the Central Regional Inpatient Rehabilitation Service at Ratonga Rua o Porirua.
In a community setting the Central Regional Forensic Mental Health Service provides:
1. Management of Specific Patients: Special patients who are transitioning from hospital or who are continuing to reside in the community on short or long leave remain under the care of the Forensic Service. Other specific patients with certain "high risk" profiles may be managed by the Forensic Service for specific reasons. Primarily the forensic services "community" is the prisons and the forensic service directly manages only a few clients in the community.
2. Consultation and Liaison: The Forensic Service provides support, advice, and liaison to other mental health services. This is predominantly assessment of potential risk, management of specific problems or advice on any legal interfaces which may be affecting a client's treatment.
3. A specialised community support service (Forensic Package of Care) provides funding for enhanced community support for clients who are re-integrating back into the community after a period in an inpatient forensic setting.
4. Forensic Residential Services: In conjunction with NGO providers the Central Regional Forensic Mental Health Service has its own housing which is accessed by clients who are transitioning from an inpatient forensic setting.