DEBORAH RICE, PRESENTER: It's insane. That's what critics are saying about a new routine that keeps some of the state's worst mentally ill patients locked up in solitary confinement cells for eighteen hours a day.
But there's not a lot of sympathy for the group; they're the inmates of one of the country's highest security jails - Long Bay. And why should any of us give a damn about the comfort of the murderers and other criminals there?
Well, the longer lockdown has been introduced, at least partly, because it makes staffing the prison hospital cheaper. But Australia's peak mental health organisation says it's a false economy and it's demanding immediate improvements.
The man at the other end of this phone line is articulate.
CALLER: We are a proud nation, proud citizens of a civilised country.
DEBORAH RICE: He's apparently well-educated and rational.
CALLER: Over $3,765 dollars a week, New South Wales and Australian hard-working taxpayers are paying for every patient inmate in Long Bay hospital.
DEBORAH RICE: He's also criminally insane and he wants your help.
CALLER: They are turning us into zombies.
DEBORAH RICE: The State's worst psychiatric offenders are housed in the hospital at Long Bay correctional centre in Sydney. Many have committed horrible crimes including murderers and sex offences, but as forensic patients they've been found not guilty due to mental illness. It's a high security facility and until recently the inmates were locked in their cells at 9:00 every night. But in April, their routine was brought in line with the general prison population, forcing them into their cells just before four o'clock in the afternoon. That means mentally ill patients now spend around 18 hours a day in isolation and they don't like it.
CALLER: It makes you feel frustrated, outraged, angry and depressed, which is not therapeutic.
BRETT COLLINS, JUSTICE ACTION: Do you have a sort of sense of, you know, of claustrophobia?
CALLER: I have, for the first time in my entire life. I have been placed, upon my request by the doctor, on Valium because I have claustrophobia and without some medication such as Valium I wouldn't be able to cope with the 18 hours locking in solitary confinement.
DEBORAH RICE: Advocates for the inmates say cost-cutting is to blame. Locking them away for longer means fewer prison officers are needed.
BRETT COLLINS: So what have you got in your cell when you're locked in solitary confinement?
CALLER: I have six concrete walls plus a couple of boxes which I have my legal documents in; clothing in it basically. There is nothing, absolutely nothing, except, I mean, of course there is a toilet and a sink.
DEBORAH RICE: Many of the inmates have signed a petition saying their human rights are being trammelled.
BRETT COLLINS: It's a very, very long time to be in a cell by yourself and with delusions and all the others problems. No, there's no question that what they're complaining about is occurring.
DEBORAH RICE: But a lot of the people who are in the hospital are there because they've committed some pretty awful crimes. Why should we care about their comfort?
BRETT COLLINS: They're human beings. These are citizens. These are people who have not even been convicted of the offence for which they were charged; and some have not even been charged. Now these are people who are the most vulnerable of our citizens. So if we as a community don't show them compassion, it says something about us as a community.
DEBORAH RICE: And those who work directly with the inmates agree.
RAY GREGORY, PSYCHIATRIC NURSE, LONG BAY HOSPITAL: Anecdotally, there's been more increase in incidents of aggression around locking down and opening up times; patients will become frustrated, you know, banging on doors, shouting through the windows; a kind of ... just sheer frustration at being locked in for so long, especially when patients have other symptoms. They may be suffering from internal voices, so auditory hallucinations.
DEBORAH RICE: The nurses say, under the circumstances, rehabilitation of the patients is impossible.
RAY GREGORY: It's not just a matter of giving patients tablets and expecting them to improve. That's a small part of mental health treatment. Social interaction and mental health assessments is a huge part of those therapies and they go hand in hand.
DEBORAH RICE: So, how do you feel?
RAY GREGORY: Nurses are expressing a lot of frustration around this. It's very difficult seeing a patient you've known for maybe months or even years to deteriorate significantly and be unable to intervene in those situations. To deliver care through a locked door isn't easy.
DEBORAH RICE: But you do have access to the patients after the lockdown, though, don't you?
RAY GREGORY: We'd have to alert officers to come down, that we needed a cell door opening. We'd have to maybe phone another ward, get those officers on to the ward where the patient was, and then wait 'til three officers arrive and then open the cell door.
DEBORAH RICE: That would be particularly difficult in an emergency, wouldn't it?
RAY GREGORY: That's right, that's right, and the client group that we deal with are particularly vulnerable to self-harm behaviour, to suicidal behaviour.
DEBORAH RICE: We asked to see for ourselves inside Long Bay hospital; instead, corrective services allowed Stateline into Silverwater Gaol.
EMPLOYEE, SILVERWATER GAOL: This is a 15 bed assessment unit.
DEBORAH RICE: So, why are you showing me this facility instead of the one at Long Bay?
EMPLOYEE, SILVERWATER GAOL: The routine that we're proposing to put in place in the new Long Bay Hospital very closely resembles the routine that's in place in this centre.
DEBORAH RICE: A new forensic hospital is being built next to Long Bay for the psychiatric inmates. Patients there will come under the control of the Health Department, and they won't be locked in cells at all. But it won't be ready for six months, and until then the patients will continue under the longer lock down in the prison, though many of them will be in new cells like this with TVs.
LUKE GRANT, ASSISTANT COMMISSIONER, CORRECTIVE SERVICES: We had more time out of cells and we reduced it back in the centre when we observed that there were high levels of agitation and adverse incidents occurring in the afternoons. So we reduced the time out of cells and found a corresponding and very positive response which was a decrease in self-harm and also assaultive and other disruptive behaviours.
DEBORAH RICE: So, was the change for therapeutic reasons or was it a work practices issues?
LUKE GRANT: Well, I think that's a case of two things coming together at the same time, so we were looking at reduced hours out of cells. But the decision for that was not based entirely on an economic rationale. It was also based on the fact that surveys of inmates indicated that a number of them preferred to be removed from the face-to-face contact. That if you're in the correctional system it can be fairly chaotic, and a lot of people like to have the time in their cells as opposed to being out when they're exposed to risks that they may perceive exist in that environment.
DEBORAH RICE: But inmates do have the choice of going to their cells to remove themselves from the rest of the inmate crowd?
LUKE GRANT: They can but can't lock their cells.
DEBORAH RICE: Are you seriously saying that inmates actually want to be in their cells for longer?
LUKE GRANT: I am. And what I would say from the literature is that what is useful is to have a variety of experiences. Some experiences that provide a lot of stimulation and opportunities for quiet time. We're trying to provide that balancing.
DEBORAH RICE: 18 hours in a cell doesn't sound like a good variety though.
LUKE GRANT: Um, well, 18 hours in a cell does sound like a long time.
DEBORAH RICE: According to some experts, it's way too long for psychiatric patients. Among them, Professor Paul Mullen, who's clinical director of Victoria's peak forensic mental health authority.
PAUL MULLEN, CLINICAL DIRECTOR, FORENSICARE: Left to themselves, the delusions and hallucinatory experiences become the sole way in which they understand and experience the world. The effect of this over any lengthy period is to potentially drive them further and further into their psychotic state.
DEBORAH RICE: The Aboriginal Justice Advisory Council calls the increased lock down cruel, inhuman, degrading. The mental health charity SANE urges the NSW Government to walk the walk as well as talk the talk on mental health services. And now the mental health council of Australia has written to the State Government demanding action.
DAVID CROSBIE, CEO, MENTAL HEALTH COUNCIL OF AUSTRALIA: Having worked in prisons, I can tell you that attending to people's mental health problems early is a very good investment, because if you don't, you end up with greater problems in the prison, not only around management, but around the need for acute care for hospital beds and for more intensive supervision. Isolating them further by locking them up at four o'clock is only gonna make the situation worse and end up costing you more and costing the community more.
LUKE GRANT: Other than the conjecture that people have made about what might happen, we've seen no evidence of people being driven crazy or harming themselves or all of those other things that are suggested might happen under this regime.
DEBORAH RICE: There are a lot of highly respective people, though, who are saying that there could be long-term consequences. Can you disregard all of that opinion?
LUKE GRANT: I think there's been some misinformation about the environment that offenders will be managed in.
DEBORAH RICE: And what are the claims by the admittedly disturbed petitioners?
LUKE GRANT: The author has been someone who has been a vexatious complainant, who has provided the type of commentary that's included in those letters and that petition over a period of time, including the time that preceded the change of routine. And should evidence be brought to light that suggests that we are causing harm to people, then we will modify our approach accordingly.