Bernard Fox
NAPICU Director of Patient Representation
“MOJ / PICU Interface.
Thank you all for attending the recent NAPICU symposium on the mental health needs of people in Prison and interface with PICU. We were very grateful for the contribution of senior representatives of the MoJ.
As an NAPICU executive representing patients, I was very pleased to co-chair the event.
Following the event, I thought it might be helpful to offer some insights derived from experience both as a patient within a PICU and as a farmer born and bred.
Insights from the farm
I would not suggest that people in hospital or prison should be treated as livestock, although based on my reflections, there are relevant lessons that can be heard from the business of farming. These lessons may also apply to any place in which some people are expected to remain under the control of others.
Interestingly, most of the large Victorian mental asylums had an integral farm so that patients could receive the positive benefits of caring for animals and contributing to the up keep. In addition, many prisons also had farms with a few still remaining today.
As a farmer, I have experienced the folly of trying to mix groups of livestock without extensive planning. This doesn’t go well without careful thought and preparation. Carefully titrated change is required to avoid confusion. When well-managed, animal behaviour can be hugely improved. For example, If the famer treats pigs well and cleanly, unknown to many non-farmers, pigs will naturally keep their pen clean and dry. When pigs are positively occupied with balls and chains to play with, they are less stressed, experience less illness and we in turn use less medication to keep them healthy.
Most importantly, it reduces tail biting, nose and ear biting or worse, bullying to death. The better we farmers organise the mix and manage our livestock, the better outcomes we see.
Again, there maybe be criticism of paralleling people with livestock, although in my view, there can be more criticism for not hearing these common-sense simple lessons.
For patients and prisoners (and prisoners who become patients) in my view, the lessons from the farm are important if people can be expected to re-join and make meaningful contributions to society.
PICU prison interface
The recent symposiums seemed to produce a thirst for simplification of the processes and improved cooperation amongst services.
During my experience as a former patient now reviewing services, we hear of consistent staff shortages of beds and staff and the consequential stress in both mental health and prison service. The knock-on inefficiencies cause more stress. Little wonder there is difficulty in recruiting and filling vacancies with willing and enthusiastic staff. These problems no doubt cause hold ups in resolving what needs to be done to improve the situation for both prisoners and patients.
Many patients within mental health hospitals still suffer with boredom which no doubt leads to grater problems. Many prison farms, sewing rooms etc are now also gone with a crisis in drug use and rehabilitation.
From the recent symposium, there seemed genuine enthusiasm to work together and improve the situation for prisoners and patients. Key themes emerge of the need for better provision of positive engagement in prisons with mental health needs. Also ensuring the type of hospital is matched to people’s needs when prisoners are transferred to hospital. Mixing patients with different needs where for one group the treatment model may not fit – will not serve either group well.
Ultimately, we have to want change and be willing to engage with each other to stand any chance of making it happen. The recent symposium showed encouraging signs in this regard.”
