Institutionalisation (2024)
Introduction
This report has been commissioned by the Bugmy Bar Book Project Committee. It is a psychiatric report about institutionalisation and its impacts, which includes detention and custodial as well as out-of-home care settings. The report includes reference to research and opinion about particular impacts for First Nations peoples.
To prepare this report, we have conducted a thorough review of the institutionalisation literature as it applies in the context of detention, custodial and out-of-home care settings. We have used this in conjunction with our combined training, study and experiences of working in institutions, including psychiatric hospitals for adults and children, adult prisons, youth detention facilities and working with persons subject to community restrictions.
In the Appendix, we have provided de-identified amalgam case examples to illustrate the points made in the report. These are cases from our practice. While they have been altered to protect identities, they retain the key clinical elements of the presentation.
We have reviewed the Bugmy Bar Book chapters titled ‘Impacts of Imprisonment and Remand in Custody’ and ‘Out-of-Home Care’, and we accept the findings of the research set out in those chapters and recommend that this report be read in conjunction with those chapters.
This report may be used in legal proceedings to assist the courts, tribunals, inquiries, inquests, as well as lawyers, advocates, practitioners, health and allied health professionals, and others to understand the impacts of institutionalisation in youth detention, prison and out-of-home care.
About the Report Authors
Dr Robyn Shields AM is an Aboriginal doctor from the Bunjalung Nation. Prior to her current role, she was a registered nurse working in mental health. During her career in nursing, she developed a model of mental health care for Aboriginal people in collaboration with the Director of Mental Health Services for Central Sydney Local Health Service, Professor Marie Bashir. The model of care was in partnership with the Aboriginal Medical Service, Redfern, New South Wales. It was recognised as the first service of its kind in Australia and still operates from Royal Prince Alfred Hospital, Sydney.
Robyn has given evidence to the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families (Bringing Them Home, Report of the Australian Human Rights Commission, 1997) and contributed to the development of the first New South Wales Aboriginal Mental Health Policy.
Pursuing her commitment to supporting people with mental illness, in 2005 Robyn studied medicine at the University of Sydney. After graduating, she began her training in psychiatry. Today she continues to work in forensic psychiatry. In 2013 Robyn was appointed as an inaugural Deputy Mental Health Commissioner at the newly established Mental Health Commission of New South Wales. Past appointments include being a member of the New South Wales Mental Health Review Tribunal and being appointed to the Board of the Sydney Children’s Hospital Network. She is currently a Board Member for the Justice Health and Forensic Mental Health Network and is Chair of the Aboriginal Health Committee.
In recognition of her achievements and contributions to Aboriginal Mental Health, in 2001 Robyn was awarded the Centenary Medal for her contribution to Australian society and government. In 2004 she was named a Member of the Order of Australia (AM) for her contribution to Aboriginal mental health. In 2015 she was recognised as a Westpac 100 Women of Influence.
Robyn holds a Bachelor’s degree in Medicine (MBBS); Master of Public Health (MPH); and a Bachelor of Science Degree (BSc).
Dr Andrew Ellis was born and grew up in Newcastle, New South Wales. His family background is from Ireland and British settlers to Australia. He is a forensic psychiatrist, training first in medicine at Newcastle University. He is a fellow of the Royal Australian and New Zealand College of Psychiatrists and a fellow of the Faculty of Forensic and Legal Medicine of the Royal College of Physicians in the United Kingdom. He has previously been the Chair of Training in Forensic Psychiatry for the Royal Australian and New Zealand College of Psychiatrists (‘RANZCP’). He is a conjoint Associate Professor with the University of New South Wales Medical School, Discipline of Psychiatry, where he jointly leads the Master of Forensic Mental Health program. His research has been in the areas of forensic patients, prisoners, pharmacology, the intersection of law and medicine, impulsivity, arson, sex offences and offender profiling. His clinical work has predominantly been in public forensic mental health services in New South Wales and the United Kingdom in secure hospitals, prisons, court services, police liaison and community services. Most recently he has been the Medical Superintendent of The Forensic Hospital in Sydney. He has been an expert witness in court cases covering a range of forensic psychiatry issues in most Australian and English jurisdictions. His work has brought him into contact with many Australian Indigenous people, and he values learning from Indigenous colleagues about how to better serve their needs.