13 December 2022
C159346
C Lane
[FYI request #20816 email]
Tēnā koe C Lane
Thank you for your email of 10 October 2022 to the Department of Corrections – Ara
Poutama Aotearoa, requesting information about traumatic brain injuries (TBI). Your
request has been considered under the Official Information Act 1982 (OIA).
The management of a person with an identified brain injury is individualised and is specific
to the identified needs of the individual.
You requested:
I would like to request the fol owing information in regards to inmates with
diagnosed (unrecovered) Brain Injuries (TBI) with a low-med security classification;
that HAS and HASN’T reached their parole eligibility date; that have ACC brain injury
cover, including ACC concussion services cover;
All support available to inmates with-in Corrections Facilities and also Serco Facilities.
Currently, on entry to prison, a Registered Nurse will complete a Reception Health Screen.
This initial health assessment aims to identify the physical and mental health needs of that
person at that point in time, and when a more comprehensive assessment is required.
Whilst we do not explicitly screen for TBIs on a person’s arrival, our health assessment does
provide opportunity for the person to disclose any relevant health information, including
services they may have been accessing in the community.
If a person presents with a known TBI, the Health team will review the services that were
being accessed prior to prison. Corrections wil work with ACC to identify the most
appropriate service to support the person, noting the complexity that can exist when the
person moves to a prison in another DHB region.
With the permission of the person, Corrections’ Health Services requests their clinical notes
from their last known general practitioner. These notes are reviewed alongside clinical
information from Te Whatu Ora to identify any health needs that need to be managed, or
NATIONAL OFFICE, WELLINGTON
Mayfair House, 44 – 52 The Terrace, Wellington, 6011, Private Box 1206, Wellington 6140,
Phone +64 4 460 3000
www.corrections.govt.nz
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where further fol ow up care is required. If the person was being treated for a current TBI,
the aim is to ensure continuity of care and continued access to services while in prison.
If a person sustains a head injury while in prison, they are managed by onsite Health
Services as per normal injury related procedures, and the same evidence-based health
pathways that are utilised in the community. People in prison are able to access primary
healthcare that is at least what they can expect in the community. The primary focus for
head injury management is on the acute phase of the injury and includes completion of ACC
documentation required to access services and referrals to other services that may be
required.
Each region in New Zealand is governed by guidelines that support access to services
including referral criteria where applicable. These guidelines are applicable to all health
services, including those provided in the community and those provided by Corrections. As
the person moves from the acute phase into ongoing rehabilitation, individual management
plans will be developed and actioned by Health Services as appropriate.
In 2020, a project between Corrections and ABI Rehabilitation Services was approved to trial
a screening tool for TBI, given that we do not currently use one. Unfortunately, the COVID-
19 lockdowns have resulted in the project being temporarily placed on hold.
- What Psychological services are available for such diagnosed inmates?
- How dose one access such support?
Please find attached Appendix One – TBI report which outlines Psychological Services’
current involvement in TBI. TBIs are predominantly managed by health services, therefore
engagement with psychological services is limited. There is currently a piece of work being
undertaken in Canterbury on TBI in youth at Christchurch Men’s Prison, more information
can be found at this link
https://openrepository.aut.ac.nz/handle/10292/12650.
- How dose one access such support if their case manager is unresponsive? What
procedures do they take around case management if unengaged?
A person in prison can raise any concerns they have with any member of staff at any point
either by a complaint form or via the Prisoner Kiosk. Corrections has established procedures
to resolve issues and complaints documented - in the Prison Operations Manual.
- How dose such inmate request a more suitable case manager?
It is our preference to resolve issues at the lowest level. If someone is not satisfied with the
level of engagement they are receiving from their assigned case manager (CM), or would
like to be allocated to a different CM for any reason, they are able to lodge a complaint as
noted above. If a person has difficulty operating or understanding the kiosk process, unit
staff are available to assist, or paper based PC.01 Prisoner Complaint Forms are still
available if they are required.
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The complaint wil be triaged to a Principal Case Manager (PCM). The PCM speaks to the
person making the request and after taking all relevant considerations into account makes a
decision. A file note is generated to ensure there is a record of the request and the action
taken, with rationale included. If this does not resolve the issue to the satisfaction of the
person making the request, it can be further escalated to the Corrections’ Inspectorate
and/or external official agencies such as the Office of the Ombudsman or the Health and
Disabilities Commission.
- What procedures are taken to keep prisoners with unrecovered brain injuries safe
from further damage?
- What procedures are taken to reduce risk of assaults by other inmates, which can
cause further damage?
Custodial management of a person who is affected by a known TBI is guided by information
from the health team and in accordance with their agreed management plan. This includes
ensuring custodial staff have access to information that supports the ongoing management
of the person’s injury, alongside information on when health staff should be alerted. Risk
assessments and management plans are also completed to ensure there is ongoing support
fol owing any reported or observed assault. Sites take a multidisciplinary team (MDT)
approach, these teams are made up of staff from different disciplines such as Corrections
Officers, Psychologists, Social Workers and Health Centre Nurses. These teams will assess
the level of risk, the needs of the person and the level of care required alongside unit
security classification to ensure holistic care pathways are wrapped around the individual.
If there is a medical or mental health need, a person can be put onto directed segregation
for medical oversight, or they can apply for voluntary protective custody (more commonly
known as voluntary segregation)
. Voluntary segregation is designed to support people with
vulnerabilities in prison to continue participating in rehabilitation, education and
employment where it is not safe to do so in the mainstream prison environment.
- What procedures are taken to allow diagnosed inmates to receive a beneficial diet
that supports recovery (which is not available on canteen ordering) (recovery diet
supported by Brain Injury Recovery Specialists)?
While there is no specific diet for those living with a brain injury, medical diets (for dietary
control or treatment for a medical condition) are provided as prescribed on a medical
officer’s recommendation. All meals provided are based on Ministry of Health food and
nutrition guidelines and, advice from dieticians.
- What available residential facility is available for diagnosed inmates to reduce an
overwhelming environment such as overcrowded units with 40+ other inmates?
(Studies show overcrowding/busyness/overwhelming environments slow down brain
development and recovery)
Each new person to prison undergoes an induction process, which includes health
staff assessing their health and mental health needs, their risk of self‐harm or suicide and
whether they require a referral to a prison doctor. This assessment process identifies those
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people who may be at risk and require to be accommodated in an Intervention and Support
Unit (ISU) for a period of time. A review of an individual’s at risk status is carried out in a
wide range of circumstances including:
• when someone returns from court, fol owing an inter-prison transfer,
• if parole is deferred for two or more years,
• following a change in family circumstances,
• confirmation that an individual has been diagnosed with a serious or terminal illness,
• if they begin to display negative signs or change in mood or behaviour,
• if information is received about them that causes staff concern.
An ISU is a safe environment with a multi-disciplinary team approach to patient care. People
in these units are closely monitored, have access to specialised care, and have individualised
plans to help them to return to a state of wel being and return to their unit on site. As noted
above, any person can be put onto directed segregation for medical oversight, or they can
also apply for voluntary segregation.
- Would internal resistance (self-care) with-in prison be more suited and provide a
safer space to reside for such diagnosed inmates?
Self-care units are for planned reintegrative activities, such as release to work. Self-care
units are residential style accommodation designed to be used primarily by people who are
nearing release and have re-integrative needs that wil be met by placement in a self-care
unit.
Self-care units assist in the reintegration from prison to community by easing the transition
between the prison environment and the community. They aim to reduce re-offending by
increasing residents' personal responsibility and self-reliance before their release from
prison.
- What available support is there for diagnosed inmates to support independent
routine, to help the brain recover from injury? (Studies show overwhelming
environments and no personally created routine or a routine with independent
flexibility slows down the recovery pathway for brain injury).
- What available residential facility is available for diagnosed inmates to support
continuous unpredictable fatigue? With-in a safe uninterrupted space? (Studies show
unrecovered brain injury consist of constant fatigue/confusion/overwhelm and that
with out such safe space in prison there is risk for further damage or recovery delay).
- If so what procedure would one take to request relocation to that safer internal
residence?
As stated previously the management of a person with an identified brain injury is
individualised and is specific to the identified needs of the individual. An MDT approach is
used and may include health staff, custodial staff, psychologists, occupational therapists,
social workers, cultural workers, mental health and addictions staff, case managers,
physiotherapists and other allied health staff. The MDT determines the level of care
required and referral for other services including those outside of prison.
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Services beyond Corrections may be managed through the regional health board’s Needs
Assessment Service Coordination (NASC) teams as they are responsible for accessing
services that sit outside of the prison. The NASC team conducts assessments when required
and works closely with Corrections health teams to identify the support required.
Corrections does not hold any agreements with specific services in the community.
- I would like to request a list of such facilities, including contact details and criteria
requirements.
The document you have requested does not exist, therefore, this part of your request is
refused under section 18(e) of the OIA, as the document alleged to contain the information
requested does not exist or cannot be found.
As per section 18(b) of the OIA we have considered whether consulting with you would
enable the request to be made in a form that would remove the reason for the refusal.
However, we do not consider that the request can be refined in this instance.
- Would Goodwood Rehabilitative Centre be an option?
Each case is viewed on a case-by-case basis. As noted above, the Needs Assessment and
Service Coordination (NASC) teams are responsible for coordinating the care of someone in
prison who needs a level of care that cannot be provided within the prison environment.
- What available brain injury rehabilitative facilities with-in the community are
available to inmates described above, not yet eligible for parole, that The
Department Of Corrections and Serco can relocate inmates to for treatment?
- What procedure would one take to request relocation to such community facility to
support their recovery treatment?
An MDT would decide the appropriate line of treatment, including those that could be
delivered in prison, or require temporary placement of someone in the community. MDT
are able to be requested by people in prison.
Every case is viewed on a case-by-case basis, and is informed by the MDT’s clinical decisions,
risk assessments and security requirements. Our experiences to date have shown that when
release has been approved, a coordinated collaborative approach is required to ensure the
appropriate and safe placement in the community.
- I would like also a list of all relevant medical support personal’s contact details to
accommodate such inmates needs with-in North Island Correction/Serco facilities.
- Is there support or staff that can be contacted for urgent support for such
diagnosed inmates, when there are concerns of risk to further brain damage in the
residing environment?
- If so could I please have those contact details.
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Please see the prison contact list. Each region and site have different levels of care and
different contacts. The contact list can be found here:
https://www.corrections.govt.nz
/about_us/getting_in_touch/our_locations.
Please note that this response may be published on Corrections’ website. Typical y,
responses are published quarterly, or as otherwise determined. Your personal information
including name and contact details will be removed for publication.
I trust the information provided is of assistance. I encourage you to raise any concerns
about this response with Corrections. Alternatively, you are advised of your right to also
raise any concerns with the Office of the Ombudsman. Contact details are: Office of the
Ombudsman, PO Box 10152, Wel ington 6143.
Ngā mihi
pp
Juanita Ryan
Deputy Chief Executive Health
Health Services
