Forensic Community Treatment Orders (FCTOs) authorise the forcible medication of individuals with mental illness within prison. These orders apply to prisoners who develop a mental illness while in prison and to forensic patients who are detained in a prison. FCTOs raise a number of ethical issues, namely the breach of one’s entitlement to equivalent treatment as available in the community, the denial of the right to autonomy and bodily integrity, and the failure of proper administration of care for vulnerable individuals within highly restrictive prison environments.
FCTOs are a practice unique to prisons in New South Wales (NSW) that does not occur elsewhere in Australia. The use of involuntary treatment of patients within prison should be ceased. It is clear the complexity of mental health issues are not being appropriately addressed. Involuntary treatment of serious mental illness has little evidence of improving mental health. Imprisonment is an inappropriate environment for the care and treatment of mentally ill persons, with a focus on custodial punishment rather than support and community reintegration. These ineffective processes should be phased out in favour of mental health care that is administered safely, effectively and carefully in the best interests of patients
We at Justice Action recommend that Section 99(1)(c)-(d) of the Mental Health And Cognitive Impairment Forensic Provisions Act 2020 be withdrawn and consequently that FCTO administration in NSW prisons is ceased. Prisoners experiencing serious mental health issues should be transferred to the health department and alternative measures should be considered. For prisoners remaining in prison formal alternatives such as counselling and complementary therapies are recommended, alongside informal alternatives including open dialogue, quality time with friends and families, and peer-mentoring with trained prisoners.