ADHD stands for attention hyperactivity disorder. Kids who’ve got it are either inattentive, hyperactive, impulsive or sometimes all three – and it affects between 3% and 5% of school age kids. As at July 2009, there were 760,859 children attending school in NZ which means somewhere between 23,000 and 38,000 children have the disorder.
According to a New Zealand support group, as many as two-thirds of children with ADHD have additional problems. 30-50% will have conduct disorder – a childhood behavioural problems which sometimes leads to anti-social personality disorder in adults. 20-25% of those with ADHD will have anxiety problems. Generally 20-30% of ADHD children also have learning problems and struggle to read and write. For approximately 75% of those with ADHD their symptoms continue into adulthood, although levels of hyperactivity may decrease with age.
What causes it? It may be genetic. But whatever the cause, the majority of evidence suggests that in those with ADHD, the frontal cortex of the brain under-performs leading to a loss of attention, planning and impulse control. It responds to stimulant medications (including ritalin). Although ritalin is a stimulant, paradoxically it has a calming effect on people with ADHD. This is because it stimulates the frontal cortex which generally improves concentration and impulse control for the sufferer.
Dr Paul Taylor, a paediatrician in Nelson, estimates that about 43% of those who end up in prison have ADHD. That means in New Zealand prisons, there are currently about 3,700 prisoners who may benefit from ritalin or a similar medication. In 2012 I made an official OIA inquiry to the Corrections Department asking how many prisoners were currently prescribed ritalin (or an equivalent). The answer was 17.
Risk factor for substance abuse and offending
When ADHD is not treated, it becomes a significant risk factor for substance abuse and criminal offending. So treating it is especially important for those who end up in the justice system. When left untreated, prisoners with ADHD struggle to concentrate in rehabilitation programmes and may become disruptive. This happened to Mr Chris Wills, an inmate in Mt Crawford prison, who I interviewed prior to his parole board hearing in 2012. Mr Wills has a long-standing drug problem and for many years self-medicated his ADHD with methamphetamine (another well-known stimulant). Eventually he sought help from mental health services in the community and was prescribed ritalin. He ended up in prison shortly thereafter, and without consulting a doctor, prison management took him off it.
Sometimes prisoners’ behavioural problems become so bad, the prisoner ends up in 24 hour lock-up. This happened to Mr Kurt Winklemann who was sent to prison for an assault in 2008; he had ADHD and was also denied ritalin when he got to prison. His behaviour deteriorated and he ended up in the ‘management unit’ for difficult prisoners. Rehabilitation programmes are not available in the management unit. To get into rehabilitation, you have to behave yourself first – without your medication.
Drugs of abuse
The Department generally justifies the denial of ritalin to prisoners on the grounds that it is a drug of abuse. So is methadone. But offenders who are sent to prison while on methadone still get it – because opiate addicts on methadone are less likely to re-offend when they get out. In 2011, 89 prisoners were on methadone. It’s dispensed in a controlled environment under strict supervision – and there is absolutely no reason why ritalin could not be dispensed in the same manner.
Inmates are also not generally allowed opiate based pain killers either – no matter how much pain they’re in. If a prisoner requires hospital treatment and is given morphine for pain relief, once they return to prison, the morphine will be terminated. This is because the Department regards opiates as drugs of abuse. So if a prisoner gets stabbed, has a broken leg, or a tooth removed, no matter how bad the pain is, probably all he will get is Panadol.
Back to the ‘ritalin rules’. On February 12, 2012 the Herald on Sunday ran a story about Mr Wells and Mr Winklemann. Acting National health manager for the Corrections Department, Bronwyn Donaldson, was quoted as saying that “Ritalin was available for some prisoners. An alternative was given to inmates who are at risk of abusing the drug.” Really? In 2010, there were 560 teenagers in New Zealand prisons and over half have ADHD. In my work as an alcohol and drug counsellor, I have interviewed dozens of prisoners with this condition. Not one was on ritalin or any other medication.
Prisoners set up to fail
What this all means is that prisoners with ADHD (and other mental health problems) are set up to fail. Not only does Mr Wills struggle to focus while attending rehabilitation in prison, he also needs to attend a drug treatment program when he gets out. He comes up for parole shortly but two community-based treatment programs have already declined to accept him until he is stabilised on medication. Catch-22. Mr Wills is likely to relapse to methamphetamine or other drugs as soon as he gets out. He needs to be stabilised now – while he’s still in custody.
One more point. Appropriate medical treatment is a basic human right and the Department has a statutory obligation to provide it. Section 75 of the Corrections Act 2004 states that: “A prisoner is entitled to receive medical treatment that is reasonably necessary” and “the standard of healthcare that is available to prisoners in a prison must be reasonably equivalent to the standard of healthcare available to the public”.
By denying prisoners access to appropriate medication, not only does the Department set them up to fail, it is also in breach of the Act. The Department should get its Act together – and read the rules instead of making up its own.