Transcript Community Forensic Outreach Service: CFOS

Insanity: Inside and Out
Ed Heffernan
Director PMHS Queensland
Australian Custodial Population
30 June 2007

27,224 people in Australian prisons
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70% East Coast
 New South Wales (10,285)
 Queensland (5,567)
 Victoria (4,183)
93% ♂, 7%♀
70% aged between 20 and 39 years.
24% identified as Indigenous
Annual numbers
Australian Imprisonment Rates
per 100,000 population
Male vs Female Rates
Incarceration Rates

169 /100,000
Indigenous Imprisonment Rates
Prison Census June 2007
Non Indigenous
Indigenous
Rate Ratio
Male / 100,000
312
4159
13.3
Female/100,000
24
401
16.7
Australasian Prison
Studies
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2001 New Zealand Prisons n=1159
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2003 Ethnicity and mental health need (Simpson et al)
2003 NSW Prison Study n= 1532
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(Simpson & Brinded)
(Butler & Allnut)
2005 Psychosis NSW n = 110
2007 Aboriginal data n= 285
2006 Comparison to community n=916
(Neilssen and Misrachi)
(Butler et al)
2006 Psychosis Qld n= 621
2006 Female Prisoners n=103
Butler et al)
(White, Chant, Whiteford)
(Tye and Mullin)
Mental Disorders in Australian Prisoners v
Community (Butler et al, 2006)
90.0
80.3
80.0
65.7
70.0
60.0
50.0
43.1
37.9
40.0
25.1
30.0
18.0
20.0
10.0
30.5
11.4
7.0
8.9
9.2
3.5 0.8
0.7
0.0
Psychoses
Any Anxiet y
Disorder
Depression
Bipolar Disorder Any Subst ance use Any personalit y
disorder
disorder
Any Disorder
% Prisoners
(n=916)
% Community
(n=8168)
How big is this problem?
A Rough Guess
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~ 75,000 people
~ 20 - 25% will need specialist Ψ services
~ 7-10% will be psychotic
Barriers to Treatment
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Security vs Health
Getting In
Movement,
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MSU’s, Protection
Sudden - Tracking People
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No Involuntarily Treatment
Suicide Cells
Medication
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Monitor, Diversion
Discharge
How do you do it?
Vast Numbers & Geography
1.
2.
3.
4.
5.
Care while in custody
Culturally sensitive
Drug & Alcohol
Diversion to health
Transitional care to
the community
Prison Benchmarking
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How many prisons and how many people
How many staff do you have
What is your MOSD
What do you do about D&A, A & TSI
How do you ensure continuity of care
Challenges
Correctional Centres serviced
No of Prisons
No prisons serviced
35
30
25
20
15
10
5
0
Matildas
Opals
Wallabies
Socceros
No of Prisons
18
13
12
29
No prisons serviced
10
11
9
25
How many do you see ?
Service
No of
prisons
Cross section
of prisoner
population
No of prisons
serviced
% total
receiving
public
MHS’s
Matildas
18
4,200
10
56%
~25%
Opals
18
5,443
11
95%
~25%
Socceroos
29
10,285
25
87%
~32%
Wallabies
12
3,847
9
?
~20%
Percentage of
open cases
Staffing Profile
Service
Administration Allied Health/ Nursing
Officer
Health
Practitioners
Medical
Matildas
3
2.7
22.8
4.2
Opals
2.5
14
2
4.6
Socceroos
0
0
36.7
8.35
Wallabies
0
0
0
1.5
Clinician Hours / week / 1000
prisoners
160
142
140
120
100
87
Nursing
Allied Health
80
64
Medical
60
38
40
23
20
35
21
13
8
0
0
0
Wallabies
Socceros
0
Matildas
Opals
Transition from Prison to Community
Service
Provides Transition
support
Period of Transition
Percentage of pts
receiving Service
Matildas

One centre only
3 weeks pre release
2-6 weeks post
release
>5%
Opals

Up to 3mths pre
2 weeks post release
3.7%
Wallabies
X
Nil
0
Socceroos
X
Nil
0
Transitions to the Community
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1st 2 weeks
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↑ Suicide rate magnitudes higher
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↑ Fatal OD 9.3X ♂, 6.4X ♀
↑ suicide rates 8.5♂, 36♀ (Pratt, Lancet 2006)
↑ hospitalisation
↑ substance use relapse
↑ homelessness
↑ recidivism
(NSW retro cohort 85,203,Kariminia et al MJA 2007)
Psychological Interventions
Service
Provides Formal Psychological
interventions
Matildas

Opals
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Wallabies

Socceroos

Delivered by
Psychologists employed by
PMHS (supplementary role)
Mental Health Reports Writing
Service
Provides
Reports
Statuary
Mental
Health Act
Reports
Parole
Board
Reports
Expert
Witness
Reports
Percentage
of time
providing
Treatment
Percentage
of time
preparing
reports
Matildas
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80%
20%
Opals
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90%
10%
Wallabies
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100%
0%
Socceroos
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90%
10%
Drug and Alcohol Services
Service
% Mental health Patients with Substance
Disorders
D&A Interventions
Offered
Matildas
75% (2007)
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Opals
84% (2006)
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Socceroos
66% (2001)
Wallabies
75-8% (2007)
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Indigenous Mental Health Worker
Service
Indigenous Mental Health
Worker

Matildas

Opals

Socceroos
Wallabies

Diversion
100%
80%
60%
40%
20%
0%
Matildas
Opals
Percentage transferred to Forensic Service
Socceroos
Wallabies
Percentage transferred to General Acute Service
Identified Greatest Challenges
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Security vs Health
Ethical issues
Finding a Bed
Finding the patients
Drug & Alcohol problems
Transitioning
What Does it Mean ?
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Little focus on developing MOSD
5 key areas;
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Improving Equity – resources & beds
Integrated Drug & Alcohol Services
ATSI workers
Transitions
Integration with broader forensic and DMHS