Its hard to get ahead when you’re sick

Correctional Services Healthcare Summit,

30 August 2013

Julie Boffa, Policy Manager,

Roger Pugh, Manager, Adult Justice Programs

Jesuit Social Services

About Jesuit Social Services

Jesuit Social Services works to build a just

society by advocating for social change and

promoting the health and wellbeing of

disadvantaged people, families

and communities.

Range of different programs

Our service delivery and advocacy focuses on the following key

areas:

• Justice and crime prevention – people involved with the

justice system

• Mental health and wellbeing – people with multiple and

complex needs and those affected by suicide, trauma and

complex bereavement

• Settlement and community building – recently arrived

immigrants and refugees and disadvantaged communities

• Education, training and employment – people with barriers to

sustainable employment

Our justice programs

Youth Justice & Homelessness • Youth Justice Community Support Service

• Youth Justice Group Conferencing

• Next Steps (intensive support pilot)

• Aboriginal Children’s Justice program (with VALS & VACCA)

Adult Justice • Intensive Transitional Support Program

• Link Out, KONNECT & WISP

Focus of presentation

• What actions can we take as the statewide

provider of the Women’s Intensive Support

Program (WISP) to improve health outcomes

for women exiting prison?

• WISP participants had poorest health outcomes of all

other groups in agency survey

• Imprisoned women have poorer physical health and

mental health than men (Carlton and Baldry in Carlton and Segrave, 2013:60)

‘The Health of Australia’s Prisoners 2012’

Australian Institute of Health and Welfare 2013 • 84% of prisoners report they smoke, 46% say they want to quit

• 32% of prisoners report being told they have a chronic condition –

including arthritis, asthma, cancer, cardiovascular disease, diabetes

• Female prison entrants had a higher prevalence of hepatitis C

antibody (34%) than male prison entrants (21%) or the Australian

general population (1.4%)

• Over half (54%) of dischargees reported drinking alcohol at risky

levels prior to imprisonment – but only 12% reported accessing an

alcohol treatment program while in prison .

• 51% of female prison entrants reported high to very high levels of

psychological distress, compared to 39% for males and general

population rates of 13% & 9% respectively (non ATSI) • Mean age of 1st pregnancy 21yrs compared to pop. average of 28yrs

Our position

“The social determinants of health and

the social determinants of prison are the same” Jill Gallagher, AO, CEO, VACCHO. Launch of Unfinished Business:

Koori Women and the Justice System, VEO&HRC, 2013

• Preventing return to prison and promoting better

health outcomes have a lot in common

• Three pronged approach to address both individual

and structural determinants and consequences: • Respectful and practical support

• Gendered health promotions activities

• Advocating for reform

Social determinants of health & prison

Poor education

Prison

Unemployment

Homelessness

Family violence

Sexual assault

Mental illness

Drug and alcohol abuse

Oppression

Pre-prison Post -prison

Poverty

Inequality

Institutionalisation

Poor education

Unemployment

Homelessness

Family violence

Sexual assault

Mental illness

Drug and alcohol abuse

Oppression

Poverty

Inequality

Institutionalisation

Women’s experience post-release

• “... aside from the well-documented material, structural and

systemic challenges experienced post-release, women’s

lifetime trajectories are overwhelmingly underpinned by trauma

and the isolation, loneliness and idleness they experienced on

release. Such experiences add greatly to the precariousness

of women’s survival (Segrave and Carlton 2010, 2011; Carlton and Segrave 2011)”

• Social gradient of health – lower social position, worse health

• "loneliness [is] on the list of risk factors for ill-health and early

death right alongside smoking, obesity and lack of exercise”

• A positive, interpersonal network will ameliorate the severity

and sequelae of illness

Intensive Transitional Support Programs

“... are funded to provide a range of pre and post release

reintegration packages targeting prisoners with moderate-to-

high risk levels of re-offending/return to prison and related

moderate-to-high transitional needs. The distinguishing feature

of these reintegration packages is the period of pre and post

release intervention and the level of intensity.

The pre release reintegration packages provide for one, three

or six months pre release transitional planning and support, and

the post release reintegration packages provide for one, four,

eight and 12 months post release transitional

support/structured reintegration activity” (Corrections Victoria, 2011, p. 53)

105 pre-release packages per year and 90 post-release packages

Pre-release indicative contact hours

Pre release transitional planning and support packages 2 hours funded for every one hour of direct contact time

Pre release

reintegration

package

Up to one month

pre release

Up to three

months pre

release

Up to six months

pre release

Average hours of

contact hours per

package

4 hours 7 hours 14 hours

Indicative frequency

of contact (for the

purpose of direct

contact hours a four

week month is

considered)

Delivered over the

course of the month.

Note: where late

allocations are made

the one month

period may be

eroded.

Fortnightly for 10

weeks then weekly

for 2 weeks.

(At least half of

direct contact hours

being face-to-face).

Weekly for 2 weeks,

fortnightly for 20

weeks and then

weekly for 2 weeks.

(At least half of

direct contact hours

being face-to-face).

Pre release transitional planning and support packages 2 hours funded for every one hour of contact time

Post-release indicative contact hours

Post release transitional planning and support packages 2 hours funded for every one hour of direct contact time

Community

Reorientation

Program

One month

post release

‘Low Intensity’

Four months

post release

‘Medium

Intensity’

Eight months

post release

‘High Intensity’

12 months post

release

Average hours of

direct contact

hours per pack.

3 hours 12 hours 22 hours 30 hours

Frequency of

contact (for the

purpose of

indicative direct

contact hours a

four week month

is considered)

Delivered on an

individual and/or

group basis over

the course of the

month.

Weekly contact 5

weeks,

fortnightly

contact 8 weeks

and then weekly

contact 3 weeks

Weekly contact

12 weeks,

fortnightly

contact 20 weeks

Weekly contact

12 weeks, then

fortnightly

contact 36

weeks.

Women’s Intensive Support Program

• 302 women released from prison in Victoria in

2009-10 (parole and straight release only)

• Funded packages (ITSP specifications)

• 105 pre-release packages per year

• 90 post-release packages

• Some variation in numbers of actual packages

since implementation given reliance on CV Intake

Assessment Worker and capacity to access

additional packages from CV

Aboriginal needs • Pre-release support to Aboriginal people provided

through Link Out and WISP.

• Removal of a culturally specific pre-release

component of the program is flawed and against the

fundamental principles of the Aboriginal Justice

Agreement.

• Up to 70% of KONNECT participants are rural based,

greatly exacerbating travel issues that not directly

funded but absorbed by agency.

• Transition for Aboriginal people requires significant

work with the individual, their family and community.

Comprehensive case plan to include:

• Education, vocational training and

employment

• Housing

• Health, alcohol and/or other drugs

• Family reunification and social support

• Living skills, community connectedness and

appropriate recreational and leisure activity

• Law abiding lifestyle

How do we respond?

• ‘Gendered justice’ framework is premised on

the understanding that women’s crimes are

embedded within the conditions of their lives

• Need to avoid ‘narrow lens of individual

failure and social inadequacy’

• Focus on ‘structural origins and impacts of

gendered injustice, subordination and control’

• Empowerment, self-determination and

survival are key

Case study

• Released from prison without medication

• Access negotiated by WISP

• History of family violence and abuse as child

• Re-admitted pregnant

• Frustrated in attempt to gain information and

change medication in light of pregnancy

• Health deteriorates

Three Pronged Approach

1. Respectful and practical support

2. Gendered health promotions activities

3. Advocating for reform

Respectful and practical support

Our Way of Working

• Value self and others

• Affirm goals and aspirations

• Utilise supports

• Build capacity

• Increase civic participation

Health Promotions approach

• “Health promotion is the process of enabling

people to increase control over their health and

its determinants, and thereby improve their

health” Bangkok Charter for Health Promotion in a Globalised World

• Social model of health http://www.vichealth.vic.gov.au/

• addresses the broader determinants of health

• involves inter-sectoral collaboration

• acts to reduce social inequities

• empowers individuals and communities

• acts to enable access to health care

Developing partnership with Women’s

Health West • Women’s Health West works within a feminist

framework to deliver projects that improve women’s

health, safety and wellbeing.

• Health is influenced by more than our biology,

lifestyles and access to health care. Poverty,

education, age, sexuality, culture and, of course,

gender also impact on our wellbeing.

• WHW’s health promotion work aims to rectify the

gender and structural inequalities that affect the

health and limit the lives of women.

• Social

Areas of WHW Health promotions work

• Equity and social justice

• Mental wellbeing and social connectedness

• Sexual and reproductive health

• WHW working in partnership with Hepatitis

Victoria and HealthWorks to develop and run a

women’s health and wellbeing program in

Dame Phyllis Frost

• Tap into Women’s Health state wide networks

Advocacy

• Core business at Jesuit Social Services

• Need to redress the lag gap in funding prior to 2010

for health & support services attached to temporary

prison beds, despite vast increases, plus • National Justice Symposium 2011

• Just Advocacy response to chief psychiatrist report on

high numbers of deaths of prisoners post release

• Media releases supporting increased resources for

parole board and protesting changes to bail act

• Submissions to government -housing, allowances,

drug and alcohol treatment services and more