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