Keeping Prisoners Out- We Don’t Take “NO” for an Answer

Puzzle Reintegration ConferenceHobart - June, 2010

Dr Sandra Sunjic & Stephen Ward

Justice Health

Case Scenario

36 year old Iranian Man

Arrived in Australia at 13 years old

Cannabis, MDMA use from 21 years old

In custody 4 months on remand

Case Scenario Current charges:

Take /detain to obtain advantage/attempt to choke

Use offensive weapon X 4 Common assault X 4 Possess unregistered firearm/unauthorised pistol Goods in custody Not keep firearm safe Drive vehicle furiously/recklessly Assault Occasioning Actual Bodily Harm X 2

Case Scenario

Referred by Solicitor via NSW Housing Bahai faith Circumstances of charges Mental Health Issues Supreme Court Bail Post release progress Court outcome

Strengths model

Rapp et al (2007)

Denial as a result of: Hopelessness about ability to change Difficulty prioritising and organising

solutions to multiple life problems Problems utilising needed resources

Personal Strengths Model of Care

Use client strengths, abilities, assets Focus on positives

Clients control goal setting No goal is unrealistic – broken down

Client-Worker relationship primary Workers assist – do not treat

Assertive outreach/advocacy

Connections Project Commenced September 2007 State-wide No eligibility criteria – offences Problematic drug use Pre-release assessment & comprehensive

care planning Post-release linkage – health & welfare

services One month post-release support - with

option of extended care Immediate extended care

What the Research says:

>80% inmates ever used illicit drugs (Butler & Milner, 2001) (Sample:7674 inmates)

Almost half used illicit drugs in prison (Butler & Milner, 2001)

~1/3 co-morbid disorder (D&A & Mental Health) (Sunjic et al 2007)

Remain OTP 8/12 post release – significant in recidivism & mortality (Dolan et al 2005)

Deaths Post Release 1988-2002

Record linkage Cohort 85,203 (4,714 males, 423 females) Total deaths 5,137 (6%) Drug Related

Deaths post-release: 31% males (1,477)

47% females (197)

26% all drug related deaths in NSW (Kariminia et al, 2006)

“…“…. part of the answer lay in the Australian prison, . part of the answer lay in the Australian prison, and the men I’d met there. Some of the men, too and the men I’d met there. Some of the men, too many of them, were serving their fourth or fifth many of them, were serving their fourth or fifth prison sentences. Many of them had begun their prison sentences. Many of them had begun their imprisonment in reform schools – Boy’s Homes, they imprisonment in reform schools – Boy’s Homes, they were called, and Youth Training Centres. Some of were called, and Youth Training Centres. Some of them had been beaten, starved, and locked in them had been beaten, starved, and locked in solitary confinement. Some of them, too many of solitary confinement. Some of them, too many of them had been sexually abused. Ask any man with a them had been sexually abused. Ask any man with a long enough experience of prisons, and he’ll tell you long enough experience of prisons, and he’ll tell you that all it takes to harden a man’s heart is a system that all it takes to harden a man’s heart is a system of justice.”of justice.”

Gregory David Roberts Gregory David Roberts Shantaram, Shantaram,

2003, p81.2003, p81.

Assistance Provided ID, Medicare Cards Liaise with Department of Community Services –access to

children Book medical appointments Advocate for patients to access services Arrange accommodation Attend appointments with patients Meeting basic needs – food vouchers, furniture Re-engage with family Orientation to the community New legal matters

Serious Offenders Assessment, preparation & care

planning several years before release De-institutionalisation Advocacy/assistance – to co-ordinate

requirements for release e.g. VOTP & OTP

Reports to Serious Offenders Review Council (SORC) and State Parole Authority (SPA)

Post release support for 3 months

Program Data September 2007 – May 2010 (2yrs 8months)

Assessment & Care Plan 3,224 (~1200pa)

Completed/Current (83%)

Returned to Custody (8%)

Lost to follow/up (6%)

Program DataConnections Outcomes Post Release to Dec 09 (N = 2118)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Sept 0

7 -N

ovem

ber 0

7

Dec 07

- Feb

08

Mar

08 -

May

08

June

08

- Aug

08

Sept 0

8 - N

ov 0

8

Dec 08

- Feb

09

Mar

ch 0

9 - M

ay 0

9

June

09

- Aug

09

Sept 0

9 - N

ov 0

9

Completed

Closed

RTC

LTFU

Program Data

Connections Lost To Follow Up By Linkage to Dec 09 (N = 389)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Sept 0

7 -N

ovem

ber 0

7

Dec 07

- Feb

08

Mar

08 -

May

08

June

08

- Aug

08

Sept 0

8 - N

ov 0

8

Dec 08

- Feb

09

Mar

ch 0

9 - M

ay 0

9

June

09

- Aug

09

Sept 0

9 - N

ov 0

9

Linked in

Not Linked in

Don't know

External Evaluation (Martire & Howard, 2009)

N=829 82% males Mean age = 34 (18-60) 89% Australian 23% Aboriginal or TSI 91% at least one previous

incarceration

External Evaluation (Martire & Howard, 2009)

Majority not complete minimum high school Aboriginal & Women-less likely ever worked 19%-difficulty keeping contact family /

friends 60%-have children(38% live with them post-

release) 90% Centrelink benefits 78% financial problems

0

10

20

30

40

50

60

70

% o

f p

atie

nts

Male Female

Type of financial concern

Health Status Physical Health

70% existing physical health problems

56% required ongoing healthcare post-release

>50% patients had head injury in the past

17% shared injecting equipment in gaol

Health Status Mental Health

56% receiving mental health treatment 35% Depression 20% Anxiety

68% of female patients experiencing mental health problems

28% considered or attempted suicide & 14% considered or attempted self harm

0

10

20

30

40

50

60

% o

f p

atie

nts

Males Females

Mental Health Diagnoses

Alcohol & Other Drugs

88% had drug problem before gaol

72% last offence was drug related

18% used drugs in gaol Cannabis (52%), Heroin (32%)

Post release problems encountered in past

Corinne

I use, because I am so afraid of “Life”, I’m lonely, alone scared of society, of Authority figures? Who pretend to help; But everything “they” say they are doing for me HA, has still not been done? – people, just do Not understand how hard it is for me? Every single time I have been out of prison – I just can’t cope? The longest time of Freedom I have had? Was 5 1/2 months – Parole have all this information? What am I supposed to do Corinne, I’ve laid awake at Night and cried, and thinking?

Why, is So hard? It’s hard, because I am 45 yrs of age, And for 36 of those 45 years I have been in and out of institutions and Prison from age Nine, over two thirds of my entire life. I am afraid of people, I can’t communicate with others. I want a life Corinne, but when you Know nothing but Prison and drugs, and really, no one has shown me any alternatives, or solutions and the people I ever have anything to do with? Are criminals. I have sat in this caravan, day after day, lonely and alone, and sinking deeper into fear of those who are supposed to be supporting and guiding me.

I’ve told you things that I have suffered and been subjected too throughout my life? If you knew everything? You would shed a tear. The bottom line is? People don’t “and never will” understand the psychological damage I have suffered from not only all the boy’s homes, And sexual and physical abuse as a child. I don’t have the skills to deal with so many things in society, yes, I am a MAN, and I am responsible for my actions?After all those years in and out of Prison living in a 12 by 8 foot cell? Then living in this caravan is making me unstable? My Brother has been good to me lately, we sorted out our differences But even though he is my Brother, I have been showering twice a week and living like a hermit?

I know my Brother cares But it goes back to what I said earlier “People don’t understand how damaged mentally I am, from a lifetime of hatred, violence, rejection, loneliness, fear. I am afraid to have showers and go inside; and this is my Brother’s house, my blood who loves me? So if I am like this with [name removed]? How afraid of Society, do you think I am? There are some good people in this world. You are the best of all those who have tried HA “Connections” deserves all the credit they get. I said to my Brother today, if it were not for yourself and Connections I would not be here –

I can Promise you this – on my Brother’s Grave – I will not go back to Prison

So even though I have taken three Nights to write this – I just want people to understand I’m not a bad person, I just am so afraid of my life.

Thankyou for all you have done [name withheld].

Patient Outcomes 70% continued necessary physical health treatment 71% continued necessary mental health treatment 45% reported using drugs in community (usually

<weekly)

Significant reduction in number drug types used 87% continued necessary D&A treatment 45% commenced additional D&A treatment

79% continued OTP post release Significant improvement in general health post-release

(GHQ) Significant improvement in general health & wellbeing

post-release (BTOM-C)

Completion v’s Return to Custody

RTC group:

Significantly less likely continue physical, mental, D&A Rx post-release

Significantly more likely to remain in pre-arranged accommodation only initially

Significantly more likely to have used drugs during post-release period, to have used daily and use more drugs

Completion v’s Return to Custody

Completion group:

Improved general health, RTC group – decline in general health

Improved social functioning (SF-12) – RTC decline

Fewer transitional changes than RTC group

Days in Community Pre v. Post Connections

Return to Custody Group:Average days in community PreC = 132 (0-559 days)

Average days in community PostC= 211 (0-552 days)

Average difference = 79 days longer Post-Connections (at census, Sig p<.005, t = 11.39)

Completed Group:Average difference = 7 months longer Post-Connections

(80% remain in the community at 2 years)

65% of patients had more time in the community Post-Connections

State Parole Authority Outcomes(n=225)

123 (54%) of patients granted Parole 123 (54%) of patients granted Parole AApplication supported by P&P.pplication supported by P&P.

63 (28%) of patients granted Parole 63 (28%) of patients granted Parole Initial application was not supported by P&P.Initial application was not supported by P&P.

17 (8%) of patients granted Parole 17 (8%) of patients granted Parole Not supported by P&P.Not supported by P&P.

22 (10%) of patients SPA requested 22 (10%) of patients SPA requested further information and granted Parole further information and granted Parole Supported by P&P.Supported by P&P.

Patient Perceptions of Connections

90% “better prepared” this time (RTC significantly less likely)

86% “transition easier” this time (RTC significantly less likely)

95% cited positive aspects about Connections Project (avg. 3.28)

98% received assistance from Connections (avg. 2.5)

90% “satisfied” or “very satisfied” (RTC significantly less likely)

“Laws can embody standards. Governments can enforce laws – but the final task is not for the government. It is a task for each and every one of us. Every time we turn our heads the other way we see the law flouted – when we tolerate what we know to be wrong – when we close our eyes and ears to the corrupt because we are too busy, or too frightened – when we fail to speak up and speak out – we strike a blow against freedom and decency and justice.”

Robert F. Kennedy, 21 June 1961.