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Insanity: Inside and Out
Ed HeffernanDirector PMHS Queensland
Australian Custodial Population 30 June 2007
27,224 people in Australian prisons 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 Ratesper 100,000 population
Male vs Female Rates
Incarceration Rates
169 /100,000
Indigenous Imprisonment RatesPrison 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
2001 New Zealand Prisons n=1159 (Simpson & Brinded)
2003 Ethnicity and mental health need (Simpson et al)
2003 NSW Prison Study n= 1532 (Butler & Allnut)
2005 Psychosis NSW n = 110 (Neilssen and Misrachi)
2007 Aboriginal data n= 285 (Butler et al)
2006 Comparison to community n=916 Butler et al)
2006 Psychosis Qld n= 621 (White, Chant, Whiteford)
2006 Female Prisoners n=103 (Tye and Mullin)
Mental Disorders in Australian Prisoners v Community (Butler et al, 2006)
7.0
37.9
25.1
3.5
65.7
43.1
80.3
0.7
8.9
0.8
9.2
30.5
11.418.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Psychoses Any Anxiety
Disorder
Depression Bipolar Disorder Any Substance use
disorder
Any personality
disorder
Any Disorder
% Prisoners(n=916)% Community(n=8168)
How big is this problem?
A Rough Guess
~ 75,000 people ~ 20 - 25% will need specialist Ψ services ~ 7-10% will be psychotic
Barriers to Treatment
Security vs Health Getting In Movement,
MSU’s, Protection Sudden - Tracking People
No Involuntarily Treatment Suicide Cells Medication
Monitor, Diversion Discharge
How do you do it?Vast Numbers & Geography
1. Care while in custody
2. Culturally sensitive
3. Drug & Alcohol
4. Diversion to health
5. Transitional care to the community
Prison Benchmarking
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
0
5
10
15
20
25
30
35
No of Prisons No prisons serviced
No of Prisons 18 13 12 29
No prisons serviced 10 11 9 25
Matildas Opals Wallabies Socceros
Correctional Centres serviced
How many do you see ?
ServiceNo of
prisons
Cross section of prisoner population
No of prisons serviced
% total receiving
public MHS’s
Percentage of open cases
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%
Staffing Profile
Service Administration Officer
Allied Health/
Health Practitioners
Nursing 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
87
21
0
142
23
64
0 0
13
38
8
35
0
20
40
60
80
100
120
140
160
Matildas Opals Wallabies Socceros
Nursing
Allied Health
Medical
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
1st 2 weeks ↑ Suicide rate magnitudes higher
↑ Fatal OD 9.3X ♂, 6.4X ♀ (NSW retro cohort 85,203,Kariminia et al MJA 2007)
↑ suicide rates 8.5♂, 36♀ (Pratt, Lancet 2006)
↑ hospitalisation ↑ substance use relapse ↑ homelessness ↑ recidivism
Psychological Interventions
Service Provides Formal Psychological interventions
Delivered by
Matildas
Opals Psychologists employed by PMHS (supplementary role)
Wallabies
Socceroos
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 80% 20%
Opals 90% 10%
Wallabies 100% 0%
Socceroos 90% 10%
Drug and Alcohol Services
Service% Mental health Patients with Substance
DisordersD&A Interventions
Offered
Matildas 75% (2007)
Opals 84% (2006)
Socceroos 66% (2001)
Wallabies 75-8% (2007)
Indigenous Mental Health Worker
ServiceIndigenous Mental
Health Worker
Matildas
Opals
Socceroos
Wallabies
Diversion
0%
20%
40%
60%
80%
100%
Matildas Opals Socceroos Wallabies
Percentage transferred to Forensic Service Percentage transferred to General Acute Service
Identified Greatest Challenges
Security vs Health Ethical issues Finding a Bed Finding the patients Drug & Alcohol problems Transitioning
What Does it Mean ?
Little focus on developing MOSD 5 key areas;
Improving Equity – resources & beds Integrated Drug & Alcohol Services ATSI workers Transitions Integration with broader forensic and DMHS