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