The challenges of health care for defendants with

intellectual disability Susan Hayes, Professor of Behavioural Sciences in Medicine, University of Sydney, NSW Australia

Michael Levy, Professor and Director, Corrections Health Program, ACT Health

International Congress of

Best Practice in Intellectual Disability Medicine

13 and 14 May 2010Bristol, UK

Research in 9 NSW Local Courts -

Results

• 329 partial data sets, 92 full data sets

• 10.9% had a diagnosis of ID with deficits in BOTH cognitive reasoning and adaptive behaviour

• Higher proportion of adaptive behaviour scores of <70 – 32.6% compared with 16.3% with IQ<70

• It is SO important to assess adaptive behaviour

Socio-Economic Indexes for Areas (SEIFA)

Using the SEIFA scale for socio-economic disadvantage –

• Significant correlation (r= .25, p < 0.02) was found between SEIFA rank and IQ standard score

• Higher economic indexes for the areas where the Court were located correlated with high IQ scores

• Poor areas had rates of ID at 18%, affluent areas 1.8%

• This could help explain different rates of ID

Mental illness -

• No significant difference between PWID and non-disabled peers for prevalence of mental illness

• Both groups had higher prevalence of mental illness than non-offending samples

• 52.6% of the sample self-reported a diagnosis of mental illness

• 50.5% were diagnosed with mental illness on the Psychiatric Assessment Schedule for Adults with Developmental Disability: PAS-ADD

PWID had higher rates of

• Previous binge drinking (66.7% of PWID, cf. 47.1% of non-disabled participants, Chi-square significant at p <.06, df = 1)

• Problematic alcohol use currently (59.3% cf. 29.4%, Chi-square p<.00, df=1)

• Previous problematic use of alcohol

(55.6% cf. 27.9%, Chi-square p<.01, df=1)

• Past attempts at self-harm (44.4% cf. 23.5%, Chi-square p<.04, df=1)

Physical health issues amongst prisoners

2001 NEW SOUTH WALES INMATE HEALTH SURVEY (Butler and Milner, 2003)

• At least one chronic condition - 95% of women, 78% of men

• Hepatitis C +ve - 64% of women, 40% of men• “Probable pathological gamblers” -11% of women, 20%

of men• Head injuries resulting in ‘blacking out’ - women 39%,

men 45%

Health issues continued –

• Alcohol abuse - 1/3 of women, 50% of men

• Current smokers – mainly smoking “rollies” (cough, cough) - 83% of women, 78% of men

• Illicit drugs regularly in the twelve months before prison - 74% of women, and 67% of men

• Childhood sexual abuse - 60% of women, 37% of men

So, the prisoner population is unwell….

And PWID have poorer health generally –

• Life expectancy poorer• Psychiatric disability more prevalent• Rates of dementia are higher especially amongst some

genetic conditions• Higher rates of other medical conditions

seizure disorders gastrointestinal disorders infections such as hepatitis, tuberculosis and

Helicobacter pylori obesity poor dental health

• Hospitalisations are of longer duration

• Poorer uptake of health promotion and disease prevention activities

• Tendency to lead sedentary lives

• Histories of poverty, abuse, homelessness

• Higher rates of vision and hearing impairments

The population of PWID is less healthy….

A LOSE-LOSE SITUATION!

Actually lose-lose-lose

if you add in poverty

What can we do?

• Top priority is to identify prisoners with ID

• If we don’t know who they are, we cannot target services or plan for services

• Basic interventions e.g. make sure these prisoners can read information and notices about health services in prison; make sure they can hear announcements; reminders about appts

A full medical screen - Why?

• Screening finds hidden “cases”

• An ID service in NZ screened 98% of its service users

• Found that 72% required at least one health intervention that they were not getting

• PWID do not always comprehend that they have a health issue, and may have difficulty describing their health or providing a good history

Health screening in prison

Advantages in using screening tool such as the Comprehensive Health Assessment Program (CHAP) developed by Professor Nick Lennox et al., University of Queensland makes sure that all health issues and regular health screens are covered (e.g. Cholesterol, PAP smears)

(also the Cardiff Health Screen)

Drug and Alcohol Programmes -

• Prisoners with ID are abusing drugs and alcohol at least as much as and possibly more than other prisoners

• ID-specific access barriers - PWID initiate and engage in D&A treatment at lower rates

• Remain in treatment for shorter periods of time

• More likely to drop out of treatment

• Programmes have to meet their needs

To deliver a good health service for PWID -

• Staff training – ongoing – given rates of ID and other deprivation ALL health staff need ID and MH training

• Development of specific programmes taking into account deficits in communication, literacy, behaviour, comprehension, compliance with treatment

• The information follows the prisoner around

• Generic AND specialist services cooperating

Health care in prison might be the best ever!

AND THEN THE PWID LEAVES PRISON......

• Important to create a follow-up pathway, especially in first few weeks after release

• One idea being trialled in Australia is a free-phone call service so ex-prisoners dial a 1800 (= 0800) number if they have a health issue

• Can talk to someone with expertise in ID

In Summary –

• Screen for ID and CASE FIND

• Screen for health issues

• Specific programmes (mental health, D&A) for ID where needed

• Attach the information to the individual

• Develop follow-up pathways

Susan Hayes

susan.hayes@sydney.edu.au