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Understanding Mental Health in the Australian Custodial Population: Challenges and Insights

This report by Ed Heffernan, Director of PMHS Queensland, examines the mental health challenges faced by Australia's custodial population. With over 27,000 individuals in prisons as of June 2007, a significant percentage are Indigenous and young adults aged 20-39. The study highlights the alarming rates of mental health issues, including psychosis, and emphasizes the need for culturally sensitive care and improved transition strategies from prison to community. Key challenges include balancing security with health and providing necessary drug and alcohol services.

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Understanding Mental Health in the Australian Custodial Population: Challenges and Insights

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  1. Ed Heffernan Director PMHS Queensland Insanity: Inside and Out

  2. 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

  3. Australian Imprisonment Ratesper 100,000 population

  4. Male vs Female Rates

  5. Incarceration Rates • 169 /100,000

  6. Indigenous Imprisonment RatesPrison Census June 2007

  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)

  8. Mental Disorders in Australian Prisoners v Community (Butler et al, 2006)

  9. How big is this problem?A Rough Guess • ~ 75,000 people • ~ 20 - 25% will need specialist Ψ services • ~ 7-10% will be psychotic

  10. Security vs Health Getting In Movement, MSU’s, Protection Sudden - Tracking People No Involuntarily Treatment Suicide Cells Medication Monitor, Diversion Discharge Barriers to Treatment

  11. How do you do it?Vast Numbers & Geography • Care while in custody • Culturally sensitive • Drug & Alcohol • Diversion to health • Transitional care to the community

  12. 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

  13. Correctional Centres serviced

  14. How many do you see ?

  15. Staffing Profile

  16. Clinician Hours / week / 1000 prisoners

  17. Transition from Prison to Community

  18. 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

  19. Psychological Interventions

  20. Mental Health Reports Writing

  21. Drug and Alcohol Services

  22. Indigenous Mental Health Worker

  23. Diversion

  24. Identified Greatest Challenges • Security vs Health • Ethical issues • Finding a Bed • Finding the patients • Drug & Alcohol problems • Transitioning

  25. 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

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