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Insanity: Inside and Out

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

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Insanity: Inside and Out

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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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