Michelle Denton Manager: Forensic MHS Southern and Central Qld PhD Candidate Uni of Qld Andrew Hockey Project Officer “Back on Track”: Transition from prison to community for people with a serious mental illness.

What we know High prevalence of mental illness, substance use disorder, health and social issues 8-14% psychosis, % some mental disorder, 70% SUD Post release high risk time for unnatural deaths: suicide, overdose, accident (higher MI) Poverty, homelessness, lack of social supports, unemployment, stigma Cycle of arrest, incarceration, release, relapse, re- offending, re-incarceration

arrest poverty unemployment substance use homelessness stigma incarceration relapse/ re-offending release transition phase Cycle of Mental Illness and Offending

Policy context Transition phase - a key point of intervention for MI Few MH transition services in Australia Sparse information internationally USA trend for MH transition support programs funded and managed within CJS rather than health Concerns that a CJS framework may lack mental health/recovery focus

QUEENSLAND FORENSIC MENTAL HEALTH SERVICE State-Wide Team COMMUNITY District Mental Health Services Court Liaison Service Community Forensic Outreach Service High Secure Hospital Prison Mental Health In-reach + Transition

Evaluation PMHS Transition Phase 1 Evaluation (completed) – Retrospective study all available data Phase 2 Evaluation (current) – Prospective study all participants 2010 – outcome data at 4 points – in partnership with RFQ Phase 3 PhD in-depth qualitative study 25 ‘typical’ cases (current) – Young men< 40 – Psychosis + SUD – < 1 year incarcerated

Aims of Phase 1 Evaluate 12 months of service activity (July 2007 – June 2008) Identify suitable data sources for analysis Build a demographic and diagnostic profile of clients receiving transition support Attempt to evaluate continuity of care outcomes Develop a method for future evaluation

Method Phase 1 Retrospective Ethics approval QH Data collection; Queensland Health data bases CIMHA, program data, case note review Queensland Corrective Services. IOMS Cross tab analysis.

Program participants How many 96/ ~ 3000 releases open clients received support and % referred RFQ (NGO) Who Acutely unwell or relatively complex – Hospital admission or recommendation – Involuntary Ax during incarceration – Ax as potentially benefiting from program support

Demographics 26 females / 70 males. Mean Age = years

Primary Diagnosis

Additional Diagnoses

Dual Diagnoses (SUD)

Previous Psychiatric Admissions

Previous Community MH Treatment

Self-Harm History

Social Support

Planned Housing Pre-release

Planned Employment Pre-release

Incarceration This intervention 26 on remand, 52 sentenced, 9 missing Average length incarceration – (~ 10 mths) males – (~ 8 mths) females History – Average 4 times incarcerated (range = 1 to 16) since 1990

Re-incarceration 27% re-incarcerated within 6 months (25% M 35%F) Av length in the community before re- incarceration was 102 days (~3 mths) (Range 15 to 181 days)

Profile Young <40 Schizophrenia + SUD / poly-substance Previous Psychiatric Admissions Previous Community MH services Self harm + suicide attempts Limited social supports Housing issues Low employment Multiple incarcerations

Continuity of Care Attended face to face local CMHS within 2 weeks post release ? – 73% of males – 61.5% of females Who attended 1 st appointment? Who continued attending?

1 st appointment attendance %

1 st appointment attendance X incarceration history %

Ongoing appointments X prior incarcerations

Ongoing appointments X diagnosis Average number of consultations

Summary Complex, high need, multi incarceration 70% attended first MH assessment 2 weeks Most maintained engagement 6 months Transition support may improve continuity of care ↑QOL ↓ relapse ↓ recidivism ↓ mortality and morbidity

Are we getting it right ? Comprehensive assessment Individual plans / personalised delivery Health and wellbeing focus Pre & post release engagement Continuity of staff across continuum Facilitate access to services ? Partnership with community Cross agency collaboration Just the beginning. More work to be done!