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

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 Rates per 100,000 population

4. Male vs Female Rates

5. Incarceration Rates 169 /100,000

6. Indigenous Imprisonment Rates Prison Census June 2007 Non IndigenousIndigenousRate Ratio Male / 100,000312415913.3 Female/100,0002440116.7

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

11. 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

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 ? Service No of prisons Cross section of prisoner population No of prisons serviced % total receiving public MHS’s Percentage of open cases Matildas184,2001056%~25% Opals185,443 1195% ~25% Socceroos 29 10,285 2587% ~32% Wallabies123,8479?~20%

15. Staffing Profile ServiceAdministration Officer Allied Health/ Health Practitioners NursingMedical Matildas 32.722.84.2 Opals 2.51424.6 Socceroos 0036.78.35 Wallabies 0001.5

16. Clinician Hours / week / 1000 prisoners

17. Transition from Prison to Community ServiceProvides Transition support Period of TransitionPercentage 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% WallabiesXNil0 SocceroosXNil0

18. Transitions to the Community 1 st 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 ServiceProvides Formal Psychological interventions Delivered by Matildas Opals Psychologists employed by PMHS (supplementary role) Wallabies  Socceroos 

20. Mental Health Reports Writing ServiceProvides 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%

21. Drug and Alcohol Services Service % Mental health Patients with Substance Disorders D&A Interventions Offered Matildas75% (2007) Opals 84% (2006)  Socceroos 66% (2001)  Wallabies75-8% (2007) 

22. Indigenous Mental Health Worker Service Indigenous Mental Health Worker Matildas  Opals Socceroos  Wallabies 

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