Reducing Vulnerability to Harm in Adults With Cognitive Disabilities in the Australian Criminal Justice System

Examining the impact of a group treatment using cognitive and social cognition remediation for young offenders: The justice health NSW school-link advantage pilot study

AIM

Young offenders experience higher rates of neurodevelopmental and mental health disorders than the general population, and significant access barriers to health treatment. Treatment combining Cognitive Remediation Therapy (CRT) and Social Cognition Remediation Therapy (SCRT) has demonstrated benefits for functional improvements and social development. However, there is limited information regarding group treatment programs in custodial settings for young offenders. This pilot study explores the effectiveness and feasibility of a group treatment program for youth offenders with cognitive deficits and mental health concerns in youth detention.

METHODS

The School-Link Advantage pilot study designed and tested a 10-week group treatment program combining CRT and SCRT for young offenders in custody. The closed groups incorporated interactive activities focussed on emotional recognition and regulation skills, optimizing executive functioning, understanding values, exploring belief systems, improving relationships, and safety planning.

RESULTS

Of the 22 male participants recruited in an Australian Youth Justice Centre, 12 completed all aspects of the treatment program, reflecting a 54.5% completion rate in a typically challenging to engage population cohort. Results demonstrated significant improvements in the ability to store and retrieve information, recognize information, and control emotions. Planning and organizing skills also showed considerable development.

CONCLUSIONS

This pilot study suggests that a combined CRT and SCRT group treatment program has the potential to effectively target cognitive challenges associated with mental health disorders in young offenders in custody. These promising outcomes suggest exploring randomized controlled trials with increased cultural sensitivity for diverse populations.

Automatic Extraction of Research Themes in Epidemiological Criminology From PubMed Abstracts From 1946 to 2020: Text Mining Study

BACKGROUND

The emerging field of epidemiological criminology studies the intersection between public health and justice systems. To increase the value of and reduce waste in research activities in this area, it is important to perform transparent research priority setting considering the needs of research beneficiaries and end users along with a systematic assessment of the existing research activities to address gaps and harness opportunities.

OBJECTIVE

In this study, we aimed to examine published research outputs in epidemiological criminology to assess gaps between published outputs and current research priorities identified by prison stakeholders.

METHODS

A rule-based method was applied to 23,904 PubMed epidemiological criminology abstracts to extract the study determinants and outcomes (ie, "themes"). These were mapped against the research priorities identified by Australian prison stakeholders to assess the differences from research outputs. The income level of the affiliation country of the first authors was also identified to compare the ranking of research priorities in countries categorized by income levels.

RESULTS

On an evaluation set of 100 abstracts, the identification of themes returned an F1-score of 90%, indicating reliable performance. More than 53.3% (11,927/22,361) of the articles had at least 1 extracted theme; the most common was substance use (1533/11,814, 12.97%), followed by HIV (1493/11,814, 12.64%). The infectious disease category (2949/11,814, 24.96%) was the most common research priority category, followed by mental health (2840/11,814, 24.04%) and alcohol and other drug use (2433/11,814, 20.59%). A comparison between the extracted themes and the stakeholder priorities showed an alignment for mental health, infectious diseases, and alcohol and other drug use. Although behavior- and juvenile-related themes were common, they did not feature as prison priorities. Most studies were conducted in high-income countries (10,083/11,814, 85.35%), while countries with the lowest income status focused half of their research on infectious diseases (47/91, 52%).

CONCLUSIONS

The identification of research themes from PubMed epidemiological criminology research abstracts is possible through the application of a rule-based text mining method. The frequency of the investigated themes may reflect historical developments concerning disease prevalence, treatment advances, and the social understanding of illness and incarcerated populations. The differences between income status groups are likely to be explained by local health priorities and immediate health risks. Notable gaps between stakeholder research priorities and research outputs concerned themes that were more focused on social factors and systems and may reflect publication bias or self-publication selection, highlighting the need for further research on prison health services and the social determinants of health. Different jurisdictions, countries, and regions should undertake similar systematic and transparent research priority-setting processes.

Art Therapy in Australian Prisons: A Research Agenda

Art therapy in prisons remains widely under-researched in Australia and beyond and represents a major gap in the literature. Despite evidence that art therapy can be a tool for social change, to date, there are no recorded studies in Australia which have investigated the therapeutic benefits of art in prison populations with measured outcomes. Literary analysis suggests that research tends to be hampered by limitations in methodological approaches that are suited to prison environments. By engaging "inside" with inmates over the course of an 8-week art therapy program, this research design addresses this knowledge gap. Building on 5 years of piloting, the research methodological design presented in this paper embodies a prototype that promises to overcome the limitations of previous research approaches. This research agenda promises to facilitate creative interventions through sensitively attuned art therapy delivery. Benefits are expected to accrue to diverse stakeholder groups, including inmates, chaplaincy and parole services, voluntary facilitators, policymakers, criminologists, and taxpayers, among others.

Impact of post-release community mental health and disability support on reincarceration for prisoners with intellectual disability and serious mental illness in NSW, Australia

BACKGROUND

Prisoners with an intellectual disability are overrepresented in custody and more likely to reoffend and be reincarcerated compared with the general prison population. Although prisoners with intellectual disability have many of the same risk factors for recidivism as the general prison population, the high rates of mental illness experienced by this group are key drivers of recidivism.

AIMS

We aimed to assess the impact of provision of post-release disability and community mental health support on rates of reincarceration in a cohort with identified intellectual disability and serious mental illness diagnosis.

METHOD

We conducted a historical cohort study using linked administrative data-sets, including data on hospital admissions, community mental health, disability support and corrections custody in New South Wales, Australia (n = 484). To assess the time to return to adult custody, we used survival analysis on multiple failure-time data.

RESULTS

Over the median follow-up period of 7.4 years, 73.7% (357) received community mental health support, 19.8% (96) received disability support and 18.6% (85) received a combination of supports during a post-release period from prison. Lower hazards of reincarceration in a post-release period were associated with receipt of community mental health support (hazard ratio [HR] = 0.58, CI 0.49-0.69, P < 0.001), or a combination of community mental health and disability support (HR = 0.46, CI 0.34-0.61, P < 0.001).

CONCLUSIONS

High rates of reincarceration for prisoners with intellectual disability and history of serious mental illness may be modifiable by provision of appropriate mental health and disability supports.

Understanding health and social service accessibility for young people with problematic substance use exiting prison in Australia

Incarcerated young people (aged 18-24) with a history of problematic substance use are a particularly vulnerable group, with a higher risk of mortality and return to custody compared to their older counterparts. Yet, there is limited research investigating service accessibility for this population. This study aimed to address this gap by investigating the characteristics of young people exiting prison on the 'Connections Program' (Connections) and their access to support services. Connections is a transitional program with a remit to link people with problematic substance use exiting prison in New South Wales, Australia, to health and social services in the community. We used an explanatory sequential mixed methods approach including (1) a retrospective cohort study of young people on Connections (n = 359), utilising self-reported data collected in a routine pre-release questionnaire from January 2008 to February 2015 and (2) a qualitative survey with Connections caseworkers (n = 10). In stage one, descriptive statistics were calculated to produce a profile of sociodemographic and health characteristics of young people with problematic substance use exiting prison. In stage two, qualitative data were thematically analysed to explore the accessibility of services to meet young people's needs from the perspective of caseworkers. The study found young people experienced substantially poorer mental health than the general population, and the vast majority had received treatment for a mental health issue (96.5%). Illicit substance use prior to incarceration was common (91.5%). Caseworkers reported substantial barriers to service accessibility in the community related to intersecting social disadvantage and co-occurring mental distress and substance use. Caseworkers have front-line knowledge of how gaps and barriers in services impact transition from prison and identified longer-term case coordination, inter-agency collaboration and holistic care as vital strategies to support young people in transition from prison to community.

Intellectual/developmental disabilities among people incarcerated in federal correctional facilities in Ontario, Canada: Examining prevalence, health and correctional characteristics

BACKGROUND

There is little research with people who experience intellectual/developmental disabilities and imprisonment.

METHODS

The study linked health and correctional data to examine prevalence of intellectual/developmental disabilities and health and correctional characteristics among adults experiencing their first federal incarceration between 1 January 2002 and 31 December 2011 (n = 9278) and two non-incarcerated groups (n = 10,086,802).

RESULTS

The prevalence of intellectual/developmental disabilities was 2.1% in the incarcerated group and 0.9% in the non-incarcerated group. Before incarceration, those with, versus without, intellectual/developmental disabilities were at greater risk of traumatic brain injury, mental illness, and substance use disorders. While incarcerated, those with intellectual/developmental disabilities were more likely to incur serious institutional disciplinary charges. Post-incarceration, persons with intellectual/developmental disabilities were at greater risk of emergency department visits, and psychiatric and acute hospitalizations, than the non-incarcerated groups.

CONCLUSIONS

People with intellectual/developmental disabilities are overrepresented in Canadian federal correctional institutions. The authors offer strategies to support people prior to, during, and post-incarceration.

Exploring the victim offender overlap among people with an intellectual disability

BACKGROUND

While there is growing international evidence pointing to the increased risks of crime perpetration and victimisation for some people with an intellectual disability, the overlap between offending and victimisation (the victim-offender overlap) remains unclear.

METHOD

This study utilised a data linkage methodology of 2600 people with an intellectual disability, exploring their contacts with public mental health services and the police in Victoria, Australia.

RESULTS

Victim-offenders accounted for a small proportion of the sample (n = 148, 5.7%). The victim-offender overlap was evident for both violent and nonviolent nonsexual crimes, particularly for theft, burglary, and threat-related crimes. Key differences were also noted between males and females.

CONCLUSIONS

People with an intellectual disability who are both victim and offenders comprise a small but particularly complex justice-involved population. Future research should explore the victim offender overlap for males and females separately, as well as any additional risks and vulnerabilities associated with specific mental health diagnoses.

A descriptive analysis of sentencing decisions by the Canadian criminal justice system of people with intellectual disabilities convicted with sexual offences

This study reviews sentencing decisions of people diagnosed with intellectual disabilities who have been convicted of sexual offences by judges in Canada. Given the prevalence of people with intellectual disabilities managed within the criminal justice system (CJS), courts have increasingly been faced with issues concerning appropriate sentencing. In addition, many people with intellectual disabilities have complex social and medical backgrounds that require multidisciplinary perspectives to account for each person's legal and moral culpability, which in turn influences sentencing decisions, including placement in prisons versus rehabilitation programs. The legal databases Canlii and LexisNexis Quicklaw were used to search full text judgements from Canadian courts for adults (over the age of 18) diagnosed with an intellectual disability and charged with a sexual offence. In total, 61 cases were included within the full-text review. These cases were analyzed based on the accused's demographics, past social history, past medical history, current diagnoses, past criminal record, current charges, mitigating/aggravating factors, use of a Gladue report, sentence, and other pertinent information that contributed to the final judgement. Recommendations on how to increase the effectiveness of the CJS in trying and sentencing people with intellectual disabilities are made based on the findings of this study.

Structural competency in the post-prison period for people who inject drugs: A qualitative case study

INTRODUCTION

Access to services is key to successful community (re-)integration following release from prison. But many people experience disengagement from services, including people who inject drugs (PWID). We use a case study approach and the notion of structural competency to examine influences on access to services among a group of PWID recently released from prison.

METHODS

This qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia).

INCLUSION CRITERIA

aged 18+; lifetime history of injecting drug use; incarcerated for > three months and released from custody < 12 months previously. From 48 participants, five case studies were selected as emblematic of the complex and intersecting factors occurring at the time participants missed an appointment at a service.

RESULTS

Numerous, concurrent, and interdependent structural influences in participants' lives coincided with their difficulty accessing and maintaining contact with services and resulted in missed appointments. The key factors involved in the cases presented here include policies around opioid agonist treatment, inadequate, unsuitable and unsafe housing, the management of mental health and side effects of treatment, the lack of social support or estrangement from family, and economic hardship. The support available from service workers to navigate these structural issues was inconsistent. One dissenting case is examined in which missing appointments is anticipated and accommodated.

CONCLUSIONS

A case study approach enabled a holistic and in-depth examination of upstream structural elements that intersect with limited social and economic resources to exacerbate the challenges of community re-entry. These results highlight structural issues that have a disproportionate impact on the choices and opportunities for PWID. The incorporation of a structural competency framework in design of services and in staff training could support person-centred and coordinated service provision that take into account PWID's experiences post-release to overcome structural barriers to service engagement.

Subspecialty training pathways in intellectual and developmental disability psychiatry in Australia and New Zealand: current status and future opportunities

OBJECTIVES

This study aimed to examine the training experiences of and determine capacity to train future Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health.

METHODS

Australian and New Zealand psychiatrists with expertise or interest in intellectual and developmental disability mental health completed an online survey detailing their training pathway, support for subspecialty training and capacity to provide rotations in this area.

RESULTS

Psychiatrists (n=71) indicated the most common reasons they started practicing in intellectual and developmental disability mental health, and these included seeing people with intellectual or developmental disability in a service in which they worked, or personal experience with intellectual or developmental disability. Compared to those trained overseas, psychiatrists trained in Australia or New Zealand had lower ratings of the sufficiency of education received in intellectual and developmental disability mental health. Of the total respondents, 80% supported the development of subspecialty training. Augmentation of intellectual and developmental disability mental health content in the intermediate stage of training was also strongly supported. Participants identified 80 potential six-month training rotations in this area.

CONCLUSIONS

Psychiatrists working in intellectual and developmental disability mental health strongly support enhancements to intellectual or developmental disability training, including the development of subspecialty training, and can identify potential training capacity if such subspecialty training was developed.

Health and wellbeing of people with intellectual disability in New South Wales, Australia: a data linkage cohort

PURPOSE

People with intellectual disability (ID) experience high rates of physical and mental health problems, while access to appropriate healthcare is often poor. This cohort was established to develop an epidemiological profile related to the health, health service use, disability services, mortality and corrective services records of people with ID.

PARTICIPANTS

The cohort contains 92 542 people with ID (40% females) with a median age of 23 years (IQR: 12-43 years) and 2 004 475 people with a neuropsychiatric or developmental disorder diagnosis (50% females) with a median age of 51 years (IQR: 29-73 years) from New South Wales, Australia. The whole sample contains records for 2 097 017 individuals with most data sets spanning financial years 1 July 2001 to 30 June 2016. A wide range of data from linked population data sets are included in the areas of disability, health, corrective services and targeted specialist support services in public schools, Public Guardian and Ombudsman services.

FINDINGS TO DATE

This study includes one of the largest cohorts of people with ID internationally. Our data have shown that the presence of ID is significantly associated with emergency department presentations and psychiatric readmissions after the first psychiatric admission based on a subcohort of people with a psychiatric admission. Adults with ID experience premature mortality and over-representation of potentially avoidable deaths compared with the general population.

FUTURE PLANS

Within the health service system, we will examine different components, that is, inpatient, emergency adult services, children and younger people services and costs associated with healthcare as well as mortality, cause and predictors of death. The neuropsychiatric and developmental disorders comparison cohort allows comparisons of the physical health, mental health and service use profiles of people with ID and those with other neuropsychiatric disorders.

A qualitative analysis of the experience of staff employed within the forensic disability sector in Victoria, Australia

BACKGROUND

This paper explores the experience of staff employed within forensic disability across Victoria in an attempt to better understand service needs in this field. The complex needs of individuals with disabilities involved in the criminal justice system or presenting with offence-related behaviours suggest that there is a requirement to improve services directed towards forensic disability.

METHODS

Four semi-structured group interviews, determined by geographical location, were completed with employees (n = 14) within the Australian Community Support Organisation, with an average of 5 years of forensic disability experience. Data were analysed based on thematic analysis.

RESULTS

Five themes were revealed. Three pre-existing themes were emphasized that included client complexity; poor responses from external services; and funding, and two novel themes labelled as staff well-being and responses to risk.

CONCLUSIONS

Recommendations include multiagency collaboration, funding forensic disability services, development of best practice initiatives and advocacy.

Measuring Social Capital in the Prison Setting: Lessons Learned From the Inmate Social Capital Questionnaire

Social capital has been associated with improved health outcomes. Measures of social capital have been developed specifically for different population groups, cultures, and contexts; however, there is no readily available measure for use among inmates in the prison setting. This study sought to translate a community concept into the prison setting through the development and piloting of the Inmate Social Capital Questionnaire (ISCQ). Thirty male inmates (living with hepatitis C) participated in the pilot phase of the ISCQ ( n = 23 sentenced and n = 7 held on remand). Dimensions of social capital were influenced by length of incarceration (time already served as well as time to release), connections with family, and duration at current prison.

Severity of cognitive disability and mental health court determinations about fitness to stand trial

BACKGROUND

Little is known about the socio-demographic, clinical and legal determinants of mental health court decisions of unsoundness of mind and unfitness to stand trial for people with cognitive disability. We aimed to estimate the association between severity of cognitive disability and mental health court determinations of unsoundness or unfitness and describe the socio-demographic, clinical and legal factors that predict these determinations.

METHODS

Case file data were extracted on 92 individuals who had a criminal case referred to the Queensland Mental Health Court between 1 January 2013 and 31 December 2014 due to cognitive disability. We fit a modified multivariable Poisson regression model to estimate the association between severity of cognitive impairment and mental health court determination, controlling for socio-demographic, clinical and legal factors.

RESULTS

Adjusting for covariate effects, severity of cognitive impairment was positively associated with being found unfit to stand trial (adjusted prevalence risk ratio = 1.57; 95% confidence interval: 1.07, 2.33; P = 0.023), and comorbid psychotic disorder predicted an increased risk of being found unsound of mind at the time of offence (adjusted prevalence risk ratio = 3.63; 95% confidence interval: 1.38, 9.54; P = 0.009) by the Queensland Mental Health Court.

CONCLUSIONS

Severity of cognitive disability is associated with determinations of unfitness but does not predict determinations of unsoundness in the Queensland Mental Health Court. Psychiatric assessments of cognitive impairment play a pivotal role in mental health court determinations for people with cognitive disability.

'I am not drunk, I have an ABI': findings from a qualitative study into systematic challenges in responding to people with acquired brain injuries in the justice system

The over-representation of acquired brain injury (ABI) amongst prisoner and juvenile justice populations is a significant issue across jurisdictions. This article reports on the findings of over 100 interviews conducted in Victoria, Australia with people who have an ABI, as well as key stakeholder groups who work in, or with, the justice system. The study identified systemic problems faced by people with ABI along multiple points of the justice system continuum. Improved identification and diagnosis of ABI, well-resourced support for those with the condition, comprehensive training to improve ABI literacy among all stakeholder groups, and a more appropriate and therapeutic approach to people with ABI in the justice system are all recommended.

Intellectual disability and patient activation after release from prison: a prospective cohort study

BACKGROUND

Intellectual disability and patient activation may be important drivers of inequities in health service access and health outcomes for people with intellectual disability transitioning from prison to the community. We assessed the association between intellectual disability and patient activation after prison release and examined whether this association varied, depending on whether intellectual disability was identified prior to prison release.

METHODS

Overall, 936 prisoners were screened for intellectual disability by using the Hayes Ability Screening Index and completed the Patient Activation Measure (PAM) within 6 weeks of prison release and again at 1, 3 and 6 months post-release. We estimated the association between intellectual disability status and PAM scores by using a multilevel linear model, adjusting for sociodemographic, behavioural, health and criminogenic factors. We used propensity score matching to estimate the impact of being identified with intellectual disability prior to release from prison on the change in mean PAM score after prison release.

RESULTS

Compared with those who screened negative for intellectual disability, ex-prisoners who screened positive, both with and without prior identification of intellectual disability, had significantly decreased mean PAM scores [(B = -4.3; 95% CI: -6.3, -2.4) and (B = -4.5; 95% CI: -6.8, -2.3), respectively] over 6 months of follow-up. Among those who reported being identified with intellectual disability prior to release from prison, a significant increase in PAM score at the 6-month follow-up interview (B = 5.89; 95% CI: 2.35, 9.42; P = 0.001) was attributable to being identified with intellectual disability prior to release.

CONCLUSIONS

Ex-prisoners screening positive for possible intellectual disability have decreased patient activation for at least 6 months after release from prison. However, individuals whose possible intellectual disability is unidentified appear to be particularly vulnerable. Incarceration is a pivotal opportunity for the identification of intellectual disability and for initiating transitional linkages to health and intellectual disability-specific community services for this marginalised population.

Estimating the risk of crime and victimisation in people with intellectual disability: a data-linkage study

PURPOSE

People with intellectual disability (PWID) appear more likely to be victims and perpetrators of crime. However, extant evidence pertaining to these risks is limited by methodological weaknesses and the absence of consistent operational definitions. This research aimed to estimate the prevalence of criminal histories and victimisation using a large, well-defined sample of PWID.

METHODS

A case-linkage study was conducted comprising 2220 PWID registered with disability services in Victoria, Australia, whose personal details were linked with a state-wide police database. Criminal charges and reports of victimisation were compared to a non-disabled community comparison sample (n = 2085).

RESULTS

PWID were at increased risk of having a history of criminal charges, particularly for violent and sexual offences. Although the non-disabled comparison group had a greater risk of criminal victimisation overall, PWID had a greatly increased risk of sexual and violent crime victimisation.

CONCLUSIONS

PWID are at increased risk of victimisation and perpetration of violent and sexual crimes. Risk of sex offending and victimisation is particularly elevated, and signalling the need for specialised interventions to prevent offending and to ensure victims is assisted with access to justice, support, and treatment.

Cohort profile: a data linkage cohort to examine health service profiles of people with intellectual disability in New South Wales, Australia

PURPOSE

People with intellectual disability are a minority group who experience poorer physical and mental health than the general population and have difficulty accessing healthcare services. There is lack of knowledge about healthcare service needs and gaps experienced by people with intellectual disability. This study aims to interrogate a large linked administrative data set containing hospital admissions, presentations to emergency departments (ED) and mortality data to provide evidence to inform the development of improved health and mental health services for this population.

PARTICIPANTS

A retrospective cohort of people with intellectual disability (n=51 452) from New South Wales (NSW), Australia, to explore health and mental health profiles, mortality, pattern of health service use and associated costs between 2005 and 2013. The cohort is drawn from: the Disability Services Minimum Data Set; Admitted Patients Data Collection; Emergency Department Data Collection, Australian Bureau of Statistics Death Registry and Registry of Births, Deaths and Marriages. Mental health service usage among those with intellectual disability will be compared to a cohort of people who used mental health services (n=1 073 139) and service usage other than for mental health will be compared with published data from the general population.

FINDINGS TO DATE

The median age of the cohort was 24 at the time of the last hospital admission and 21 at the last ED presentation. The cohort has a higher proportion of men than women and accounts for 0.6% of the NSW population in 2011. Over 70% had up to 5 ED presentations and hospitalisations between 2005 and 2012. A high proportion of people with intellectual disability live in the most disadvantaged neighbourhoods.

FUTURE PLANS

Results will be used to inform the development of more responsive healthcare, including improved interactions between health, social and disability supports. More generally, the results will assist the development of more inclusive policy frameworks for people with intellectual disability.

Aboriginal prisoners and cognitive impairment: the impact of dual disadvantage on Social and Emotional Wellbeing

BACKGROUND

Negligible information is available regarding the Social and Emotional Wellbeing (SEWB) needs of Aboriginal Australian individuals in custody with cognitive impairment. This is problematic given that Aboriginal people with cognitive impairment often experience dual disadvantage in the context of the justice system. This study sought to ascertain the relationship between cognitive impairment and mental health/cultural needs (SEWB) Aboriginal and Torres Strait Islander people in custody.

METHOD

A sample of 122 Aboriginal and Torres Strait Islander people were administered a culturally themed semi-structured questionnaire in custodial settings in Victoria, Australia. The questionnaire included measures of cognitive impairment, SEWB and forensic needs. Analyses were performed to determine differences in the presence of SEWB and unmet custodial needs by level of cognitive impairment.

RESULTS

Findings revealed a diminished level of wellbeing for cognitively impaired participants across several factors. Cognitive impairment was associated with poorer coping mechanisms, additional experiences of racism, difficulties handling emotions, discomfort around non-Aboriginal people and reduced access to meaningful activities in custody. All participants regardless of their level of impairment recognised the importance of cultural engagement; however, cognitively impaired participants had greater difficulty accessing/practicing cultural activities.

CONCLUSIONS

Culturally responsive disability assistance should be available at all phases of the justice system for Indigenous people with cognitive impairment to ensure that equitable care is accessible and needs are addressed.

Aboriginal and non-aboriginal Australian former prisoners' patterns of morbidity and risk of hospitalisation

Background

People who have been in custody are more likely to experience multiple, long standing health issues. They are at high risk of illness and injury post release and experience poor access to health services both of which contribute to high rates of recidivism. The study was conducted to examine Aboriginal and non-Aboriginal former prisoners’ risk of hospitalisation and rehospitalisation in the five years post release from custody and identified the common reasons for hospitalisations.

Methods

Common reasons for hospital admission were identified by conducting descriptive analysis of linked data, related to former prisoners, from NSW Ministry of Health and Corrective Services NSW. This relied upon admitted patient data for 1899 patients. Of this cohort, 1075 people had been admitted to hospital at least once and remained out of custody over a five year period. The independent variables we studied included age, sex, and whether or not the person was Aboriginal. We conducted univariate and multivariate analysis on the following dependent variables: number of admissions over five years after release; more than one admission; days between custody and first hospitalisation; and days between first and second hospitalisation.

Results

Mental and behavioural disorders, injuries and poisoning, and infectious or parasitic diseases were the three most common reasons for admission. Aboriginal and non-Aboriginal former prisoners had a broadly similar pattern of reasons for admission. Yet Aboriginal former prisoners were more likely than non-Aboriginal former prisoners to have a shorter mean interval between hospital admission and readmission (187 days compared to 259 days, t = 2.90, p-0.004).

Conclusions

Despite poorer health among Aboriginal people, there were broadly similar patterns of reasons for admission to hospital among Aboriginal and non-Aboriginal former prisoners. There may be a number of explanations for this. The cohort was not a representative sample of the NSW prison population. There was an overrepresentation of individuals with cognitive disability (intellectual disability, acquired brain injury, dementia, fetal alcohol spectrum disorder) in the study population, which may have impacted on this group accessing hospital health care. Alternatively perhaps there were fewer presentations to hospital by Aboriginal former prisoners despite a greater need.

The shorter interval between hospital admission and readmission for Aboriginal former prisoners may suggest the need for better follow up care in the community after discharge from hospital. This presents an opportunity for primary health care services to work more closely with hospitals to identify and manage Aboriginal former prisoners discharged from hospital so as to prevent readmission.

Intellectual Disabilities Among Prisoners: Prevalence and Mental and Physical Health Comorbidities

BACKGROUND

Limited evidence suggests that people with ID (ID) are overrepresented in prisons although prevalence rates of ID among prisoners vary significantly across studies, making it difficult to identify prevalence and assess existing need.

METHOD

A systematic review of relevant literature was conducted, and results were organized and compared in relation to study aims, design, measures used to screen for ID, sample, limitations and key findings.

RESULTS

Existing international data suggest a prevalence of prisoners with ID between 7 and 10%. Most frequent coexisting health issues among this population are hearing and vision impairments, obesity, diabetes and a range of mental health disorders, notably anxiety and personality and conduct disorders.

CONCLUSION

More research is required on prevalence rates and associated comorbidities of ID within prison settings, taking into account the heterogeneity of the population with ID.

Inter-rater reliability of the Hayes Ability Screening Index in a sample of Australian prisoners

BACKGROUND

Reliable ascertainment of intellectual disability (ID) is important to identify those with special needs, in order for those needs to be met in the criminal justice system. Although the Hayes Ability Screening Index (HASI) is valid and widely used for the identification of possible ID, the risk of inter-rater bias between researchers when scoring the HASI has not yet been established. The current paper estimates the inter-rater reliability of the HASI in a sample of Indigenous and non-Indigenous prisoners in Western Australia.

METHODS

We estimated intra-class correlation coefficients (ICC) for the consistency of agreement among three blinded raters using a two-way random-effects model assessing the inter-rater agreement of the HASI. Kappa was also estimated for the dichotomous HASI screening threshold outcome between the raters.

RESULTS

The HASI exhibited very good within-subject consistency of agreement for Section B (ICC = 0.95; 95%CI:0.94-0.96), Section C (ICC = 0.97; 95%CI: 0.96-0.98) and Section D (ICC = 0.90; 95%CI: 0.87-0.92) subscales and for the total scaled score (ICC = 0.97; 95%CI: 0.96-0.98). The inter-rater reliability of the dichotomous adult ID screening threshold (<85) was also very good (Kappa = 0.95).

CONCLUSIONS

The current study provides new evidence that the HASI has a low risk of bias from between-rater scoring and can be reliably scored by both non-clinicians and clinicians with little training, when administered in prison settings. Pre-scoring training should focus on the more subjective 'clock-drawing' section, in order to maximise inter-rater reliability.

The role of primary health care services to better meet the needs of Aboriginal Australians transitioning from prison to the community

Background

Aboriginal Australians are more likely than other Australians to cycle in and out of prison on remand or by serving multiple short sentences—a form of serial incarceration and institutionalisation. This cycle contributes to the over-representation of Aboriginal Australians in prison and higher rates of recidivism. Our research examined how primary health care can better meet the health care and social support needs of Aboriginal Australians transitioning from prison to the community.

Methods

Purposive sampling was used to identify 30 interviewees. Twelve interviews were with Aboriginal people who had been in prison; ten were with family members and eight with community service providers who worked with former inmates. Thematic analysis was conducted on the interviewees’ description of their experience of services provided to prisoners both during incarceration and on transition to the community.

Results

Interviewees believed that effective access to primary health care on release and during transition was positively influenced by providing appropriate healthcare to inmates in custody and by properly planning for their release. Further, interviewees felt that poor communication between health care providers in custody and in the community prior to an inmate’s release, contributed to a lack of comprehensive management of chronic conditions. System level barriers to timely communication between in-custody and community providers included inmates being placed on remand which contributed to uncertainty regarding release dates and therefore difficulties planning for release, cycling in and out of prison on short sentences and being released to freedom without access to support services.

Conclusions

For Aboriginal former inmates and family members, release from prison was a period of significant emotional stress and commonly involved managing complex needs. To support their transition into the community, Aboriginal former inmates would benefit from immediate access to culturally- responsive community -primary health care services. At present, however, pre-release planning is not always available, especially for Aboriginal inmates who are more likely to be on remand or in custody for less than six months.

Comparison of social circumstances, substance use and substance-related harm in soon-to-be-released prisoners with and without intellectual disability

BACKGROUND

The transition out of prison is likely to be a challenging time for prisoners with intellectual disability (ID). However, little evidence exists to inform interventions for people with ID making this transition. In this study we aimed to describe social circumstances, patterns of substance use and substance-related harm in soon-to-be-released prisoners with ID. We compare this group with those without ID, to better understand how the health-related needs of this group compare with the 'mainstream' prison population.

METHODS

Data came from face-to-face, confidential interviews with 1325 adult prisoners in seven adult prisons in Queensland, Australia. Prisoners with ID were identified using the Hayes Ability Screening Index (HASI). We used cross-sectional data to examine (i) demographics and criminographics; (ii) social circumstances; and (iii) substance use and substance use related harm. We compared characteristics of those with and without ID using univariable logistic regression.

RESULTS

Prisoners with ID (n = 115) were more likely than their peers without ID to be male, to identify as Indigenous Australian, and to report low educational attainment (<10 years) and pre-incarceration unemployment. Those with ID reported a high prevalence of poly-drug use (28.0%), unsafe tattooing (51.1%), unsafe sex (91.0%) and HCV infection (55.6%), although differences with their peers were non-significant.

CONCLUSIONS

The health and social needs of prisoners with ID transitioning into the community are a significant concern for researchers, policy makers and practitioners. Our findings highlight the need for proactive, appropriate and targeted service responses from disability, health and justice sectors.