Complex needs

Presenter : Eileen Baldry Research Team: Eileen Baldry, Leanne Dowse, Melissa

Clarence, Phillip Snoyman, Devon Indig, Ruth McCausland, Han Xu, Peta MacGillivray, Julian Trofimovs

IC Syd Complex needs 11.12.12

Presentation Outline

•  ‘Complex needs’ • MHDCD project findings

• Discussion • Conclusions

2

Why the development of ‘complex needs’?

•  Moving beyond limited categorizations to recognise reality of lived experience

•  Terms dual diagnosis & co-morbidity assume an individual is: •  defined by the presence of a primary medical

diagnosis, •  only two disorders or impairments exist

simultaneously •  these attributes are in some way static within

each individual and do not interact

Complex needs

•  People who have complex needs require high levels of health, welfare and other community based services including individuals who experience various combinations of mental illness, intellectual disability, acquired brain injury, physical disability, behavioural difficulties, homelessness, social isolation, family dysfunction, and have problematic drug and/or alcohol use (Hamilton 2010).

•  Will return to the problems with this definition.

Negative synergistic interactions in the CJS

The cumulative long-term effect of moving among these different [CJS] sites is rarely explored … combined personal, social and economic costs of this re-cycling process tend not to appear in the formal calculations of cost effectiveness… [through] tracing the movement of these offenders through these regulatory agencies … less likely to see custodial and community-based sanctions as two divergent courses… better able to appreciate the collaborative and mutually reinforcing nature of these sanctions… (2003: 229)

Matthews, R. (2003) ‘ Rethinking Penal Policy: Towards a Systems Approach’ in Matthews, R. and Young, J. (eds) The New Politics of Crime and Punishment, Willan, Cullompton,

The study

!  ARC Linkage study 2007-2010 !  CIs: Eileen Baldry, Leanne Dowse, Ian Webster

!  PIs: Tony Butler, Simon Eyland, Jim Simpson

•  Partner Organisations: Corrective Services NSW, Justice Health, NSW Police, Housing NSW, NSW Council for Intellectual Disability, Juvenile Justice NSW

!  Continuing with ARC Linkage Indigenous Australians with mental health disorders and cognitive disability in the CJS

6

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Justice Health

Child Services

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Disability

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Juvenile Justice

Cognitive Disability

•  ID = >70IQ

•  BID = <70- >80 IQ

•  ABI = persons with brain injury that significantly affects their cognitive and social capabilities

!  1464 people in the CD cohort (All CD) !  Approx 2/3rd in the CD group experience

compounding / complex needs

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Pathways

12

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Higher proportion of those in the MHDCD cohort both males (44%v 39%) and females (35%v29%) had ever been expelled from school. Much larger % reported being suspended.

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Disability service

16

" Of those in the ID range (680) 26% ADHC clients

" Of those BID range (783) 5% ADHC clients.

" Very low rate (15%) of CD in cohort with ADHC services " Only 10/709 JJ CD group were ADHC clients " 79% of ADHC clients imprisoned prior to becoming a client

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ADHC BID ID

Housing Assistance " Significant numbers of the complex

groups experienced homelessness and unstable housing as young people and as adults

" Significant numbers had parent(s) in public housing

" Significant numbers accommodated in refuges and other crisis accommodation.

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•  All CD complex significantly higher police contacts before JJ client

•  Younger at first police contact and younger at first custody than no diagnosis group.

JJ Custodial episodes & LOS

21

CD complex significantly more JJ custodial episodes than MH & no diagnosis. All groups significantly shorter av days (largely remand) than no diagnosis groups

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Pathways Individuals who experience these multiple and compounding

difficulties have significantly: !  higher rate and earlier contact with police !  worse education experience & levels !  lower level disability services than community counterparts !  higher housing support but also higher failed tenancies !  Very high LA provision !  low rates of Sec 32 !  higher rate of JJ contact !  higher offences, convictions, imprisonments (particularly

remand) from an earlier age than single (although these are also generally worse than non diagnosis) and non-diagnosis groups

!  shorter and more frequent prison episodes !  higher continuing lifelong CJS episodes

23

Indigenous Australians

•  Over-represented in all categories

•  Aboriginal women experienced highest levels of compounding factors and disability

Pathways: iterative, looping, cycling, compounding

Poverty/disadvantage

Poor School Education

Lack Disability services

Mental Health Legal Aid

Police

Housing/homelessness

Courts Prison

Post-release

Breaching

Reincarceration

25

Complex Needs

•  disability experiences and negative factors that are not addressed and over time compound to form ‘a complex’ or a web that grows more complicated and multifaceted;

•  multiple interlocking and compounding experiences and factors that span health and social matters (Rankin & Regan 2004:i).

Individualisation

•  The compounding disabilities and disadvantages are attributed primarily to the individual

•  Problems individualized (she or he is responsible for the complexity); social & structural factors that created and maintained the need or dysfunction written out of the story

•  From at risk to being a risk

So …

•  Not simply compiling a checklist of needs. •  Three dimensional web of factors, elements

and circumstances that interact simultaneously and across time. The interactions have a compounding effect (like interest on money in a bank account) in that the effect is not just the sum of the individual parts but each aspect adds to and increases the potency of each of the other effects.

Creation of complex needs

•  Lack of appropriate support and services, the use of control agencies (eg police as ‘care managers’), application of ‘risk’ management for individuals experiencing multiple disadvantages together with mental and/ or cognitive impairment, compounds these multiple difficult life issues creating complex needs