Michelle Denton Manager: Forensic MHS Southern and Central Qld PhD Candidate Uni of Qld Andrew...
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Transcript of Michelle Denton Manager: Forensic MHS Southern and Central Qld PhD Candidate Uni of Qld Andrew...
Michelle DentonManager: Forensic MHSSouthern and Central QldPhD Candidate Uni of Qld
Andrew HockeyProject 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, • 40 -60% 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
povertyunemploymentsubstance usehomelessness
stigma
incarcerationrelapse/
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 SERVICEState-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 2007-08
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 1-7-07 and 31-6-08• 80% 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 = 32.26 years
28.5
29
29.5
30
30.5
31
31.5
32
32.5
33
33.5
34
Indigenous Non IndigenousAvera
ge A
ge (
Years
)
Female
Male
Primary Diagnosis
0
10
20
30
40
50
60
70A
ntis
ocia
l Per
sona
lity
Dis
orde
r
Bip
olar
Affe
ctiv
e D
isor
der
Bor
derli
ne P
erso
nalit
y D
isor
der
Dep
ress
ive
Epi
sode
Dru
g In
duce
d P
sych
osis
Dys
thym
ia
Pol
y S
ubst
ance
Abu
se
Pos
t Tra
umat
ic S
tres
s D
isor
der
Sch
izoa
ffect
ive
Dis
orde
r
Sch
izop
hren
ia
Male
Female
Additional Diagnoses
0
10
20
30
40
50
60
Acquired Brain Injury
Adjustment Disorder
Intellectual Impairment
Nil. Personality Disorder
Affective Disorder
Drug and Alcohol
Psychosis Anxiety Disorder
Male
Female
Dual Diagnoses (SUD)
0
10
20
30
40
50
60
70
Alc
ohol
Dep
ende
nce
Am
phet
amin
e A
buse
and
D
epen
denc
e
Ben
zodi
azep
ine
Dep
ende
nce
Nil.
Opi
ate
Dep
ende
nce
Pol
y S
ubst
ance
Abu
se
Sol
vent
Abu
se
Male
Female
Previous Psychiatric Admissions
0
10
20
30
40
50
60
No Unknown Yes
FemaleMale
Previous Community MH Treatment
0
5
10
15
20
25
30
35
40
45
50
No Unknown Yes
FemaleMale
Self-Harm History
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
History of Self-harm
History ofSuicide
Attempts
No History
Perc
en
tag
e
Female
Male
Social Support
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Limited Social Support Socially Supported
Per
cent
age Female
Male
Planned Housing Pre-release
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Per
cen
tag
e
Female
Male
Planned Employment Pre-release
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
DSP PSPProgram
NSAllowance
Employed Retired Unknown
Per
cen
tag
e
Female
Male
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 <40Schizophrenia + SUD / poly-substancePrevious Psychiatric Admissions Previous Community MH services Self harm + suicide attempts Limited social supportsHousing issues Low employmentMultiple incarcerations
Continuity of Care
• Attended face to face appointment @ local CMHS within 2 weeks post release ?– 73% of males – 61.5% of females
• Who attended 1st appointment?• Who continued attending?
1st appointment attendance
0
20
40
60
80
100
AffectiveDisorder
AnxietyDisorder
PersonalityDisorder
Psychosis SubstanceUse Disorder
Did Not Attend
Attended%
1st appointment attendance X incarceration history
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 >5
Prior Incarcerations
Did notattendAttended
%
Ongoing appointments X prior incarcerations
0
2
4
6
8
10
12
LOW (1-2) AVERAGE (3-6) HI (>6)
Prior Incarcerations
Ave
rag
e n
um
ber
of
con
sult
atio
ns
Female
Male
Ongoing appointments X diagnosisAverage number of consultations
0
2
4
6
8
10
12
14
Affective
Dis
ord
er
Anxie
ty
Dis
ord
er
Pers
onalit
y
Dis
ord
er
Psychosis
Substa
nce U
se
Dis
ord
er
Avera
ge n
um
ber
of
co
nsu
ltati
on
s
Female
Male
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 deliveryHealth and wellbeing focusPre & post release engagementContinuity of staff across continuumFacilitate access to services? Partnership with communityCross agency collaboration
Just the beginning. More work to be done!