Trajectories in to the criminal justice system for young people with complex needs: Experiences in early life and out of home care

Presenter : Leanne Dowse

Research Team: Eileen Baldry, Leanne Dowse, Jung-Sook Lee, Terry Cumming, Iva Strnadová, Han Xu, Julian Trofimovs

Association of Child Welfare Agencies Conference 2014, SMC, Sydney, 18-20 August

Presentation Outline

• Context of the problem

• Background to the MHDCD in the CJS project

• Selected key findings: pathways & case studies

• Discussion/Conclusions: understanding and addressing complex needs in people with disabilities in the CJS

Context of the problem

• Concern with the social exclusion and criminalisation of a group of young people with disabilities.

• As young people (and later as adults) this group figure significantly in policing, justice and prisons, both as victims and offenders.

• Needs are complex, trajectory into the CJS begins early in life. • Responsive welfare provision and early intervention can be effective in

addressing social exclusion and reducing vulnerability for young people at risk of entering the criminal justice system.

• BUT specific experience for young people who have complex needs and are at risk of CJS involvement is poorly understood

• In Australia and comparable jurisdictions current systemic and welfare responses appear to have only limited impact on preventing early contact from escalating into a cycle of incarceration and re-incarceration.

• Need for multi-systemic pathway understanding & advocacy

People with Mental Health Disorders and Cognitive Disability (MHDCD) in the Criminal Justice System study• ARC Linkage Project 2007-2010 UNSW

• 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

• ARC Linkage Project 2011-2014 Indigenous Australians with mental health disorders and cognitive disability in the CJS• CIs: Eileen Baldry, Leanne Dowse, Julian Trollor, Patrick Dodson• Partner Organisations: Justice Health, Legal Aid, NSW Housing, ADHC

• Range of other ‘nested’ studies eg. Lifecourse costing; Use of S32; Acquired Brain Injury; Youny People with Disability in the CJS; Victimisation experiences

http://www.mhdcd.unsw.edu.au/

Study approachMethod: Innovative data linkage and merging• Cohort: 2001 Inmate Health Survey & CSNSW Statewide Disability

Service database – purposive sample not representative• Data on each individual drawn from:

• The Centre for Health Research in CJS Health NSW• NSW Department of Corrective Services – adult custody• BOCSAR – reoffending database - courts• NSW Police – events, charges and custody• Juvenile Justice – clients and custody• Housing NSW – application and tenancy• ADHC – disability service• Legal Aid NSW – advice, application• NSW Health (mortality, pharmacotheraphy, hospital admissions)• Community Services – out of home care

SQL server, relational dataset

CohortID

2,731

DCS

Police

Court

Housing

Justice Health

Child Service

s

Health

Disability

Legal Aid

Juvenile Justice

MHDCD Study Cohort by Diagnoses

BID_MH_AOD

ID_MH_AOD

BID_AOD BID_MH ID_AOD ID_MH MH_AOD AOD BID ID MH No MHDCD

Diagnosis

Total 351 308 214 121 163 105 612 337 97 104 145 174

50

150

250

350

450

550

650

Diagnostic profile of the MHDCD Cohort

Full Cohort N=2,731 Intellectual Disability (IQ <70) N=680 Borderline Intellectual Disability (IQ 70-80) N=783 Mental health disorder N=1642 Substance abuse disorder N= 1985 No diagnosis N= 174 Acquired brain injury identified for 19% N=511 Women = 11% Indigenous Australians = 25% ~40% had been Juvenile Justice clients 69% of the cohort have complex/multiple diagnoses (groups

not mutually exclusive)

Mental Health & Cognitive Impairment in JJ

• Juvenile detainees: 87% at least 1 psychological disorder.

• JJNSW most recent health survey:– ID (20%) Aboriginal young people IQ below 70,

7% ID non-Aboriginal young people (both sig above the norm).

– 1/3rd (32%) borderline ID (IQ 70 to 79), with Aboriginal 39% vs non Aboriginal 26% (again sig above norm)

(Indig et al 2010 Young People in Custody Health Survey)

Defining complex needs• Associated with vulnerability and social marginalisation. • Multiple interlocking experiences and factors that span health and

social issues (Rankin & Regan 2004).• Includes: (a) mental health disorder;

(b) cognitive disability including intellectual and developmental disability and acquired brain injury; (c) physical disability; (d) behavioural difficulties; (e) precarious housing;(f) social isolation; (g) family dysfunction; (h) problematic drug and/or alcohol use (i) risk of harm in early life (k) early educational disengagement (Archer, 2009; AIHW, 2012; Baldry, Dowse, & Clarence, 2012; Carney, 2006; Draine & Salzer, 2002; Hamilton, 2010; Keene, 2001 MacDonald, 2012).

Key selected findings: the experience of young people with mental health and

cognitive disability in the CJS

Education

Those with complex support needs and cognitive disability had significantly lower educational attainment

BID_M

H_AOD

ID_M

H_AOD

BID_A

OD

BID_M

H

ID_A

OD

ID_M

H

MH_AOD

AODBID ID MH ND

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

College certificate/Diploma Completed Sec School Degree/tertiary qualification

HSC/VCE/Leaving Certificate Left school with no qualification Missing

Never Attended School Primary school only School certificate

Technical or Trade qualification

School Expulsion: MHDCD cohort compared with Inmate Health Survey Sample

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.

men women men womenTotal sample Cohort sample

0

10

20

30

40

50

60

70

80

90

100

Ever been expelled from a school

NoYes

%

Experiences in education• Diagnosed groups in the MHDCD cohort have even lower levels

of education than general prisoner population. • Those with some form of Cognitive Disability have the worst

levels of education.• Complex groups: over 80% have no formal qualification with

majority leaving school without completing Yr10• Comparison between MHDCD cohort and non-MHDCD prisoner

(HIS) cohort shows that those in the MHDCD cohort had higher proportions • leaving school without a qualification• being expelled and suspended from school• attending special school (12% V 8%)

Out Of Home Care: MHDCD cohort by diagnostic category

AOD BID BID_AOD BID_MH BID_MH_AOD

ID ID_AOD ID_MH ID_MH_AOD

MH MH_AOD ND

Total 27 11 35 9 71 7 28 19 72 3 37 3

5

15

25

35

45

55

65

75

Family Context • 23% of the MHDCD cohort had been in OOHC compared with

19% non-MHDCD cohort• Of those who had been in OOHC 60% have complex diagnoses,

with 80% of this group having a cognitive impairment.• No difference in raised by family between ages 0-10 but from

11-16 significant difference where MHDCD group (45%) more likely to move into OOHC than non-MHDCD (40%).

• Intergenerational disadvantage greater for MHDCD cohort• Larger proportion of MHDCD cohort (18%) having a parent who

had been incarcerated compared to non-MHDCD cohort (12%)• Higher proportion of MHDCD cohort (11%) having a parent who

had also been in OOHC compared with non-MHDCD cohort (9%).

OOHC placements and average days in placement across diagnostic categories

AOD BID BID_AOD

BID_MH

BID_MH_AO

D

ID ID_AOD

ID_MH ID_MH_AOD

MH MH_AOD

ND AOD BID BID_AOD

BID_MH

BID_MH_AO

D

ID ID_AOD

ID_MH ID_MH_AOD

MH MH_AOD

ND

Average distinct placements

3.3076923076923

1

2.6363636363636

4

2.46875

3.6666666666666

7

3.515625

2.1428571428571

4

2.5185185185185

2

3.3529411764705

9

4.7323943661971

8

5.6666666666666

7

2.6562499999999

9

1.6666666666666

7

Average Days in Placement

1317.2756410256

4

806.38111888111

7

679.58333333333

4

1185.5934343434

3

970.41604662698

4

700.78571428571

4

666.05114638447

7

830.69607843137

3

1232.5439749608

8

468.22222222222

2

1241.0648674242

4

2124.2222222222

2

1

2

3

4

5

6

250

750

1250

1750

2250A

vg P

lacem

ents

Avg D

ays

OOHC and JJ involvement - proportion

Higher proportion of those in the MHDCD cohort who have been in OOHC have been in custody as a Juvenile.

No OOHC OOHC

Not DJJ Client 1721 75

DJJ Client 688 247

5%

15%

25%

35%

45%

55%

65%

75%

85%

95%

OOHC and JJ involvement - frequency

Higher frequency of DJJ custody episodes for those in the MHDCD cohort who have been in OOHC.

No OOHC OOHC

Total 4.39619047619047 9.14018691588785

1

2

3

4

5

6

7

8

9

10

OOHC and Gender

Females in the MHDCD cohort who have been in OOHC are more likely than males to have been in JJ custody and in adult custody

No OOHC OOHC

Avg DJJ Custody Eps

3.90697674418605 7.2

Avg DCS Cus-tody Eps

7.20370370370371 9.27906976744186

1

2

3

4

5

6

7

8

9

10

OOHC and Indigenous Australians

Higher proportion of Indigenous Australians in the MHDCD cohort have been in OOHC as compared with non-Indigenous.

No OOHC OOHC

Non-Indigenous 1821 178

Indigenous 537 139

5%

15%

25%

35%

45%

55%

65%

75%

85%

95%

OOHC and Police Contact

Higher average number of Police contacts for those in the MHDCD cohort who have been in OOHC (90 contacts) than for those with no OOHC history (48 contacts). No OOHC OOHC

Total 49.0709838107098 89.4596273291926

5

15

25

35

45

55

65

75

85

95

OOHC and Adult Custody

Higher average number of episodes of adult custody for those in the MHDCD cohort who have been in OOHC (7.5 episodes) than for those with no OOHC history (6.7 episodes).

No OOHC OOHC

Total 6.77210460772105 7.43788819875776

1

2

3

4

5

6

7

8

Impact of out of home care

Those in the MHDCD cohort who had been in OHC had:• 84% of the OOHC group have complex needs• 90% of this group has cognitive impairment• Younger age at first police contact • Twice as many police contacts over their lives• Twice as many custodial episodes over their lives• Three times as likely to have been incarcerated as a

juvenile• Aboriginal Australians more likely to have been in OOHC

Eddie• Indigenous man now in his late 30s.• Diagnosed with ID, Borderline Personality Disorder and AOD• Poly drug use from age 6 including alcohol, cannabis, prescription drugs,

amphetamines, heroin, methadone and buprenorphine. • Victim of violence and abuse from a young age.• He was first placed in OOHC at age 9 for 2 weeks, and over the following 6

years was placed in 9 different foster homes lasting between 5 days to 2 weeks.

• First police contact at age 11 and first custodial episode at age 13. • Constantly suspended and expelled from schools and from age 13 does not

attend any school and was known to distribute drugs when at school.• From age 14, moves between foster care, a youth refuge and his aunt’s house.

All placements break down due to his aggressive behaviour and his assaults on others. He tells police that he is “having problems coping with life generally, and that he is not able to get on with anyone and everyone is against him”.

• Much of his contact with police is related to his drug use and break and enter and robbery offences, often violent.

• As a young person regularly imprisoned for breaching bail conditions which state that he can only go out accompanied by a responsible adult.

• Regular self-harm and suicide attempts from a young age and history of overdose.

• As an adult regularly scheduled under the MHA and hospitalized for suicide and self-harm.

• Multiple custody episode for theft and when not in custody often noted by police as NFPA.

Eddie: Estimated lifecourse institutional costs

Baldry, E., Dowse, L., McCausland, R. & Clarence, M. (2012) Lifecourse institutional costs of homelessness for vulnerable groups. Report for the National Homelessness Research Agenda 2009-2013

http://www.mhdcd.unsw.edu.au/sites/www.mhdcd.unsw.edu.au/files/u18/Lifecourse-Institutional-Costs-of-Homelessness-final-report.pdf

Disability Service

• Of those diagnosed ID only 23% were Ageing Disability and Home Care (ADHC) clients

• Of the BID group 4% were ADHC clients

• Very low rate (15%) of CD in cohort with ADHC services

• Only 10/709 JJ CD group ADHC clients

• 79% of ADHC clients imprisoned prior to becoming a client. ie. were diagnosed and referred for the first time whilst in prison.

ADHC BID ID0

100

200

300

400

500

600

700

800

Total

Housing Assistance

Significant numbers of the complex groups experienced homelessness and unstable housing as young people

Significant numbers had parent(s) in public housing

Significant numbers accommodated in refuges and other crisis accommodation as young people.

28

Police Contacts

MH

_ID

MH

_BID

MH

_AO

D

ID_A

OD

BID

_AO

D ID

BID MH

PD

/AO

D

ND

0

10

20

30

40

50

60

70

80

90

100

0

1

2

3

4

5

6

7

Avg

Po

lice

Co

nta

cts

Ra

te P

oli

ce

Co

nta

cts

People with Complex Cognitive Disability had significantly more police contacts over their lives, starting young, and significantly higher rates of police contacts per year

First police contact & JJ

30

MH_ID MH_BID

MH_AOD

ID_AOD

BID_AOD

ID BID MH PD/AOD

No Diag-nosis

Total0

2

4

6

8

10

12

14

16

18

0

2

4

6

8

10

12

14

16

18

Avg Age First Police Contact Avg Age First DJJ CustodyPolice Contacts Pre First DJJ Custody

Age

Police C

onta

cts

Befo

re F

irst

DJJ

Custo

dy

Av. age first Police & JJ contact & number police contacts prior to custody:All CD significantly higher police contacts before JJ client& were younger at first police contact and younger at first custody than no diagnosis group.

Age at first record in DJJ involvements

First

Alerts

First

As-sess

First

Classi-fi-

cation

First

Community

First

Custody

First

DJJ

First

Notes

First

Specialist

First

YJC

First

YJCCon

First

YLSI

First

Alerts

First

As-sess

First

Classi-fi-

cation

First

Community

First

Custody

First

DJJ

First

Notes

First

Specialist

First

YJC

First

YJCCon

First

YLSI

Minimum Age

11 9 16 10 10 8 12 11 11 8 12

Maximum Age

19 19 21 21 19 21 25 19 18 18 19

Mean of Age

15.6666666666667

15.1814814814815

17.4285714285714

15.2683896620278

15.3712121212121

14.9546142208775

16.5189873417722

15.9823008849558

15.5633802816901

13.8349514563107

16.1447368421052

2.57.5

12.517.522.527.5Many in this

MHDCD subgroup have lowest minimum age possible for DJJ detention (10) and informal contacts below the legal threshold for formal charging

JJ Custodial episodes & LOS

32

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

Offences

Average National Offence Index rating for all offences was in lowest (least serious) 10%

Most common: road traffic & theft (50% of all convictions), justice, public order & acts intended to cause injury (~ 10% each)

33

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

34

New Conceptualisation of Disability in CJS

• Highly disadvantaged places early in life & funneled into a liminal marginalised community/criminal justice space (Baldry 2013)

• Not falling through the cracks, rather, as young people on the conveyor belt / given a ticket on the CJS train. Systematic and patterned (Baldry 2013).

• The lack of appropriate support and services and the use of control agencies for persons experiencing multiple disadvantages together with mental and/ or cognitive disability, compounds these life issues creating complex needs (Baldry & Dowse 2012).

Understanding complex support needs for young people with cognitive disability in contact with CJS • Complex set of vulnerabilities across individual, social and

institutional domains, work together to bring people with complex support needs into contact with the CJS.

• Many risk factors are known and identifiable from a young age • Pathways into the CJS for these young people with complex needs are

multi-factorial and multi-stage (Baldry 2013).• Difficult for currently disconnected service systems to identify and

address. • Failure to address contributory conditions often precipitate further

involvement in the criminal justice system • Poor coordination across areas of criminal justice, welfare and human

services and education, appears to result in responsibility for management often falling to the criminal justice system (Baldry & Dowse, 2013).

Addressing support needs for people with mental health and cognitive disability in contact with the CJS• Comprehensive response means addressing models and practices in

individual and family support, service system cohesion, and overarching policy direction.

• Premised on support not criminalisation. • Responses specifically recognise and address complex needs as pervasive

and interlocking rather than simply co-occurring, and therefore cannot to be addressed in isolation from each other.

• Service providers face a challenge in recognising the presence of complex support needs in their clients and ensuring assessment and early intervention.

• Policy makers to enact strategies that enable shared recognition and understanding of the nature of complex support needs, including common criteria and language.

• Specific cross-portfolio integration promoting collaborative and coordinated service response across education, child protection, disability and criminal justice system agencies.

ReferencesArcher, W. D. (2009). Introduction: Challenging the school to prison pipeline. New York Law

School Law Review, 54, 875-908.Australian Institute of Health and Welfare (AIHW). (2012). Children and young people at risk

of social exclusion: Links between homelessness, child protection and juvenile justice. Data linkage series no. 13. Cat. no. CSI 13. Canberra: AIHW

Baldry, E. (2013) Pathways from school to prison: Intellectual disability, mental health and school education. Paper presented to Forum on intellectual disability, mental health and school education. UNSW May 31.

Baldry, E. & Dowse, L. (2012) Pathways into and avenues out of criminal justice for young people with cognitive and mental disabilities. UNSW, Public Lecture. December 6th.

Baldry, E. & Dowse, L. (2013) Compounding mental and cognitive disability and disadvantage: police as care managers in Duncan Chappell (ed) Policing and the Mentally Ill: International Perspectives. Boca Raton: CRC Press, Taylor and Francis Group.

Baldry, E., Dowse, L., & Clarence, M. (2012). People with intellectual and other cognitive disability in the criminal justice system: Report for NSW Family and Community Services Ageing, Disability and Home Carehttp://www.adhc.nsw.gov.au/__data/assets/file/0003/264054/Intellectual_and_cognitive_disability_in_criminal_justice_system.pdf

ReferencesCarney, T. (2006) Complex Needs at the Boundaries of Mental Health, Justice and

Welfare: Gatekeeping Issues in Managing Chronic Alcoholism Treatment? Current Issues in Criminal Justice 17(3): 347-361.

Draine, J., Salzer, M. S., Culhane, D.P., and Hadley, T.R. (2002) Role of social disadvantage in crime, joblessness, and homelessness among persons with serious mental illness. Psychiatric Services 53(5): 565-573

Hamilton, M. (2010) People with Complex Needs and the Criminal Justice System Current Issues in Criminal Justice 22(2): 307-324

Indig, D., Vecchiato, C., Haysom, L., Beilby, R., Carter, J., Champion, U., Gaskin, C., Heller, E., Kumar, S., Mamone, N., Muir, P., Van Den Dolder, P. & Whitton, G. (2009) NSW Young People in Custody Health Survey: Full Report. Justice Health.

Keene, J. (2001) Clients with Complex Needs: Interprofessional Practice. Oxford: Blackwell

MacDonald, (2012). Macdonald, S. J. (2012). "Journey's end": Statistical pathways into offending for adults with specific learning difficulties. Journal of Learning Disabilities and Offending Behaviour, 3, 85-97.

Rankin, J & Regan, S (2004), Meeting Complex Needs: The Future of Social Care, The Institute for Public Policy Research

Contact

Associate Professor Leanne DowseChair in Intellectual Disability and Behaviour Support

School of Social SciencesUNSW Australia

L.Dowse@unsw.edu.au

MHDCD Project website UNSW http://www.mhdcd.unsw.edu.au/