We Don`t Take “NO”
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Transcript We Don`t Take “NO”
Keeping Prisoners OutWe Don’t Take “NO” for an Answer
Puzzle Reintegration Conference
Hobart - June, 2010
Dr Sandra Sunjic
& Stephen Ward
Justice Health
Case Scenario
36 year old Iranian Man
Arrived in Australia at 13 years old
Cannabis, MDMA use from 21 years
old
In custody 4 months on remand
Case Scenario
Current charges:
Take /detain to obtain advantage/attempt to
choke
Use offensive weapon X 4
Common assault X 4
Possess unregistered firearm/unauthorised pistol
Goods in custody
Not keep firearm safe
Drive vehicle furiously/recklessly
Assault Occasioning Actual Bodily Harm X 2
Case Scenario
Referred by Solicitor via NSW Housing
Bahai faith
Circumstances of charges
Mental Health Issues
Supreme Court Bail
Post release progress
Court outcome
Strengths model
Rapp et al (2007)
Denial as a result of:
Hopelessness about ability to change
Difficulty prioritising and organising
solutions to multiple life problems
Problems utilising needed resources
Personal Strengths Model of Care
Use client strengths, abilities, assets
Focus on positives
Clients control goal setting
No goal is unrealistic – broken down
Client-Worker relationship primary
Workers assist – do not treat
Assertive outreach/advocacy
Connections Project
Commenced September 2007
State-wide
No eligibility criteria – offences
Problematic drug use
Pre-release assessment & comprehensive
care planning
Post-release linkage – health & welfare
services
One month post-release support - with
option of extended care
Immediate extended care
What the Research says:
>80% inmates ever used illicit drugs
(Butler & Milner, 2001) (Sample:7674 inmates)
Almost half used illicit drugs in prison
(Butler & Milner, 2001)
~1/3 co-morbid disorder (D&A &
Mental Health) (Sunjic et al 2007)
Remain OTP 8/12 post release –
significant in recidivism & mortality
(Dolan et al 2005)
Deaths Post Release
1988-2002
Record linkage
Cohort 85,203 (4,714 males, 423 females)
Total deaths 5,137 (6%)
Drug Related
Deaths post-release: 31% males (1,477)
47% females (197)
26% all drug related deaths in NSW
et al, 2006)
(Kariminia
“…. part of the answer lay in the Australian prison,
and the men I’d met there. Some of the men, too
many of them, were serving their fourth or fifth
prison sentences. Many of them had begun their
imprisonment in reform schools – Boy’s Homes, they
were called, and Youth Training Centres. Some of
them had been beaten, starved, and locked in
solitary confinement. Some of them, too many of
them had been sexually abused. Ask any man with a
long enough experience of prisons, and he’ll tell you
that all it takes to harden a man’s heart is a system
of justice.”
Gregory David Roberts
Shantaram, 2003, p81.
Assistance Provided
ID, Medicare Cards
Liaise with Department of Community Services –access to
children
Book medical appointments
Advocate for patients to access services
Arrange accommodation
Attend appointments with patients
Meeting basic needs – food vouchers, furniture
Re-engage with family
Orientation to the community
New legal matters
Serious Offenders
Assessment, preparation & care
planning several years before release
De-institutionalisation
Advocacy/assistance – to co-ordinate
requirements for release e.g. VOTP & OTP
Reports to Serious Offenders Review
Council (SORC) and State Parole
Authority (SPA)
Post release support for 3 months
Program Data
September 2007 – May 2010
(2yrs 8months)
Assessment & Care Plan
(~1200pa)
3,224
Completed/Current
(83%)
Returned to Custody
(8%)
Lost to follow/up
(6%)
Program Data
Connections Outcomes Post Release to Dec 09 (N = 2118)
50%
45%
40%
35%
30%
Completed
25%
20%
RTC
15%
10%
Se
pt
0
7
-N
ov
em
be
De
r0
c
7
07
-F
eb
M
ar
08
08
-M
Ju
ay
ne
08
08
-A
Se
ug
pt
08
08
-N
De
ov
c
08
08
-F
M
ar
eb
ch
09
09
-M
Ju
ay
ne
09
09
-A
Se
ug
pt
09
09
-N
ov
09
5%
0%
Closed
LTFU
Program Data
Connections Lost To Follow Up By Linkage to Dec 09 (N = 389)
80%
70%
60%
50%
Linked in
40%
Not Linked in
30%
Don't know
20%
10%
Se
pt
0
7
-N
ov
em
be
De
r0
c
07
7
-F
M
eb
ar
08
08
-M
Ju
ay
ne
08
08
-A
Se
ug
pt
08
08
-N
De
ov
c
08
08
M
-F
ar
eb
ch
09
09
-M
Ju
ay
ne
09
09
-A
Se
ug
pt
09
09
-N
ov
09
0%
External Evaluation
(Martire & Howard, 2009)
N=829
82% males
Mean age = 34 (18-60)
89% Australian
23% Aboriginal or TSI
91% at least one previous
incarceration
External Evaluation
(Martire & Howard, 2009)
Majority not complete minimum high school
Aboriginal & Women-less likely ever worked
19%-difficulty keeping contact family /
friends
60%-have children(38% live with them
post-release)
90% Centrelink benefits
78% financial problems
Male
Ba itie
s
nk
ru
pt
cy
Ut
il
Ta
x
Ce
en ntre
lin
to
Ba
k
fH
nk
ou
Ac
Ba sin g
co
nk
un
t/
Lo
C
an
re
di
tC
Pe
ar
rs
d
on
al
Lo
an
Pr
op
Re
er
nt
ty
al
Da
m
Vi
ag
ct
im
e
s
SD
Co
RO
m
pe
ns
at
Ch
io
ild
n
Su
pp
or
t
De
pa
rtm
% of patients
Type of financial concern
70
60
50
40
30
20
10
0
Female
Health Status
Physical Health
70% existing physical health
problems
56% required ongoing healthcare
post-release
>50% patients had head injury in
the past
17% shared injecting equipment
in gaol
Health Status
Mental Health
56% receiving mental health treatment
35% Depression
20% Anxiety
68% of female patients experiencing
mental health problems
28% considered or attempted suicide &
14% considered or attempted self harm
po
la
r
Males
O
th
er
An
Pe
xie
rs
on
ty
al
it y
Di
Al
so
co
rd
ho
er
lD
ep
Su
en
bs
de
ta
nc
nc
e
e
D
ep
en
de
nc
e
AD
D
/A
DH
D
Bi
De
pr
es
sio
Sc
n
hi
zo
ph
re
m
ia
% of patients
Mental Health Diagnoses
60
50
40
30
20
10
0
Females
Alcohol & Other Drugs
88% had drug problem before gaol
72% last offence was drug related
18% used drugs in gaol
Cannabis (52%), Heroin (32%)
Ph
ys
ica
M lH
en e
ta alt
lH h
ea
Ho lth
u
D& sin
A g
Fi U s
na e
nc
es
Re
la Le
tio ga
ns l
hi
ps
F
Pe am
Ne er il
ig G y
hb r o
u
Em o ur p
pl ho o
oy d
m
G en
am t
/A
-F
La bli
irs
ck ng
tT
of
im
ID
e
in Ot
C he
us r
to
dy
% of Patients
Post release problems encountered in past
60
50
40
30
20
10
0
Corinne
I use, because I am so afraid of “Life”, I’m lonely, alone scared
of society, of Authority figures? Who pretend to help; But
everything “they” say they are doing for me HA, has still not
been done? – people, just do Not understand how hard it is for
me? Every single time I have been out of prison – I just can’t
cope? The longest time of Freedom I have had? Was 5 1/2
months – Parole have all this information?
What am I supposed to do Corinne, I’ve laid awake at Night
and cried, and thinking?
Why, is So hard? It’s hard, because I am 45 yrs of age, And
for 36 of those 45 years I have been in and out of institutions
and Prison from age Nine, over two thirds of my entire life. I
am afraid of people, I can’t communicate with others. I want
a life Corinne, but when you Know nothing but Prison and
drugs, and really, no one has shown me any alternatives, or
solutions and the people I ever have anything to do with? Are
criminals. I have sat in this caravan, day after day, lonely
and alone, and sinking deeper into fear of those who are
supposed to be supporting and guiding me.
I’ve told you things that I have suffered and been subjected too
throughout my life? If you knew everything? You would shed a
tear. The bottom line is? People don’t “and never will”
understand the psychological damage I have suffered from not
only all the boy’s homes, And sexual and physical abuse as a
child. I don’t have the skills to deal with so many things in
society, yes, I am a MAN, and I am responsible for my actions?
After all those years in and out of Prison living in a 12 by 8 foot
cell? Then living in this caravan is making me unstable? My
Brother has been good to me lately, we sorted out our
differences But even though he is my Brother, I have been
showering twice a week and living like a hermit?
I know my Brother cares But it goes back to what I said
earlier “People don’t understand how damaged mentally I
am, from a lifetime of hatred, violence, rejection,
loneliness, fear. I am afraid to have showers and go
inside; and this is my Brother’s house, my blood who
loves me? So if I am like this with [name removed]? How
afraid of Society, do you think I am? There are some good
people in this world. You are the best of all those who
have tried HA “Connections” deserves all the credit they
get. I said to my Brother today, if it were not for yourself
and Connections I would not be here –
I can Promise you this – on my Brother’s Grave – I
will not go back to Prison
So even though I have taken three Nights to write
this – I just want people to understand I’m not a bad
person, I just am so afraid of my life.
Thankyou for all you have done
[name withheld].
Patient Outcomes
70% continued necessary physical health treatment
71% continued necessary mental health treatment
45% reported using drugs in community (usually
<weekly)
Significant reduction in number drug types used
87% continued necessary D&A treatment
45% commenced additional D&A treatment
79% continued OTP post release
Significant improvement in general health post-release
(GHQ)
Significant improvement in general health & wellbeing
post-release (BTOM-C)
Completion v’s Return to Custody
RTC group:
Significantly less likely continue physical,
mental, D&A Rx post-release
Significantly more likely to remain in prearranged accommodation only initially
Significantly more likely to have used drugs
during post-release period, to have used
daily and use more drugs
Completion v’s Return to Custody
Completion group:
Improved general health, RTC group
– decline in general health
Improved social functioning (SF-12) –
RTC decline
Fewer transitional changes than RTC
group
Days in Community
Pre v. Post Connections
Return to Custody Group:
Average days in community PreC = 132 (0-559 days)
Average days in community PostC= 211 (0-552 days)
Average difference = 79 days longer Post-Connections
(at census, Sig p<.005, t = 11.39)
Completed Group:
Average difference = 7 months longer Post-Connections
(80% remain in the community at 2 years)
65% of patients had more time in the community PostConnections
State Parole Authority Outcomes
(n=225)
123 (54%) of patients granted Parole
Application supported by P&P.
63 (28%) of patients granted Parole
Initial application was not supported by P&P.
17 (8%) of patients granted Parole
Not supported by P&P.
22 (10%) of patients SPA requested
further information and granted Parole
Supported by P&P.
Patient Perceptions of Connections
90% “better prepared” this time
(RTC significantly less
likely)
86% “transition easier” this time
(RTC significantly less
likely)
95% cited positive aspects about Connections
Project (avg. 3.28)
98% received assistance from Connections
(avg.
2.5)
90% “satisfied” or “very satisfied”
likely)
(RTC significantly less
“Laws can embody standards. Governments can
enforce laws – but the final task is not for the
government. It is a task for each and every one of
us. Every time we turn our heads the other way
we see the law flouted – when we tolerate what we
know to be wrong – when we close our eyes and
ears to the corrupt because we are too busy, or
too frightened – when we fail to speak up and
speak out – we strike a blow against freedom and
decency and justice.”
Robert F. Kennedy, 21 June 1961.