Keeping Prisoners Out- We Don’t Take “NO” for an Answer Puzzle Reintegration Conference Hobart - June, 2010

1. Keeping Prisoners Out- We Don’t Take “NO” for an AnswerPuzzle Reintegration ConferenceHobart - June, 2010 Dr Sandra Sunjic & Stephen Ward Justice Health

2. 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

3. 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

4. Case Scenario • Referred by Solicitor via NSW Housing • Bahai faith • Circumstances of charges • Mental Health Issues • Supreme Court Bail • Post release progress • Court outcome

5. 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

6. 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

7. 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

8. 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)

9. 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 (Kariminia et al, 2006)

10. “…. 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.

11. 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

12. 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

13. Program Data September 2007 – May 2010 (2yrs 8months) • Assessment & Care Plan 3,224 (~1200pa) • Completed/Current (83%) • Returned to Custody (8%) • Lost to follow/up (6%)

14. Program Data

15. Program Data

16. 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

17. 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

18. Type of financial concern

19. 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

20. 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

21. Mental Health Diagnoses

22. Alcohol & Other Drugs • 88% had drug problem before gaol • 72% last offence was drug related • 18% used drugs in gaol • Cannabis (52%), Heroin (32%)

23. Post release problems encountered in past

24. 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?

25. 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.

26. 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?

27. 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 –

28. 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].

29. 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)

30. 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 pre-arranged accommodation only initially • Significantly more likely to have used drugs during post-release period, to have used daily and use more drugs

31. 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

32. 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 Post-Connections

33. 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.

34. 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 aboutConnections Project(avg. 3.28) • 98% received assistance fromConnections(avg. 2.5) • 90% “satisfied” or “very satisfied”(RTC significantly less likely)

35. “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.