1. Michelle Denton Manager: Forensic MHS Southern and Central Qld PhD Candidate Uni of Qld Andrew Hockey Project Officer “Back on Track”: Transition from prison to community for people with a serious mental illness.

2. 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

3. arrest poverty unemployment substance use homelessness stigma incarceration relapse/ re-offending release transition phase Cycle of Mental Illness and Offending

4. 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

5. QUEENSLAND FORENSIC MENTAL HEALTH SERVICE State-Wide Team COMMUNITY District Mental Health Services Court Liaison Service Community Forensic Outreach Service High Secure Hospital Prison Mental Health In-reach + Transition

6. 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

7. 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

8. 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.

9. 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

10. Demographics 26 females / 70 males. Mean Age = 32.26 years

11. Primary Diagnosis

12. Additional Diagnoses

13. Dual Diagnoses (SUD)

14. Previous Psychiatric Admissions

15. Previous Community MH Treatment

16. Self-Harm History

17. Social Support

18. Planned Housing Pre-release

19. Planned Employment Pre-release

20. 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

21. 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)

22. Profile Young <40 Schizophrenia + SUD / poly-substance Previous Psychiatric Admissions Previous Community MH services Self harm + suicide attempts Limited social supports Housing issues Low employment Multiple incarcerations

23. Continuity of Care Attended face to face appointment @ local CMHS within 2 weeks post release ? – 73% of males – 61.5% of females Who attended 1 st appointment? Who continued attending?

24. 1 st appointment attendance %

25. 1 st appointment attendance X incarceration history %

26. Ongoing appointments X prior incarcerations

27. Ongoing appointments X diagnosis Average number of consultations

28. 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

29. Are we getting it right ? Comprehensive assessment Individual plans / personalised delivery Health and wellbeing focus Pre & post release engagement Continuity of staff across continuum Facilitate access to services ? Partnership with community Cross agency collaboration Just the beginning. More work to be done!