assoc prof leanne dowse - unsw

A/Prof Leanne Dowse Chair Intellectual Disability Behaviour Support, UNSW

7th Annual Correctional Services Healthcare: Addressing the gaps, promoting multidisciplinary care and improving the continuum of care into the community. Novotel Brisbane, 25-26 Oct, 2016

Addressing the Predictable and Preventable Imprisonment and Re-Imprisonment of Aboriginal People with Mental Health and Cognitive Disability

•  Context of the issue

•  Background to the IAMHDCD in the CJS project

•  Findings

•  Data linkage study

•  Experiences

•  Principles and strategies to inform the way forward: Solutions from Communities

•  Conclusions

2 7th Annual Correctional Services Healthcare, Novotel Brisbane, 25-26 Oct 2016

Presentation Outline

Context of the issue •  Significant and increasing over-representation •  Previous project on People with MHDCD in the CJS suggested far worse

outcomes for Aboriginal Australians •  Lack of critically informed

•  evidence •  analysis •  co-ordinated policy and service response

•  Need for deeper understanding of •  Lived experience •  Systemic and social challenges •  Service failures •  Positive program interventions •  Culturally responsive approaches and remedies


•  ARC Linkage Project 2011-2014

•  Investigators: Prof Eileen Baldry, A/Prof Leanne Dowse, Prof Julian Trollor, Prof Patrick Dodson, Dr Devon Indig.

•  Project Partners: NSW Justice Health; Housing NSW, NSW Ageing Disability and Home Care and Legal Aid NSW

•  Project Researchers: Peta McGillivray, Elizabeth McEntyre, Ruth McCausland, Han Xu, Julian Trofimovs.


Indigenous Australians with mental and cognitive disabilities in the CJS Study

•  Decolonisation

•  Complexity

•  Complex Support Needs

•  Critical Research Methodologies –  Indigenous methodology –  Intersectionality –  Social conceptualisation and disability and offending


Key ideas informing the research

•  Data-Linkage Study •  Linked data on 2371 people who had been in the CJS and examined their service

interactions and pathways into the CJS •  676 of this group were Aboriginal people (25%)

•  Community-based Research •  Consulted with key people in indigenous-informed research •  Established research partnerships and worked in collaboration with 4 communities in

NSW and 1 in Northern Territory •  Interviewed aboriginal people with MHDCD, their families, Aboriginal Community

members, Aboriginal and non-aboriginal service providers •  Verified and validated findings with all communities •  Developed education and advocacy resources for community use.


What we did

Data Linkage Study: Approach •  Cohort: 2001 Inmate Health Survey & CSNSW Statewide Disability Service

database – purposive sample not representative. 2371 individuals

•  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

•  Analysis described the experiences of a cohort of Indigenous Australians with MHDCD in contact with the CJS (n=676) and a comparison with their non-Indigenous peers

XIV International Conference EUSARF 2016

•  Aboriginal people with MHDCD are significantly more likely to have experienced earlier and more frequent contact with the CJS and greater disadvantage than non-Indigenous people.

•  They are significantly more likely to have: •  been in Out-Of-Home-Care •  contact with Police at a younger age, at a higher rate as victims and offenders •  higher numbers and rates of convictions •  more episodes of remand •  higher rates of homelessness

•  Those with complex needs (multiple diagnosis and disability)more likely to have •  Earlier Police contact •  Been in Juvenile Justice system •  More Police and prison episodes over their lifetime


Data Linkage Study: key findings (1)

•  Offences - Aboriginal people with MHDCD less serious offence categories. •  Theft and related •  Public order •  Offences against Justice procedures •  Traffic and vehicle regulatory

•  Indigenous Women •  Highest rates of complex needs •  More likely to be in OOHC •  More likely to be in Juvenile custody •  Earlier age of first police contact •  Higher rates of convictions and incarceration •  higher rates of homelessness •  More likely to be victim of crime


Data Linkage Study: key findings (2)

Data collection in communities –  Indigenous people with MHDCD who have been or are enmeshed in

CJS (n=22)

–  Family members and carers of Indigenous people with MHDCD (n=2)

–  Aboriginal community members (n=24)

–  Service providers across multiple sectors; •  Aboriginal controlled (n=17), Government (n=42); NGOs (n=16)


Qualitative Study: approach

•  Identity, Definition And Stigma •  Institutional Racism •  Poor identification of cognitive impairment •  Lack of diversion options •  Stigma

•  Normalisation of over-representation •  Systemic normalisation of disadvantage, disability and offending •  Over-policing •  Intergenerational issues

•  Multiple and Complex support needs •  Siloed service provision •  Families have multiple and complex support needs •  Need for culturally appropriate, holistic, integrated response


What people told us about their experiences(1)

•  Trauma and Violence •  Complex trauma •  Violence as pervasive •  Violence against women

•  Capacity for Support •  “We take care of our own” •  Lack of support for Aboriginal community capacity •  Lack of capacity in services and systems


What people told us about their experiences

Principles and strategies to inform

the way forward: Solutions from Communities


Principle: Self-determination is key to improving access to and exercise of human rights and to the wellbeing of Aboriginal and Torres Strait Islander people with mental and cognitive disability, especially for those in the criminal justice system.

Strategies ü  Indigenous-led knowledge and solutions and community based services ü  Policy focus on women and people in regional and remote areas

ü  Resources to build cultural competency and security of non-Indigenous agencies, organisations and communities.


Self Determination

Principle: Person-centred care, which is culturally and circumstantially appropriate is essential for Aboriginal and Torres Strait Islander people with mental and cognitive disability, placing an individual at the centre of their own care in identifying and making decisions about their needs.

Strategies ü  Disability services and NDIS have a complex support needs strategy ü  Specialised accommodation and treatment options in communities ü  No return to community from custody without specialist support for

those at risk of harm to themselves or others


Person-Centred Support

Principle: A defined and operationalised holistic and flexible approach in services to Aboriginal and Torres Strait Islander people with mental and cognitive disability and complex support needs, is needed from first contact with service systems.

Strategies ü  Early recognition leading to positive and preventative support ü  Range of ‘step-down’ accommodation options ü  Resourced, integrated and inclusive community based sentencing

options


Holistic and Flexible Approach

Principle: Integrated services are better equipped to provide effective referral, information sharing and case management to support Aboriginal and Torres Strait Islander people with mental and cognitive disability in the criminal justice system. Strategies ü  Collaborative approach by Justice, Corrections and Human Services

and NGOs in program pathway design ü  Referral to Public Advocate for all prisoners with cognitive impairment


Integrated Services

Principle: It is vital that Aboriginal and Torres Strait Islander people’s understandings of ‘disability’ and ‘impairment’ inform all approaches to the development and implementation of policy and practice for Indigenous people with mental and cognitive disability in the criminal justice system, with particular consideration of issues facing Aboriginal and Torres Strait Islander women. Strategies ü  Better education and information for all stakeholders in understanding

and working ü  Culturally informed and accessible information and resources for

communities, families and carers. ü  Acknowledgement of distinct and specific needs of women

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7th Annual Correctional Services Healthcare, Novotel Brisbane, 25-26 Oct 2016

Culture, Disability and Gender-informed practice

•  Pathways into and around the CJS are embedded and entrenched by the absence of coherent frameworks for holistic disability, education and human services support.

•  Indigenous Australians with MHDCD are forced into the CJS early in life in the absence of alternative pathways.

•  Thousands are being ‘managed’ by CJS in lieu of support in the community. •  Experience is of multiple, interlocking and compounding disadvantage •  Poor diagnosis and unclear definitions of MHD and CD •  Need for coherent framework which encompasses

•  Legal – Police and Courts •  Policy – NDIS is crucial •  Service Capacity


Conclusions

A Predictable and Preventable Path: Aboriginal people with mental and cognitive disabilities in

the criminal justice system. https://www.mhdcd.unsw.edu.au/

Contact: [email protected]


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