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
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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
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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
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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)
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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)
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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.