Release from prison: public health challenges and opportunities

1
Release from prison public health challenges and
opportunities

• Dr. Stuart Ross
• School of Political Science, Criminology and
  Sociology, University of Melbourne

VAADA Conference 2007
2
Presentation issues

• Prisoners present a number of important public
  health challenges and opportunities
• A key element in responding to these challenges
  is active management of the transition from
  prison to release
• In order to achieve this, we need to understand
  more about the relationship between health issues
  and the transition from prison to the community

3
Prisoner health problems are serious

• Poor general health status
• High rates of infectious diseases
• Poor mental health status
• High rates of brain injury

4
Prisoners health problems have multiple causes

• Some problems are related to lifestyle (smoking,
  drugs, alcohol, risk taking)
• Lack of access to general and mental health care
• Problems of social marginality (poverty,
  homelessness, social dislocation)

5
Prisoner health problems have significant social
costs

• Role of prisons in the transmission of
  blood-borne disease
• Impact on rates of recidivism and re-imprisonment
• Impact on prisoners families
• Burden of death and disease on the general and
  mental health systems

6
Prisoner health as an opportunity for better
health care

• An opportunity to deliver treatment to people who
  remain outside the reach of services
• An opportunity to deliver specialized treatment
  and assessment services
• Access to concentrations of health problems eg.
  smokers, HepC

7
Comparison of Mentally Ill Prisoners and Patients
in Psychiatric Hospitals in Australia
From Ogloff (2000)
8
Achieving better health outcomes for prisoners

• Improved assessment and treatment within prison
• Effective post-release support is a critical
  element in any intervention involving prisoners

9
Amity therapeutic community post-release results
(Prendergast et al., 2004 Wexler, Melnick et
al., 1999)
10
Achieving better post-release health outcomes

• Post-release priorities are mainly about meeting
  basic needs accommodation, income and family
  reconciliation
• Therapeutic or quality of life changes are
  secondary and only take place when primary needs
  are satisfied

11
Achieving better post-release health outcomes

• Interventions that target deficits (risks and
  needs) need to be supplemented by strengths
  based approaches
• Better re-offending/health outcomes involve
  changing the way that people think about
  themselves

12
Achieving better post-release health outcomes

• Need for integrated service delivery
• For those in most need, service delivery needs to
  take place within a framework of outreach support