Study reveals stark mental health figures for indigenous prisoners

Nearly 90 per cent of indigenous women in Queensland prisons have a diagnosed mental illness, the first systematic research into Queensland’s indigenous prisoners has revealed.
Nanjing Night Net

That is four times the rate of mental illness in the general community.

And nearly half of indigenous prisoners have been imprisoned four or more times.

The Australian-first research – soon to find its way into a new Queensland government policy called Inside Out – found 73 per cent of indigenous males in prison had a diagnosed mental illness; severe depression, psychosis and severe anxiety.

It is 21 years since the Royal Commission into Aboriginal Deaths in Custody highlighted poor mental health was a contributing factor to why indigenous people were over-represented in Australian prisons.

It is only now that a carefully constructed research project, based on interviews with 396 indigenous prisoners in six of nine Queensland prisons, reveals the truth about mental health.

The study, produced after four years of research, has found clear evidence of the link between poor mental health and repeat offending.

“The high prevalence of diagnosed psychotic disorder, particularly among women is of concern,” the report finds.

“Psychotic disorder is associated with significant morbidity and increased risk of re-incarceration.”

Interviews were completed over eight weeks in May and June 2008, but published for the first time yesterday in the Medical Journal of Australia.

The survey, carried out by researchers from Queensland’s Forensic Mental Health Service, included assessments by culturally-trained forensic pyschiatrists.

Overall, the research finds that 73 per cent of male indigenous prisoners had a diagnosed mental illness, while 86 per cent of women suffered mental illness.

Psychiatrists Ed Heffernan and Kimina Andersen, from the QFMHS, said the research gave evidence of the problems people had assumed since 1991.

“In Queensland we didn’t have a specifically identified mental health service (for prisoners) up until 2006,” Dr Heffernan said.

“And the bit that has developed in parallel along that way has been the identification of the prevalence of mental disorder among the general prisoner population.”

The research released this week discovers the situation for indigenous prisoners in Queensland.

“While those of us who have been working in the area always suspected the prevalence of this, we didn’t have the data in a reliable and systematic way and that is what this study adds to the picture for the first time,” Dr Heffernan said.

The study found:51 per cent of indigenous women suffered severe anxiety problems, (20 per cent of men);69 per cent of indigenous women suffered substance abuse problems, (66 per cent of men);29 per cent of indigenous women suffered severe depression, (11 per cent of men); and23 per cent of indigenous women suffered psychotic disorders (8 per cent of men).

Aboriginal and Torres Strait Islander people are still 14 times more likely to be jailed than non-indigenous people.

They make up almost 26 per cent of Queensland’s prisoners, despite being about 3 per cent of the general community.

Dr Heffernan said the researchers used cultural experience to exclude aspects which could have exaggerated the results by reducing the “cultural bias” of the sensitive research.

“Psychotic illness is a severe brain disorder, characterised by hallucinations, delusions, disorganised thoughts and behaviour,” hen said.

“Many of the things that go towards diagnosing a psychotic brain illness are question such as ‘Do you hear voices?’.

“Whereas, for an indigenous person, it would not be uncommon for them to say ‘Well yes, I hear the voices of my relatives who are deceased who help me as guidance from elements of the spirits’, for example.

“So if you misunderstood that, as not being part of indigenous culture, you might say that was a delusion, or a hallucination.”

The project team then had the interviews overseen by forensic psychiatrists and indigenous experts, who sat on a panel to accurately assess the interviews.

Ms Andersen, an indigenous women, said community ties played a much stronger role in protecting mental health in the indigenous community.

“Health systems are, in general, about treating individuals,” she said.

“Where with Aboriginal and Torres Strait Islander people it is about your family, your community, your system that support community members.

“It is not so much about getting treatment as an individual person.”

A five-year mental health plan for indigenous prisoners is now being developed.

Ms Andersen said there was no doubt women prisoners felt most vulnerable in prisons.

“Women were obviously quite vulnerable in this population to psychotic disorders, to substance misuse,” she said.

Alcohol and cannabis are the drugs of choice among indigenous prisoners, rather than the amphetamines and opiates found among the wider community.

Ms Andersen said the research also showed communities did not feel they had the ability to look after people with mental illness.

“There is almost a lack of comprehension of how to manage family members who have a mental disorder,” she said.

The research shows the problem, worsened by mental illness, could become a horrible self-perpetuating circle of “prison-release-prison-release-prison”.

“In our study, what we have found is that around about 50 per cent of males (indigenous prisoners) and over 40 per cent of females have been in custody more than five times,” Dr Heffernan said.

“These are people that are coming in out, in out, in out.

“So what that starts to suggest is that not only is it good enough to have services that are culturally sensitive and meets the needs of people while they are in prison, you actually have to have services that meets their needs once they get released and link them to community services.”

This period of time when an indigenous prisoner was first released was the high risk period, Dr Heffernan said.

“The data about deaths, about relapsed mental illnesses, and about re-hospitalisation, about drug overdoses and suicides, are at rates during that period – particularly in the first few weeks – that are so much higher than the general community,” he said.

“It is just extraordinary. It is such a very high risk time.”

Dr Heffernan said it made sense to invest money at this stage of treatment, because otherwise people were simply re-admitted to public hospitals, which was a major public health cost.

“So really it makes a public health dollar argument that you should invest in transitional services,” he said.

“So you should be helping people re-connect into the community.”

Ms Andersen said video links for indigenous prisoners into remote communities, sports, culture rooms in prisons plus visits from elders were making improvements.

* Diagnosed mental illness was classified as regular bouts of mental illness over the 12 month period before the 2008 interviews as assessed by forensic psychiatrists.

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