Development of an intervention to increase health service utilisation in ex-prisoners
Health and Justice
Development of an intervention to increase health service utilisation in ex-prisoners
Stuart A Kinner 0 1 2 6
Kate van Dooren 5
Frances M Boyle 4
Marie Longo 3
Nicholas Lennox 5
0 School of Medicine, The University of Queensland , 288 Herston Road, Herston QLD 4006 , Australia
1 Melbourne School of Population and Global Health, The University of Melbourne , 207 Bouverie Street, Carlton VIC 3010 , Australia
2 School of Public Health and Preventive Medicine, Monash University , 99 Commercial Road, Melbourne VIC 3004 , Australia
3 Drug and Alcohol Services South Australia , 60 Marryatt Street, Port Adelaide SA 5015 , Australia
4 School of Population Health, The University of Queensland , Herston Road, Herston QLD 4006 , Australia
5 Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland , Raymond Terrace, South Brisbane QLD 4010 , Australia
6 Murdoch Children's Research Institute , 50 Flemington Road, Parkville VIC 3052 , Australia
The world prison population is growing at a rate well in excess of general population growth, with more than 10 million adults currently in custody around the world and around 30 million moving through prison systems each year. There is increasing recognition of the complex and chronic health needs of incarcerated populations, but evidence-based responses to these needs remain elusive. Most prisoners return to the community after a relatively short period of time in custody, however few transitional interventions for prisoners have been subjected to rigorous evaluation. This paper details the process of developing a service brokerage intervention for ex-prisoners in Queensland, Australia, and describes the resultant intervention. The intervention could be adapted for use in other settings and is amenable to methodologically rigorous evaluation. The collaborative design and development process involved extensive consultation with ex-prisoners and key government, community and consumer stakeholders. The intervention evolved considerably during the process of consultation, as we came to better understand the needs and priorities of our target population, and of the community organisations that served them. We consider genuine consultation with consumers, in a safe and supportive environment, to be an integral part of intervention research in this area. Given the poor outcomes experienced by many people after release from prison, evidence-based interventions developed in the way described here are urgently required.
Prisoner; Transition; Re-entry; Randomised controlled trial; Service brokerage; Case management; Intervention
Background
The world prison population is growing at a rate well in
excess of general population growth, with more than 10
million adults currently in custody around the world
(Walmsley 2011)
and around 30 million moving through
prison systems each year
(UNODC 2008)
. Australia
accounts for only a small proportion of this total – just
under 30,000 on any given day – although the rate of
imprisonment in Australia has increased by 9% over the
past decade
(ABS 2012)
and due to the rapid turnover of
prisoners serving short sentences, around 55,000 adults
move through Australia’s prisons each year
(Martire and
Larney 2012)
. One striking feature of Australia’s prison
population is the over-representation of Indigenous people,
who comprise around 2.5% of the Australian population
but 27% of adult prisoners
(ABS 2012)
.
There is increasing recognition of the complex and
chronic health needs of incarcerated populations. Despite
their relative youth, prisoners experience impaired general
health on a range of measures
(Butler et al. 2007)
, and the
prevalence of blood-borne viruses, particularly HIV and
hepatitis C, is typically orders of magnitude higher than in
the community
(Butler et al. 2011; Dolan et al. 2007;
Macalino et al. 2004; Weinbaum et al. 2005)
. The
prevalence of mental illness is similarly elevated, particularly
for post-traumatic stress disorder, psychotic disorders
and substance use disorders
(Butler et al. 2006; Fazel
and Danesh 2002; Heffernan et al. 2012)
. These
complex and interconnected health problems are set against a
backdrop of entrenched poverty and relative social
disadvantage
(Baldry et al. 2003; Social Exclusion Unit 2002;
Travis and Petersilia 2001)
.
Although there is evidence that incarceration can both
exacerbate mental illness
(Douglas et al. 2009; WHO 2008)
and precipitate risky drug use
(Dolan et al. 2010; Dolan
et al. 1996)
, for the most part prisoners bring their health
problems with them from the community. For many, health
improves while in custody, where food and
accommodation are provided in a highly structured setting, illegal
drugs are less readily available, and health services are
provided at a level well in excess of that found in most
communities
(Feron et al. 2005; Marshall et al. 2001)
.
However, almost all prisoners (...truncated)