Australian Institute of Criminology

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Introduction

Poor mental health among people in the Australian criminal justice system is increasingly being identified and targeted for remediation. This is evidenced by Australian and international governments establishing specialist services for prisoners with mental disorders such as forensic hospitals, forensic units within prisons and specialist drug treatment programs within correctional environments (eg Birgden & Grant 2010; Justice Health & Forensic Mental Health Network 2011). Drug courts, mental health courts, court liaison services and pre-court diversion schemes for drug addicted or mentally ill offenders are also increasingly being established to divert mentally disordered and/or substance dependent offenders away from the criminal justice system and towards treatment (Justice Health & Forensic Mental Health Network 2011; Payne 2006; Richardson 2008).

This focus by the criminal justice system on addiction and mental health stems from evidence indicating that these factors may be related to offending behaviour and rehabilitation prospects (Andrews & Bonta 2010; Day & Howells 2008). The link between illicit drug use and criminal offending has been well established (Andrews & Bonta 2010; Bradford & Payne 2012; Kinner et al. 2009) and evidence also suggests a relationship between mental disorders and illicit drug use (Degenhardt 2008; Frisher et al. 2005; Marsh 2008; Mattick & O’Brien 2008). However, the findings regarding a relationship between mental disorders and offending behaviour are varied (Andrews & Bonta 2010), with some studies suggesting that the relationship is not a direct one but rather, may be mediated by substance abuse (Elbogen & Johnson 2009; Fazel et al. 2009).

While it is arguable that mental disorders play a causal role in offending behaviour, studies have identified that imprisoned offenders experience poor mental health (AIHW 2012; Butler & Allnutt 2003; Fazel & Danesh 2002). It is also widely accepted that offenders who are mentally ill are less able to respond to offender rehabilitation programs (Andrews & Bonta 2010), thereby making mental health treatment important not only on humanitarian grounds but also to give offender rehabilitation programs the best possible chance of success.

It is important to note that prisoners constitute a minority of offenders, as most people who appear in court are not given a custodial sentence (BOCSAR 2012), however recent studies of police detainees suggest that alleged offenders (ie those not yet brought before the courts) may also experience poor mental health at the time of their arrest (Baksheev, Ogloff & Thomas 2010; Forsythe & Gaffney 2012; Heffernan et al. 2003). One issue that has been highlighted by such studies is the challenge of accurately measuring mental health among people who are detained for short periods of time in police cells or watchhouses.

Measuring mental health concerns: Lessons from the Drug Use Monitoring in Australia program

This report is focused on describing and discussing the process and challenges inherent in measuring mental health concerns among alleged offenders in police custody. This is, in part, informed by the author’s experience as the Site Manager responsible for DUMA data collection in New South Wales from 1999–2010; a role that included evaluating and improving the mental health information collected as part of the DUMA program.

Terminology

Throughout this report, the term mental disorder is used to refer to psychological states that meet diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which is the diagnostic classification system most commonly used by mental health professionals in Australia (APA 2000). The term mental health is used more broadly to refer to overall psychological states.

It should be noted that problematic substance use is classified by the DSM-IV-TR as a mental disorder under the category of Substance Use Disorders (APA 2000). Substance Use Disorders include both substance abuse and dependence (APA 2000). The term substance refers to a range of substances but most commonly alcohol, illicit drugs and pharmaceutical medications (APA 2000). In this report, discussion is centred mainly on illicit drug use, which reflects the focus of the DUMA program. The co-existence of two or more mental disorders is generally referred to as comorbidity. In this report, comorbidity will be used specifically to refer to the co-existence of a substance use disorder and another category of mental disorder (eg a mood disorder, schizophrenia, anxiety etc). Comorbidity has been found to be associated with more severe ill health, poor treatment outcome and high service utilisation (Teesson & Proudfoot 2003). Comorbidity in conjunction with criminal offending presents many challenges for criminal justice systems (Day & Howells 2008).

Related links

Measuring mental health in criminology research: Lessons from the Drug Use Monitoring in Australia program: