Supporting Ex-Offenders with Mental Disabilities 31 July 2014 Presenters: Ms. Charlotte Kooi Ms. Julia Lee Medical Social Workers Institute of Mental Health, Singapore Overview • Literature Review • Service Gaps in Singapore • Introduction of the Forensic Psychiatry Community Services (FPCS) • Case Illustration • Challenges Faced Prisoners with Mental Illness US Bureau of Justice(2006):  16% of prisoners have mental service records  55% and 73% of male and female prisoners have a diagnosable mental illness (Self-report)  74% of mentally-ill prisoners have co-occurring substance dependence/abuse diagnosis  Only 1/3 prisoners have received any treatment for mental illness during incarceration Steffan (2005) stated that in 2004, 45% of prisoners with greatest mental health needs do not receive mental health services Prisoners with Mental Illness  Lack of availability of programs (Norton, 2005; Barbara, 1995) • • • Lack of substance abuse programs. Lack of economic self-sufficiency skills Lack of establishment of family & personal issue: Insecurity about future prospects (work/ relationship)  An absence of reintegration programs to reduce stigma and discrimination in the community (Norton, 2005) Prisoners with Mental Illness  Lack of provision of information/education for mentally-ill prisoners and their families on mental health issues (Norton, 2005)  An absence of discharge planning from Prisons to community-based mental health services • Housing & employment issues • Overcrowding • Lack of privacy (Mental Health Legal Centre, 2009)  Few community programs for female prisoners when released from custody (Nieto, 1999) Service Gaps Identified in Singapore 1. 2. 3. 4. Lack of specific service provision for offenders with mental disabilities released to the community after serving their term in Singapore Prisons Absence of aftercare model for high risk forensic patients 80% default rate by released prisoners on their First Visit appointments in IMH despite given appointments before their release 70% of remand cases in IMH are repeated remands  a possible reflection of recidivism FORENSIC PSYCHIATRY COMMUNITY SERVICES Programme Objective Establish Forensic Psychiatry Community Services (FPCS) to support ex-offenders with mental disabilities (exOMDs) in their reintegration into the community, encompassing psychiatric treatment and social support in collaboration with partners. Programme Scope Inclusion Criteria Exclusion Criteria 1. 1. Psychotic disorders     2. Schizophrenia Schizo-affective Delusional disorder Other psychotic disorders Affective disorders   3. Depressive disorders Bipolar affective disorders Anxiety disorders      4. Generalised anxiety disorder Obsessive compulsive disorder Phobic disorders Panic disorder Post traumatic stress disorder Dual diagnosis  One of the disorders should be from the above list 2. Predominant severe personality disorder(s) Predominant substance abuse disorder(s) The Team Multidisciplinary Team (MDT) consists of:  1 Consultant Psychiatrist (Programme Director)  1 Programme Executive  1 Programme Assistant  3 Medical Social Workers  1 Social Work Assistant Programme Service Flow Review SPS referrals Interview OMD at SPS On-going effort Enhance social support via collaboration with partners Case management Monthly phone call Interview report: Index offence, Family contact info, Family genogram, Family and social background, Educational history, Employment history, Psychiatric history Forensic history, Finances, Risk assessment (HCR-20), Accommodation and living environment Enhance ex-OMD and community’s safety network Ex-OMD visits IMH Outpatient appointment, or Direct escort upon release MDT meeting Consultant supervises risk assessment, advises risk management Statistics as of 11 July 2014 Since FPCS was started in September 2011: • 209 referrals were accepted into the programme • 144 ex-OMDs were discharged from FPCS • 72% were seen at IMH (clinic/emergency services) within 14 days of release from prison versus 80% default rate for cases referred by Singapore Prison Services for aftercare management in 2010 (January to July) Demographic Profile CASE EXAMPLE Programme Service Flow Review SPS referrals Interview OMD at SPS On-going effort Enhance social support via collaboration with partners Case management Monthly phone call Interview report: Index offence, Family contact info, Family genogram, Family and social background, Educational history, Employment history, Psychiatric history Forensic history, Finances, Risk assessment (HCR-20), Accommodation and living environment Enhance ex-OMD and community’s safety network Ex-OMD visits IMH Outpatient appointment, or Direct escort upon release MDT meeting Consultant supervises risk assessment, advises risk management Singapore Prison Services Referral to IMH for Mr A Interview with Mr A in Prison Imprisoned in 2009 for Drug Consumption Released 2014 died 2004 died 2004 stays in JB no contact for many years ? ? ? unemployed ex-offender 46 30 Mr A Mrs A 5 H ? ? Interview with OMD in Prison Employment History Social Relationships Psychiatric History Education History Forensic History Finances Substance Use History Housing Housing Issue Programmes Officer of SPS Family Resource Centre Psychiatric Rehabilitation Step-Down Care Centre Programme Service Flow Review SPS referrals Interview OMD at SPS On-going effort Enhance social support via collaboration with partners Case management Monthly phone call Interview report: Index offence, Family contact info, Family genogram, Family and social background, Educational history, Employment history, Psychiatric history Forensic history, Finances, Risk assessment (HCR-20), Accommodation and living environment Enhance ex-OMD and community’s safety network Ex-OMD visits IMH Outpatient appointment, or Direct escort upon release MDT meeting Consultant supervises risk assessment, advises risk management Family Interview • Lack of Corroborative Information o Family of Origin Not Contactable o Wife did not share much Multi-Disciplinary Team (MDT) Discussion Programme Service Flow Review SPS referrals Interview OMD at SPS On-going effort Enhance social support via collaboration with partners Case management Monthly phone call Interview report: Index offence, Family contact info, Family genogram, Family and social background, Educational history, Employment history, Psychiatric history Forensic history, Finances, Risk assessment (HCR-20), Accommodation and living environment Enhance ex-OMD and community’s safety network Ex-OMD visits IMH Outpatient appointment, or Direct escort upon release MDT meeting Consultant supervises risk assessment, advises risk management After Release from Prison Settling Down at StepDown Care Centre Monthly Appointments: IMH, Prisons Reintegration Officer, Urine Tests Employment Multi-Agency Collaboration Issues with Wife: illegal subletting of rental flat, financial demands, restricting Mr A’s access to Son Multi-Agency Collaboration IMH Step-Down Care Centre Prisons RO Mr A Family Service Centre (FSC) Child Protection Specialist CHALLENGES FACED Challenges Faced • Participation in FPCS is on a volunteer basis • Intensity of Accommodation Problems o only 10% of referrals have accommodation needs o But these takes up a significant proportion of time. • Crisis Management o Unpredictable timings o E.g. Family Violence, Return to Substance Abuse SPECIAL THANKS TO… Partner Agencies • Singapore Prison Services o Programme Officers o Reintegration Officers • Family Resource Centres • Psychiatric Rehabilitation Step-Down Care Centres • Halfway House • Family Service Centres References  Barbara Owen. (1995).Profiling the needs of California’s female prisoners. California, California State University.  Norton, S.C.(2005). Successfully managing mentally ill offenders: Thoughts and Recommendations. Corrections Today 67(1), 28-29. Retrieved from http://www.aca.org/fileupload/177/prasannak/Norton_web.pdf  Nieto, M. (1999). Mentally Ill Offenders in California’s Criminal Justice System. Sacramento, CA: California Research Bureau. Retrieved from http://www.library.ca.gov/crb/99/02/99002.pdf  Steffan, J.S.(2001). Meeting the Needs Of Mentally Ill Offenders: Inmate Service Utilization. Retrieved from: http://www.redorbit.com/news/health/126056/meeting_the_need s_of_mentally_ill_offenders_inmate_service_utilization/ Q&A THANK YOU