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Predictors of rapid reincarceration in mentally ill young offenders
1Consultant Forensic Psychiatrist, Adolescent Unit, The Forensic Hospital, Justice Health, Sydney, NSW, and; Conjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Forensic Mental Health Service, ACT Health, Canberra, ACT, and; Visiting Fellow, Centre for Mental Health Research, Australian National University, Canberra, ACT, and; The Level 8 Practice, Sydney, NSW Australia johnkas@med.usyd.edu.au.
Objective:
Describe characteristics of mentally ill young offenders released from custody and predictors of those who rapidly returned to custody.
Method:
Ambidirectional cohort study of 51 young males with mental disorders released from the largest New South Wales Juvenile Justice Centre (2005-2007), a health file audit at time of release and prospective determination of reincarceration.
Results:
Overall 47% were Aboriginal, 43% originated from regional communities, substance disorders were highly prevalent and only 12% accessed prior community mental health care. Over half (57%) satisfied diagnostic criteria for schizophrenia spectrum disorder. In custody, 39% were suicidal and 18% were homicidal. A majority (90%) returned to custody over a median of 28 months; half within five months of release. Schizophrenia/schizophreniform disorder (p<.001), bipolar disorder (p=.001) and schizoaffective disorder (p=.005) predicted rapid reincarceration, with shorter community survival than those without those diagnoses (p=.009). Antipsychotic treatment (p=.006) and treatment duration in custody (p=.006) predicted longer community survival. Aboriginality, younger age, prior incarceration and substance disorders were not predictive of rapid reincarceration.
Conclusions:
Serious mental illness was a significant predictor of rapid reincarceration in young offenders. Treatment improved community survival. The findings highlight the need for optimal psychiatric treatment and post-release care for young offenders with mental illness.
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