بهداشت روانی در تقاطع ها: تاثیر نیازهای پیچیده در اثر تماس با پلیس و بازداشت برای مردان بومی استرالیا

Indigenous Australians experience significant social risk, vulnerability and disadvantage. Nowhere is this more starkly demonstrated than in the levels of contact that Indigenous Australians have with the criminal justice system, particularly the police. Utilizing a linked dataset of extant criminal justice, human and health service administrative data in New South Wales (NSW) Australia, this paper explores patterns of police contact and custody for a cohort of Indigenous males with complex needs. Four significant factors are identified that alone or in combination appear to impact on the frequency with which these men experience police contact and custody, including young age at first police contact, experiencing out of home care as a child, alcohol misuse, and limited locational mobility. Whilst it might be expected that the presence of mental ill-health and/or cognitive disability would be a key predictor of the frequency and intensity of police contact and custody, the findings suggest rather that the presence of multiple disadvantages beginning in the early years and compounding throughout individuals' lives, in which mental illness may or may not be a factor, is more significant than the presence of any one diagnosis in precipitating police contact and custody for this group.

The position of Indigenous persons in contemporary Australian society is complex on numerous levels. Indigenous Australians make up 3% of the Australian population (ABS, 2012a) but comprise over one quarter (27%) of the total prisoner population (ABS, 2012b). Pressing issues regarding the differences in life expectancy between Indigenous and non-Indigenous Australians (Biddle & Taylor, 2012), substantially worse social, economic and health position (Vos, Barker, Begg, Stanley, & Lopez, 2009), the rate of drug and alcohol abuse in Indigenous communities (Cunneen, 2006a) and the impact of mental health and cognitive disorders on the Indigenous population (Glasson et al., 2005 and Simpson and Sotiri, 2006) are all part of this picture of over-representation of Indigenous Australians in the criminal justice system (CJS). Whilst the factors are varied and interlocking, all occur within a historical context of colonisation and dispossession (Calma, 2008) and together precipitate significant levels of social risk, vulnerability and disadvantage for Australia's First Peoples. Concern regarding the high rates of police contact and custody for Indigenous Australians has a substantial history, most publicly recognised in the 1987 Royal Commission into Aboriginal Deaths in Custody (RCIADIC), established following a spate of Indigenous deaths in custody during the 1980s. The Commission's mandate was broadened from the investigation of these deaths to incorporate a sociological or advisory investigation into why so many Indigenous individuals were being incarcerated (Marchetti, 2005). Factors identified included the harmful use of alcohol and other drugs, poor schooling and disengagement from education, unemployment and poverty, lack of suitable housing and infrastructure, land needs, and self-determination (Cunneen & McDonald, 1997) as interacting in the process of increasing the vulnerability of Indigenous persons to contact with the CJS. The RCIADIC concluded that the high number of deaths in custody was directly related to the over-representation of Indigenous people in police and prison custody (Marchetti, 2005). In the years since the 1991 tabling of the Commission's findings, the problem of over-representation has not abated. Rather it has worsened from an Indigenous imprisonment rate of 15 times the non-Indigenous population to current figures indicating upward of 18 times the non-Indigenous rate (Weatherburn & Holmes, 2010). Explanations for this variously identified systemic bias in the CJS that at its core is reflective of the power structure of Australian society. Further factors include the limitations of statistical data to reveal and analyse discrimination based on cultural background, institutional racism (Cunneen, 2006b, Cunneen, 2006a and Cunneen and McDonald, 1997) or that over-representation is more reflective of over-representation of Indigenous Australians in crime more generally (Weatherburn & Holmes, 2010). Competing accounts aside, there is a resolute agreement that the impacts of socio-economic disadvantage, family dissolution, unemployment, substance abuse, cognitive impairment due to intellectual disability, borderline intellectual disability or acquired brain injury and poor physical health are factors directly or indirectly contributing to over-representation. The issue of mental illness and its relationship to criminal justice contact is assumed to form a key part of this picture although the impact of the presence of mental illness in the context of these myriad dimensions of social disadvantage is not clearly understood. These issues are most pressing, not because such people are necessarily large in number, but rather these patterns of disadvantage signal highly significant personal and social cost to Indigenous individuals and communities and to the Australian social fabric more generally. The flow on effects is significant in demand on community, justice and correctional resources, and in particular is a key concern in frontline police work. 1.2. Complex needs and police work The recognition by the RCIADIC of the multiple interlocking individual and socio-economic elements that contribute to Indigenous disadvantage and over-representation in the CJS was a step toward apprehending and addressing the complexity of the problem. In NSW for example, policing responses to the findings of the RCIADIC have been implemented via the Aboriginal Strategic Direction Policy which identifies a range of measures at programme and policy level aimed at bringing about ‘positive outcomes between police and Aboriginal people’ (NSW Police Force undated). The enactment of the Law Enforcement (Powers and Responsibilities) Regulation 2005 also addressed the issue by identifying the need for ‘immediate steps to be taken to contact a support person’ should a ‘vulnerable person’ (including both people who have impaired intellectual functioning and people who are Aboriginal or Torres Strait Islanders) be placed under arrest at a police station (New South Wales Police Force, 2012). In relation to mental health and policing, initiatives such as the NSW Police Force Mental Health Intervention Team have been developed to respond to the challenges facing community policing of acute mental illness through the provision of mental health training to frontline officers (Donahue & Andrews, 2013). These measures, whilst signalling separate programmatic attention in policing to address indigenous over-representation and issues specifically associated with mental illness and policing, have occurred in relative isolation, with limited integration of the considerations which arise when multiple individual, systemic, social and cultural dimensions of disadvantage intersect. Intersections of multiple dimensions of disadvantage and the ways these tend to combine in negatively synergistic ways are increasingly identified as ‘complex need’ (Carney, 2006 and Draine et al., 2002). Broadly, individuals identified as having complex needs experience various combinations of mental illness, cognitive disability, acquired brain injury, physical disability, behavioural difficulties, homelessness, social isolation, and family dysfunction, have problematic drug and/or alcohol use (Hamilton, 2010) and systemically may be known to utilize a wide range of different services, often with high frequency but with limited benefit (Keene, 2001). It is now well recognised that in the context of the CJS those with complex needs are particularly vulnerable to a range of harms and are more likely than people with only one impairment or none to have earlier contact with police, be victims as well as offenders, enter the juvenile justice system in their childhood or adolescence, have more police contacts, more police and prison custody episodes (Baldry and Dowse, 2013, Dowse et al., 2009 and New South Wales Law Reform Commission, 2012) and be more likely to be refused bail and to be imprisoned (Lyall, Holland, & Styles, 1995). The presence of the multiplicity, breadth and depth of factors and their nature as interlocking and compounding (Rankin & Regan, 2004) goes some way to accounting for the limited impact for this group of traditional interventions which tend to take account of only one or two layers of risk or disadvantage. Substantial research has focused on factors surrounding the over-representation of Indigenous Australians in the CJS since the RCIADIC in 1991, with studies examining singly the role of risk factors for individuals in the CJS such as substance abuse (Smith & Trimboli, 2010), mental illness (Butler and Allnutt, 2003 and Fazel and Danesh, 2002), cognitive disability (Glasson et al., 2005 and Simpson and Sotiri, 2006) or in specific combination such as mental health and drug use (Day and Howells, 2008 and Treloar and Holt, 2008). However there has been very limited work that addresses the experience of individuals at the intersection of all these. For example, Indigenous young people are already at a much greater risk of contact with the criminal justice system as compared to their non-indigenous counterparts, but it appears that the intersection of being Indigenous and having a cognitive disability or a mental health disorder results in increased contact with the CJS from a young age. Nationally, Indigenous young people are 23 times more likely to be placed in detention than non-Indigenous young people, whilst adding cognitive disabilities and/or mental health issues into the mix increases a young person's disadvantage, and therefore, risk of contact with the criminal justice system (Allard et al., 2010 and Calma, 2008). Studies also indicate that Indigenous Australians with cognitive disability are at higher risk of re-offending than non-Indigenous Australians and have often been excluded from treatment services that target criminogenic needs (Frize & Kenny, 2010). The combination of a person's Indigenous background and cognitive disability or mental health disorder therefore appears to reinforce a cycle of police contact and custody beginning at a young age. Specific consideration of the presence of individuals with complex needs in policing work is limited despite the recognition that individuals with single or dual diagnoses increasingly make up a major proportion of police work. Research undertaken in NSW examining the nature and patterns of frequent presenting to Police associated with apprehension under the Mental Health Act1 established that Indigenous persons were consistently over represented when compared to the current Aboriginal population rate in NSW at 2.2%, with 14% of individuals presenting frequently to police in the study snapshot year of 2005 being Indigenous persons (Baldry, Dowse, & Clarence, 2012). The longitudinal evidence from the study further indicated that over the nine year period (2001–2009) examined, Indigenous persons were twice as likely as non-indigenous persons to come into contact with Police under the MH Act, with an average of 73 contacts during the period found for Indigenous men, or a rate of 3.5 events per year. Qualitative research investigating this phenomenon indicates that frontline police are perhaps less conscious of this disproportionate representation in their policing work, but that the issue is itself a significant concern as a broader programmatic challenge (Andrews & Baldry, 2013). A recent Australian study investigating the prevalence of mental illness in offenders detained by police found that almost half of the 690 detainees screened may have had a diagnosable mental disorder at the time of arrest (Forsyth & Gaffney 2012). Moreover, it is recognised that individuals with mental illness or psychiatric disorders present particular challenges to police work. These include recognition at the point of entry (Baksheev et al., 2011 and Ogloff et al., 2007), appropriate responding both in the community (Fry et al., 2002 and Godfredson et al., 2010) and in police custody (Baksheev, Thomas, & Ogloff, 2010), as well as referral and acceptance into other more appropriate settings such as psychiatric units (Lamb, Weinberger, & Gross, 2004). Similar research into the presence of cognitive impairment for those coming into contact with police is particularly scant. Whilst recent Australian research suggests that there is growing awareness amongst some police of the presentations associated with cognitive impairment (Spivak & Thomas, 2012), significant challenges remain in operational policing work, including communication with such individuals and gaining access to assistance and co-operation from other service providers (Henshaw & Thomas, 2012). The general difficulty in policing and cognitive impairment is evident in the lack of an evidence base and agreed frameworks for police recognition and response. There are particular problems for recognising cognitive disability and/or mental ill health for Indigenous individuals prior to entry into and once in the CJS. Simpson and Sotiri (2006) suggested that in Indigenous communities, especially in remote or rural areas, recognition of disability is unlikely both due to poor access to adequate services and to community resistance to such a label. The likelihood that disability will be recognised in the CJS is also low. Reasons include criminal justice system workers being more likely to connect problematic behaviour to the use of drugs and alcohol or even implicitly to the fact of Aboriginality rather than to disability, or that language and cultural differences may mask disability (Snoyman, 2010). This is combined with a general lack of training and skills in CJS workers including police and also the impact of time constraints inherent in the frontline and administrative work of police and other CJ agencies. The specific complex of vulnerabilities associated with being Indigenous, male, having a cognitive disability and/or a mental health disorder, and undertaking offending behaviour appears to signal a significant risk of frequent contact with police and police custody. That identification of this problem is difficult and that support and service delivery is not adequate for this specific group are not debated. However specific engagement with evidence which goes beyond simply the presence of mental disorder diagnoses and takes account of the multiple and complex circumstances that create and sustain pathways into police custody has not to date been the object of any in-depth investigation. The present study examined a selected cohort of Indigenous Australian men with complex needs who have been in custody in NSW. NSW is Australia's most populous state with seven and a half million residents (ABS, 2012a). Recent figures indicate that whilst Indigenous persons made up only 2.1% of NSW's general population, they represent 21% of the prison population, with a rate of imprisonment more than 13 times higher than the imprisonment rate for non-Indigenous Australians (Corben, 2010). Utilizing extant administrative data, the present study examined the cohort's interactions with criminal justice agencies and human services. Analysis explored the range of factors that appeared to bring this group into contact with the police and to lead to individuals entering into police custody. Previous evidence privileging the role of primarily diagnosed mental illness or cognitive disability might suggest that the presence of one or more of these diagnoses would be the key predictor of the frequency and intensity of police contact and custody. The present study aimed to take account of the multiple and interlocking disadvantages which characterize this group, and which precipitate their police contact. That is, rather than being diagnosis driven, the analysis sought to assess the complex picture presented by these individuals and ascertain which, if any, factors appeared to be strongly associated with high levels of police contact and custody.

This study has demonstrated that the presence of co-occurring mental illness fails to explain high levels of CJS contact for Indigenous Australian men with complex needs. So whilst mental ill health may be one intersecting factor in a compound picture of disadvantage, the presence of an inter-locking range of social, material and individual factors is more crucial in predicting police contact and custody. Four significant factors have emerged from this study that alone or in combination appear to impact on the frequency with which Indigenous males with complex needs experience police custody. These include young age at first police contact, instability in early life, the problematic use of alcohol and drugs and locational stability over time. The findings suggest that the consequences of having contact with police at a young age are higher rates of police custody over the life course. However, it is important to recognise that young age at first police contact is not necessarily itself the reason why an individual will experience higher rates of police custody. Rather, early police contact is an indicator that there are contextual factors which may signal the development of behaviours, associations and patterns that can lead to intensive contact with police and subsequently a higher frequency of police custody. This finding is in line with previous academic work indicating that young Indigenous Australians experience substantially higher contact with police and the CJS compared to non-Indigenous Australians (Allard et al., 2010 and Calma, 2008). The evidence presented here however indicates that this association is intensified for Indigenous males who also experience complex needs, indicating that this group is particularly at risk in a subgroup of young men who are already very vulnerable to enmeshment in the CJS. This suggests that very young offenders who present with complex contextual factors are a group which Police and other criminal justice agencies would do well to explicitly identify and work to divert to support agencies in order to prevent their likely progression to more frequent contact and custody over their lifecourse. The introduction of specialist training in policing of very young offenders, which combines knowledge and skills in recognising the hallmarks of complex social disadvantage is one positive step toward addressing the current apparent funnelling of these complex young people into the CJS. Specialist police liaison officers with skills in supporting the cognitive, social and cultural needs of such children and who are networked with human and community services, in particular the education system, will enable better engagement with them and more effective diversion away from the punitive criminal justice space and toward more supportive spaces in the community.