2.2.2 Findings of the MHDCD study
Of the full cohort of 2,731 people, the primary diagnosis for 25% (n=680) is recorded as intellectual disability (ID), for 29% (n=783) it is borderline intellectua disability (BID) and for 35% (n=965) it is a mental health disorder (MHD). Substance abuse disorder is diagnosed in 47% (n=1276) of the cohort[1] and for 12% (n=339) no diagnosis is recorded (Baldry, Dowse, Xu & Clarence 2013, 7). There are overall 1463 people in the cohort with cognitive disability (CD):[2] The majority of the 465 (68%) individuals who have ID also have other MHD or AOD diagnoses (identified here as complex needs) while 215 (32%) have no other diagnosis. Of those 783 (54%) individuals in the BID range, 517 (66%) have additional MHD or AOD diagnoses (complex) and 266 (34%) have no other diagnosis. Taken together these figures indicate that approximately two-thirds (67%) of those with a cognitive disability have complex needs.
Men make up the majority of the MHDCD cohort at 89% (n= 2,431), with a smaller proportion of 11% (n= 300) being women. In terms of Indigenous representation 25% (n=676) of the total cohort are Indigenous. Of these individuals 86% (n=583) are men (21% of the whole cohort) and 14% (n=93) are women (3% of the whole cohort). A total of 91% of the Indigenous sub-cohort have at least one identified cognitive disability or mental health diagnosis, with most having complex needs – for example, of those with MHD, 77% have AOD and 36% also have a CD.
Findings from the MHDCD study revealed significant systemic and social disadvantage. In relation to educational attainment, people with mental and cognitive impairment were found to have achieved lower levels of education when compared with the already low levels of attainment found in the general prison population, with those with some form of CD having the worst levels. The study also found a very high rate of persons in prison with ID and BID not receiving a disability service and in fact for a significant proportion, their cognitive impairment was first diagnosed whilst in prison. The proportion of the cohort who had been in out-of-home-care (OOHC) at some time in their childhood was also found to be significantly higher than the general population and to have significantly higher rates of CD and complex support needs.
Analysis of the MHDCD Dataset reveals how individuals have been shaped and directed into particular pathways by failures and deliberate arrangements in policy and program approaches and systems. There is evidence of avoidance by human service agencies of working with children and adults with complex needs resulting in criminal justice services, particularly Police, being used as frontline child protection, housing, mental and cognitive disability services (Baldry, Dowse, McCausland & Clarence, 2012, 7).
The needs of Indigenous Australians were found to be particularly acute and poorly serviced by past and current policy and program approaches. Indigenous persons in the MHDCD Dataset have the highest rates of complex needs (multiple diagnoses and disability) and Indigenous women with complex needs have significantly higher convictions and episodes of incarceration than their male and non-Indigenous peers. They experience multiple, interlocking and compounding disadvantageous circumstances. This analysis provided the imperative for seeking to undertake further quantitative and qualitative investigation of the pathways and experience of Indigenous persons with MHDCD in the criminal justice system.
Notes:
[1] Note the substance abuse and mental health groups overlap with each other and with the ID and BID groups.
[2] Cognitive disability (CD) ie intellectual disability (ID), borderline intellectual disability (BID) and either of these with other diagnoses (complex) and acquired brain injury (ABI) with either below 70 or between 70 and 80 IQ.
