How the prison-to-community transition risk environment influences the experience of men with co-occurring mental health and substance use disorder
| Published date | 01 March 2017 |
| Date | 01 March 2017 |
| Author | Michelle Denton,Michele Foster,Robert Bland |
| DOI | 10.1177/0004865815620703 |
| Subject Matter | Articles |
Australian & New Zealand
Journal of Criminology
2017, Vol. 50(1) 39–55
!The Author(s) 2015
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DOI: 10.1177/0004865815620703
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Article
How the prison-to-community
transition risk environment
influences the experience
of men with co-occurring
mental health and
substance use disorder
Michelle Denton
University of Queensland, Brisbane, Australia
Michele Foster
University of Queensland, Brisbane, Australia
Robert Bland
Australian Catholic University, Brisbane, Australia
Abstract
Previous research has established that people with severe mental illness and co-occurring
substance use disorder leaving prison have multiple and complex health, social and economic
challenges. How the criminal justice and mental health systems influence the individual prison-
to-community transition experience of this population is less well understood. This paper
draws on unique qualitative data from a study of 18 men with co-occurring severe mental
illness and substance use disorder leaving prison in Queensland, Australia. A repeat in-depth
interview method was used to explore the experiences of the men in prison just prior to
release and at two points post-release. Two themes are discussed from analysis of interviews:
‘‘risk behaviour and relapse’’ and ‘‘once a criminal always a risk’’. The findings suggest that
individual risk behaviour is structured within a transition risk environment that reduces
individual agency, thus facilitating a vicious cycle of release, relapse and reincarceration.
Keywords
Community, mental illness, prison, risk behaviour, risk environment, substance use, transition
Introduction
Prison-to-community transition is an important opportunity for health, social and eco-
nomic interventions to help mitigate the challenging circumstances that typically face
prisoners as they leave custody (Cutcher, Degenhardt, Alati, & Kinner, 2014; Kinner &
Corresponding author:
Michelle Denton, University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia.
Email: m.denton@uq.edu.au
Wang, 2014; Petersilia, 2003). People with severe mental illness are overrepresented in
prison and it is estimated that up to 70% of them have a co-occurring substance use
disorder (Swartz & Lurigio, 2007). This population face additional difficulties during
transition compared to their non-mentally ill counterparts (Borzycki, 2005; Cloyes,
Wong, Latimer, & Abarca, 2010; Cutcher et al., 2014; Draine, Wolff, Jacoby,
Hartwell, & Duclos, 2005; Kouyoumdjian et al., 2015). The primary focus for interven-
tions with this group has traditionally been on mental health treatment in prison and
continuity of care into the community (Skeem, Manchak, & Peterson, 2011; Wolff et al.,
2013). However, current approaches are showing only modest results and are not sig-
nificantly reducing poor post-release health and social outcomes, post-release death and
the ongoing overrepresentation of people with a mental illness in prison (Cutcher et al.,
2014; Wright, Zhang, Farabee, & Braatz, 2014).
Prior research has established that the majority of prisoners returning to the commu-
nity face multiple challenges including poor housing, unemployment, social exclusion,
and complex health and substance use problems (Baldry, McDonnell, Maplestone, &
Peeters, 2006; Graffam, Shinkfield, & Hardcastle, 2008). Of great concern is the extre-
mely high risk of death in the weeks and months post-release (Chang, Lichtenstein,
Larsson, & Fazel, 2015; Spittal, Forsyth, Pirkis, Alati, & Kinner, 2014). People with
mental illness and co-occurring substance use disorder have all of these problems with
the addition of increased health needs, often accompanied by limited coping strategies
(Draine et al., 2005). This population also frequently experience lower levels of access to
family and social support than their peers (Baillargeon, Hoge, & Penn, 2010) and are
more likely to experience homelessness and unemployment (Baldry et al., 2006; Draine,
Salzer, Culhane, & Hadley, 2002). They are also more likely to return to prison earlier
than other ex-prisoners (Cloyes et al., 2010), have a history of previous incarceration
(Baillargeon, Binswanger, Penn, Williams, & Murray, 2009), to serve short sentences for
misdemeanours or technical violation of parole conditions (Lovell, Gagliardi, &
Peterson, 2002), often interspersed with mental health related hospitalisations (Alan,
Burmas, Preen, & Pfaff, 2011). It has been suggested that people with severe mental
illness can be caught in a ‘‘revolving door’’ (Baillargeon et al., 2009) and that ‘‘mentally
ill offenders are often trapped in a cycle of petty crime, incarceration, release, homeless-
ness and reimprisonment’’ (Thompson, 2008, p. 103).
Criminal justice and to some extent mental health systems in Western jurisdictions
including Australia have focussed attention over the last two decades on individual risk
factors which tend to minimise, or ‘‘conveniently disappear’’ the influence of the broader
structural context (Hannah-Moffat, 2005, p. 43). Individual risk assessment, risk pre-
diction, risk classification and risk management have been the dominant discourses with
many theorists and researchers supporting and defending the approach as scientifically
rigorous and evidence based (Andrews & Bonta, 2010; Wolff et al., 2013). Policy frame-
works in criminal justice systems are strongly based on individual risk considerations,
primarily aimed at improving community safety and specifically focussed on the preven-
tion of re-offending (Hannah-Moffat, 2005). Parole revocation processes and resources
for support services during transition are frequently aligned with this perspective
(Cunneen et al., 2013; Ward, Yates, & Willis, 2012). Moreover, the focus for prisoners
with severe mental illness has been primarily on the provision of individual treatment by
mental health services in prison and transfer of this care into the community rather than
40 Australian & New Zealand Journal of Criminology 50(1)
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