Australians with MHDCD in the CJS Project

The Mental Health Disorders and Cognitive Disabilities (MHDCD) in the Criminal Justice System (CJS) study involved a cohort of 2,731 people drawn from the 2001 NSW Prisoner Health Survey and from the NSW Department of Corrective Services Disability Unit Database. This project represented an innovative approach to researching complex populations by creating a detailed dataset on the lifelong criminal justice involvement for a cohort of offenders. This study used linked but de-identified extant administrative records from The ARC project, and had partnerships with and/or collaboration from all CJS agencies:

  • Corrective Services
  • Police
  • Juvenile Justice
  • Courts
  • Legal Aid and human service agencies
  • Housing
  • Ageing, Disability and Home Care
  • Community Services
  • Justice Health
  • NSW Health (giving access to Mortality, Pharmacotherapy and Admitted Patient databases).

Linking data across CJS sub-systems with Health and Human Services data revealed a coherent picture of the multiple factors contributing to the complicated pathways of people with MHDCD into and through the CJS. It also assisted in the development of new interventions to address offending, preventable health, duty of care and human rights needs.

The project developed a unique and innovative method of collecting, merging and analysing data relating to complex individuals and populations such as those who experience homelessness. Merging data across the criminal justice sub-systems and with relevant human services was seen as a highly beneficial way to provide a broad, trans-CJS and human service, dynamic understanding of persons with MHDCD's criminal justice involvement. It sidestepped the problem of using prospective, life-course or longitudinal tracking approaches, which potentially require up to 30 years or more and risk yielding limited numbers of persons in the groups of interest in any case.

The objectives of the project were to:

  • Construct a detailed dataset on the lifelong criminal justice involvement for a cohort of offenders identified by existing Justice Health data as having MHDCD, using linked but de-identified extant administrative records from all criminal justice agencies.
  • Integrate into the linked dataset this cohort's involvement with mental health, disability and public housing by drawing relevant data from these human services' developmental records.
  • Provide outcome data through the statistical analysis of these records, particularly in such key indices as:
    • Gender
    • Age
    • Type of first involvement
    • Numbers and types of cautions, arrests, court appearances and their outcomes
    • Community-based orders, including breaches and revocations
    • Incarceration/reincarceration
    • Sentence lengths
    • Bail conditions
    • Use of social housing, mental health and disability services
    • Levels of mortality.
  • Draw a purposeful stratified subset of 250 records to create "life-course criminal justice histories". These shed light on what actually happens at points of diversion or support, by inference what would have prevented entry to the CJS or contributed to a worsening of the situation.
  • Provide the basis for further targeted or specific secondary analyses of the linked data, some based on new directions for interventions with this population as identified in the initial study.
  • Identify current gaps in policy, protocols and service delivery and areas of improvement for the CJS, as well as relevant human service agencies in regard to people with MHDCD.
Chief Investigators

Professor Eileen Baldry

Emeritus Professor Leanne Dowse

Emeritus Professor Ian Webster

Partner Investigators

Tony Butler, Justice Health NSW

Simon Eyland, Department of Corrective Services NSW

Jim Simpson, Council for Intellectual Disability

Project Staff

Melissa Clarence (Data Manager)

The approach created for the project combined qualitative and quantitative methods to give a rich, detailed dataset large enough on which to perform robust statistical analyses, as well as to develop typical pathways. Such inclusive data linking or merging had not been attempted in Australia (nor internationally as far as could be ascertained). The project's MHDCD dataset was established using a confirmed cohort of interest compiled into a relational database using MS SQL server 2000. Each individual in the cohort was matched in each agency, and all matches for each person for that agency were added to the SQL database as an agency-specific subset. This allowed merging of data related to any individual from any subset with any other subset, with the potential to create both specifically related subsets of interest and overall administrative lifecourse pathways. The dataset was stored on a secure IT Services facility at UNSW Sydney and was not accessible to anyone other than the data manager.

One early theoretical direction taken was to explore the nature of the space in which these persons live. They appeared to be cycling in a liminal, marginalised, community/criminal justice space in which housing/homelessness is a key factor (Dowse, Baldry & Snoyman 2009). This situation is not just attributable to social exclusion; it is centred on the development of a lifespace straddling the community and criminal justice institutions, into which these persons are funneled.

It was theorised that this space is created through a confluence of personal, systemic and institutional circumstances that are poorly understood. It was hypothesised that if more timely, targeted and appropriate support, and more culturally appropriate support for Indigenous persons (24% of the cohort), had been given at a variety of particular points such as early school education, early family support, childhood disability support, and so on, as revealed in the pathways, then there would have been a reduced chance of eventual imprisonment.

  • Those with complex needs (dual/comorbid diagnoses and multiple combinations) have significantly earlier police events, higher juvenile justice involvement, offences, convictions and imprisonments than the single and no-diagnosis groups.
  • Almost all of the MHDCD group were clients of Legal Aid.
  • Those with cognitive impairment in combination with any other disability had the highest rates of CJS involvement.
  • Those with MHDCD have experienced very poor school education and low disability service recognition and support; there has been a strong housing response but further analysis is being undertaken to determine why tenancies failed.
  • One one quarter of those with intellectual disability and virtually none of those with borderline functioning were clients of Ageing, Disability and Home Care (ADHC). Of those clients of ADHC, 79% became clients after going to prison. Those becoming clients of ADHC after going to prison then fared significantly better than previously, especially in regard to stable supported housing, and than their peers who were not ADHC clients.

Corrective Services NSW

Juvenile Justice NSW

The NSW Police Force

Justice Health

NSW Bureau of Crime Statistics & Research

Legal Aid NSW

NSW Community Services

Ageing Disability & Home Care NSW

Housing NSW

Health NSW

Reeve, R., Martin, C., McCausland, R., Pawson, H., & Baldry, E. (2023) ‘Evaluating the impact of public housing after prison for a sex offence’, Housing Studies forthcoming (ARC DP190101944 ‘Housing Sex Offenders’ Hal Pawson, Eileen Baldry (2019-2020)).

Martin, C., Reeve, R., McCausland, R., Baldry, E., Burton, P., White, R., & Thomas, S. (2021) Exiting prison with complex support needs: the role of housing assistance, AHURI Final Report No. 361, Melbourne: Australian Housing and Urban Research Institute Limited.

Baldry, E., McCausland, R., Dowse, R., & McEntyre, E. (2015) A Predictable and Preventable Path: Aboriginal people with mental and cognitive disability in the criminal system, Sydney: UNSW Sydney. ISBN: 978-0-9873593-9-1

Baldry, E., Dowse, L., & Clarence, M. (2013) People with Mental Health Disorders and Cognitive Disabilities in the Criminal Justice System – Impact of Housing NSW interventions and contacts with social housing system, Housing NSW.

McCausland, R., Baldry, E., & PwC (2013) People with mental health disorders and cognitive impairment in the criminal justice system Cost-benefit analysis of early support and diversion, report for AHRC.

Baldry, E., Dowse, L., & Clarence, M. (2012) Mental Health Frequent Presenters to Police. ISBN:978-0-9873593-0-8

Baldry, E., Dowse, L., & Clarence, M. (2012) People with intellectual and other cognitive disability in the criminal justice system, report for NSW Family and Community Services Ageing, Disability and Home Care.  

Baldry, E., Dowse, L., McCausland, R., & Clarence, M. (2012) Lifecourse institutional costs of homelessness for vulnerable groups, report for FaHCSIA, funded by FaHCSIA Homelessness study grant. ISBN 978-0-9873593-1-5 

Baldry, E., Dowse, L., & Clarence, M. (2011) Mental Health Frequent Presenters to Emergency and Mental Health Services in 2005 – Stage 1 Final Report, Sydney: UNSW Sydney.

Fisher, D., Clarence, M., Dowse, L., & Baldry, E. (2011) People with problematic alcohol use, mental health disorders and cognitive disabilities in the criminal justice system: Cohort Report, Foundation for Alcohol Research and Education.

Fisher, D., Clarence, M., Dowse, L., Baldry, E., & McCausland, R. (2011) Protocol and Training Resource: researching people with complex needs using data linkage, Foundation for Alcohol Research and Education.

Baldry, E., Dowse, L., & Clarence, M. (2010) Lifecourse Pathways for People with Mental Health Disorders and Cognitive Disability into the Criminal Justice System: Background paper, Sydney: Australasian Juvenile Justice Administrators.

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People with intellectual and other cognitive disability in the criminal justice system December 2012