Stephane M. Shepherd

Cultural ‘Inclusion’ or Institutional Decolonisation: How should prisons address the mental health needs of Indigenous prisoners?:

Australian & New Zealand Journal of Psychiatry, 50(4) A recent report Keeping Our Mob Healthy In and Out of Prison (Halacas and Adams, 2015) detailed the shortage of culturally appropriate mental health care available to Aboriginal people in custody. While it is important that these critical gaps in service delivery are documented and emphasised, this particular issue is not a new phenomenon. The capacity of mental health workers to confidently engage, interact with and proficiently assess Aboriginal clients is currently inadequate. The longstanding dissatisfaction of Kooris in custody with culturally insensitive mental health service provision is similarly outmoded information. An intense mistrust of the ‘system’ and by extension, mental health services prevails; the perception of service provider racism subsists and ceaseless criticisms of clinicians ignorant of or incapable of understanding and handling aboriginal specific issues such as grief, disconnection, powerlessness, discrimination and intergenerational trauma endure. Again, these examples are not revelations, but are seemingly immutable attributes of a system ineffectively delivering equitable mental health care to people who have already faced long periods of social injustice. The unaddressed health needs of Aboriginal people subject to the criminal justice system are well documented (Heffernan et al., 2014) and have deleterious consequences. Whether these dilemmas are suitably acknowledged or well understood by both non-Aboriginal clinicians and the associations that represent them is unclear. However, the emergence of Reconciliation Action Plans and Aboriginal health frameworks and strategies across various health and government sectors are positive steps forward in addressing pervasive inequities and improving the mental health and wellbeing of Aboriginal offenders in custody and in the community. The recommendations in such frameworks stress the need for greater partnerships with the Aboriginal community, the hiring and retention of more frontline Aboriginal health professionals and improved transitional care and cultural training for nonAboriginal staff. However, whether such reports and frameworks will lead to demonstrable change remains to be seen. The Royal Commission into Aboriginal Deaths in Custody outlined similar recommendations back in 1991. The fact that ‘new’ reports are releasing similar recommendations to those proposed 25 years ago either demonstrates ongoing systematic unresponsiveness or ineffectual responses to recommendations. Teasing out the reasons for this apparent inactivity is complex and necessitates closer analysis. Aboriginal mental health initiatives are often afflicted by absences of program fidelity, long-term institutional support, ongoing funding, crossorganisational communication and appropriate evaluation (Dudgeon et al., 2014). Generic mental health services face additional difficulties as providers grapple with Aboriginal conceptualisations of mental health. Few attempts have been made to remedy this widespread deficit despite regular feedback that Aboriginal clients prefer services attuned to their cultural needs. Efforts to systematically educate forensic mental health workers in cultural competency and arrange for culturally tailored therapeutic programs are typically hindered by both institutional constraint and an unavailability of appropriately resourced cultural service providers to deliver intensive training of the magnitude required. When cultural training for non-Indigenous health staff has been rolled out, it is often ephemeral, impractical, and it is not made clear to staff as to why and how such training is necessary. When offender rehabilitation programs tailored to Aboriginal clients are ‘implemented’, they are often inconsistently presented, unavailable to numerous clients, fragmentary and rarely afforded ongoing institutional support. Poor implementation in these circumstances is unlikely due to ineffectual programs with unrealistic objectives. It is a likely reflection of the shortcomings and culture of the institutions responsible for prisoner health and wellbeing. The lack of improvements in health outcomes may well suggest that unless Cultural ‘Inclusion’ or Institutional Decolonisation: How should prisons address the mental health needs of Indigenous prisoners?

The Role of Protective Factors and the Relationship With Recidivism for High-Risk Young People in Detention:

This study sought to ascertain the prevalence of protective factors and association with client risk level and future offending in a sample of 177 Australian youth in detention. The Protective Domain on the Structured Assessment of Violence Risk in Youth (SAVRY) instrument was utilized to identify protective items in the cohort. The mean number of protective factors for the entire sample was low (under two) with higher risk clients averaging less than one current protective item. Although the number of protective factors engendered criminal desistance, this effect did not extend to the highest risk young offenders. Clients who re-offended were significantly less likely to present with five out of the six SAVRY protective items. In addition, pro-social involvement and school engagement had the strongest associations with non re-offense. Clinical implications for client risk management are discussed.

Does the Youth Level of Service/Case Management Inventory Generalize Across Ethnicity?

Few studies have explored the cross-cultural utility of youth violence risk instruments. Moreover both the discrimination and calibration performance indicators of such instruments are rarely investigated. This study aimed to address both gaps in the literature by exploring the predictive validity of the YLS/CMI instrument for an Australian multi-ethnic cohort of young offenders in custody. The YLS/CMI total score was able to discriminate between re-offenders and non-reoffenders for the overall sample; however, a breakdown across ethnicity showed only strong effects for Australian English Speaking Background youth. Despite an inability to distinguish re-offenders from non-reoffenders for both Culturally and Linguistically Diverse and Indigenous youth, the instrument was able to accurately predict recidivism for high-risk youth for all ethnic groups. Findings highlight the importance of adopting both calibration and discrimination indicators when assessing predictive validity.

Finding Color in Conformity A Commentary on Culturally Specific Risk Factors for Violence in Australia

This article outlines the current utility of Indigenous culturally specific risk factors for violence and the ramifications for cross-cultural risk prediction. The Indigenous culturally specific violence risk factor literature has provided a rich body of contextual information outlining Indigenous patterns of criminal behaviour. This information has the capacity to facilitate offender responsivity and treatment targets in addition to assisting clinicians identify the presence of risk markers among Indigenous clients. However, if intended for inclusion in risk prediction models, culturally specific risk items then require further quantitative analysis to establish robust associations and probability estimates for recidivistic outcome.

Violence risk instruments may be culturally unsafe for use with Indigenous patients.

Objective: Violence risk assessment assumes a critical medico-legal role addressing offender/patient needs and informing forensic mental health decision making. Yet questions remain over the cross-cultural applicability of such measures. In their current form, violence risk instruments may not reflect the unique life and cultural experiences of Indigenous Australians rendering them culturally unsafe. Conclusions: To realize equitable forensic assessment, it is necessary to ascertain whether there are cultural differences across risk factors for violence and that risk instruments are validated as culturally appropriate. Greater cross-cultural rigour in forensic mental health risk assessment, research and practice is proposed.

Are Youth Violence Risk Instruments Interchangeable? Evaluating Instrument Convergence in a Sample of Incarcerated Adolescent Offenders

In light of the growing number of youth violence instruments at a clinician’s disposal, this study sought to investigate the interchangeability of two widely validated adolescent violence risk instruments. The concurrent and incremental validity of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) were evaluated in a young Australian custodial population. A significant degree of dimensional construct overlap between instruments was discovered. Both measures were similarly found to be moderately predictive of general and violent recidivism. Findings indicate that the instruments are potentially substitutable when used to evaluate future violence in these settings. Clinical implications for risk assessment practice are discussed.

The utility of the psychopathy checklist: Youth Version (PCL: YV) and the Youth Psychopathic Trait Inventory (YPI)-is it meaningful to measure psychopathy in young offenders?

This study examined the convergent validity of 2 youth psychopathy instruments, the Psychopathy Checklist: Youth Version (PCL: YV) and the Youth Psychopathic Trait Inventory (YPI) and their relationship with problem behaviors and recidivism in an Australian sample of young offenders in custody. The PCL: YV demonstrated a capacity to identify severely antisocial youth; however, the tool was unable to differentiate between potentially psychopathic and nonpsychopathic antisocial youth. The YPI was receptive to a wide variety of problem behaviors which precluded the unique identification of core psychopathic traits in the sample. Both instruments were unable to meaningfully distinguish between recidivists and nonrecidivists. As such, the PCL: YV and the YPI demonstrate limited utility for antisocial young offenders in custody. Further research on the durability and developmental manifestation of psychopathy in adolescents is necessary before these instruments are employed in similar contexts. Implications for the clinical use of psychopathy measures are discussed.

Maori and Pacific Islander overrepresentation in the Australian criminal justice system—what are the determinants?

ABSTRACT Maori and Pacific Islanders are heavily overrepresented in the Australian criminal justice system. Despite these circumstances, little is known about the risk factors uniquely underpinning their involvement in criminal behavior. A review of the literature discovered that acculturation stressors, widespread educational disengagement, family and cultural disintegration, job insecurity, economic disadvantage, and social service inaccessibility were prevalent issues among both young Maori and Pacific Islander offenders and their communities. The findings signal the need for culturally tailored interventions that divert young Maori and Pacific Islanders from law-breaking behaviors while reconnecting them with family, culture, education, employment, and prosocial activities. Local efforts to address this significant gap in service delivery have been made and are discussed within.

Aboriginal prisoners and cognitive impairment: the impact of dual disadvantage on Social and Emotional Wellbeing

BACKGROUND Negligible information is available regarding the Social and Emotional Wellbeing (SEWB) needs of Aboriginal Australian individuals in custody with cognitive impairment. This is problematic given that Aboriginal people with cognitive impairment often experience dual disadvantage in the context of the justice system. This study sought to ascertain the relationship between cognitive impairment and mental health/cultural needs (SEWB) Aboriginal and Torres Strait Islander people in custody. METHOD A sample of 122 Aboriginal and Torres Strait Islander people were administered a culturally themed semi-structured questionnaire in custodial settings in Victoria, Australia. The questionnaire included measures of cognitive impairment, SEWB and forensic needs. Analyses were performed to determine differences in the presence of SEWB and unmet custodial needs by level of cognitive impairment. RESULTS Findings revealed a diminished level of wellbeing for cognitively impaired participants across several factors. Cognitive impairment was associated with poorer coping mechanisms, additional experiences of racism, difficulties handling emotions, discomfort around non-Aboriginal people and reduced access to meaningful activities in custody. All participants regardless of their level of impairment recognised the importance of cultural engagement; however, cognitively impaired participants had greater difficulty accessing/practicing cultural activities. CONCLUSIONS Culturally responsive disability assistance should be available at all phases of the justice system for Indigenous people with cognitive impairment to ensure that equitable care is accessible and needs are addressed.

Assessing the mental health, substance abuse, cognitive functioning, and social/emotional well-being needs of Aboriginal prisoners in Australia

This study sought to identify the incidence of mental illness, substance misuse, and cognitive impairment among a representative cohort of 123 Aboriginal people in custody in Australia. In addition, the study measured levels of social and emotional well-being (SEWB) and considered the interrelationship of mental health issues, SEWB, and unmet needs. Both male and female Aboriginal prisoners were found to have high rates of mental health, substance abuse, and cognitive functioning needs that were heavily contextualized within perceptions of their own SEWB. Findings provide important information with regard to the specific needs of Aboriginal people in custody. Implications for the development and implementation of effective, culturally themed best practice programming for this population are discussed.