From prison to treatment
People who have been in prison often find the transition to treatment very difficult, and are often misunderstood by workers. But there are simple steps your service can take to support this transition.
Motivation and criminal justice clients
People who have a drug and alcohol issue and are in contact with the criminal justice system often have their motivation to change questioned when accessing treatment. Whether they are appearing at court for bail or sentencing, or applying for parole, there can be an assumption by service providers that a request to access treatment is a 'get out of jail free card' that can result in a person being denied treatment. However, research has identified that treatment outcomes for people mandated into treatment are no different to those who are not mandated (Ip et al 2008).
Institutionalised behaviours from time in custody can sometimes support a worker's belief that the person isn't motivated or doesn't have the 'right' motivation. This can influence a worker's decision not to allocate places in treatment to people who may be perceived as not committed to treatment. Coercion into treatment through the criminal justice system is just one factor among many that motivate people to decide to access drug and alcohol treatment.
A key role of drug and alcohol workers is to build clients' motivation. As motivation is a product of the relationship the person has with you as a worker, and with their family and community, you should build on any element of motivation that exists to support them in their process of change.
Access to treatment in prison
Often a person's motivation can be questioned if they haven't accessed drug and alcohol treatment programs while in prison. But this is not always a question of motivation, as a range of factors influence access to treatment services while in prison.
For some, prison can provide an opportunity to address their physical, mental and drug and alcohol needs. A range of drug and alcohol programs exist in NSW prisons, including Getting SMART, SMART Recovery maintenance groups, a pre-release three-month residential therapeutic program (Ngara Nura), POISE for women and Narcotics and Alcoholics Anonymous.
However, for many people accessing the appropriate program for their drug and alcohol issue/s is limited by the following factors: (CRC & NADA 2011):
- The availability of drug and alcohol programs and drug and alcohol workers differs across prisons in NSW.
- Not all programs are available in all prisons.
- Caseloads for welfare and drug and alcohol workers in prison are very high (sometimes up to 150 inmates per worker), making it difficult for even initial casework sessions to identify and facilitate client needs.
- The security classification of a prisoner determines which prison they are housed in, in turn determining what type of programs may be available to them (every prison has differing levels of prisoner classification).
- Rehabilitation programs are usually available only for longer-term prisoners (six months plus) and are not available in all prisons.
- People on remand (over 25% of prisoners) cannot access any prison programs.
- With up to 30,000 receptions (people being received into prison) each year, waiting lists to access drug and alcohol programs can be long. Prisoners can be moved to a different prison before their name comes up or moved before they complete a program.
For more information on prison programs and issues affecting program availability visit www.nobars.org.au/criminal-justice-system.html (go to the 'Prisons and Community Offender Management' page under 'About the Criminal Justice System').Back to top
Access to treatment on release from prison
Access to treatment on release from prison is critical for people with problematic alcohol and drug use:
- The first 72 hours after leaving prison is the danger time for relapse and overdose. People often don't realise their tolerance has dropped so they can fatally overdose on amounts they formerly would have handled.
- The first two weeks after leaving prison is the critical period for relapsing into drug and alcohol use. This can quickly lead to reoffending (e.g. petty theft, arrest for drunken behaviour) and a return to the criminal justice system.
- The first three months after leaving prison are critical for transitioning back to living in the community. In this period, a key issue is finding accommodation, as this provides a base from which people can get work, start to deal with their drug and alcohol issues and reconnect with society. For some people who have left prison, the transition back to society can be even harder than serving time.
Challenges on release - Getting out and getting treatment
There are many practical challenges faced by people on exit from prison. Many of these are beyond the person's immediate control and can affect their ability to access drug and alcohol treatment services in the community. Service flexibility in making small adjustments in intake, waiting list and admission procedures will support access to treatment, lower instances of relapse and save lives for people seeking treatment on release from prison.
These challenges include (CRC & NADA 2011):
Inability to plan for release when on remandOver 25% of prisoners in NSW are on remand, meaning they're awaiting trial or sentencing and have no identified fixed term of imprisonment (Corben 2011). People can be on remand for many months. When their matter is heard at court, they may be released directly from court back into the community (because of a finding of not guilty or time already served) and not transported back to prison to collect any personal belongings and money. Not knowing a release date poses many problems in planning for transition to the community, including not being able to advise a drug and alcohol rehabilitation service of a treatment start date.
Limited phone accessA range of factors affect a person's ability to access a phone and therefore maintain a place on a treatment service waiting list. Prisoners have phone cards limited to a few of programmed numbers that need to be prepaid to use. It's unlikely that a prisoner will be able to call a service on a specific day, at a specific time, to maintain a spot on a waiting list, due to prison lock down, lack of phones, and lack of access to phone money despite their motivation to access treatment on release.
Lack of personal identificationPeople released from custody often have no identification other than their MIN (Master Index Number) and prison discharge certificate. Any personal belongings not with them when taken into custody may have been lost or destroyed. Prison discharge papers are accepted as forms of valid identification by Centrelink and Housing NSW, but generally not by drug and alcohol treatment services. Gaining other forms of ID is costly and can take time.
Limited finances and accrued debtOn release, a person will be given any money left in their prison bank account. If they've been in prison for 14 days or more, they'll be eligible for a Centrelink crisis payment. This payment can provide some immediate financial relief, but it's issued as a one-week advance payment of the regular fortnightly payment. This means in the next fortnight the person will receive only one week of their Centrelink payment to cover a two-week period. Many people coming out of prison have accrued debt through ongoing direct debits, account fees, contract fees (e.g. phone, bank, credit card) or rental payments while in prison. This can make it difficult to afford basic needs before budgeting for the cost of upfront fees to enter drug and alcohol treatment.
Challenges getting from prison to drug and alcohol servicesMost NSW prisons are in regional areas with minimal and infrequent transport options. People can wait up to 24 hours in some areas for public transport after release. When a person leaves prison, Corrective Services will give them a ticket for direct travel back to the place of arrest only. These issues can often impact on a person being able to arrive at a treatment service by the cut-off date or time for admission.
Getting released directly from courtPrisoners can be released directly from court into the community. They're released in their prison 'greens' (clothing) with no belongings, no money and no identification. It's likely that nothing is in place for release, including accommodation, transport or medication. Emergency assistance can often be required for food, clothing, transport and accommodation.
Getting released from a correctional centreOn release from prison, a person will be given back any belongings they entered with and any money remaining in their prison bank account. Some people may have had an opportunity to discuss and plan for their release with prison welfare staff. However, even when a release date is known, effective post-release and transition planning are not always possible.
Transitioning from prison to treatment
The transition from prison to a drug and alcohol residential treatment setting can be challenging for the client, and can impact on staff and other clients in the service. These issues (referred to as the 'culture clash' and explored in more detail in Practice Tips for Workers) often stem from the institutionalisation experienced by the person while in prison.
The behaviours required to survive and stay safe in prison are contradictory to the behaviours required to receive treatment in a residential rehabilitation setting. For example, in prison a person doesn't share any personal information, thoughts or feelings, so that they can survive emotionally and physically. In a treatment setting, sharing information and feelings is an essential part of the therapeutic process and not doing so can lead to the person being described as unmotivated or non-compliant.
For service staff, the key is to understand the impact of time in prison on the person's behaviour and to help them make the cultural shift so they can experience a positive treatment outcome. The challenge for you as a worker is to not make assumptions that a person is unmotivated or non-compliant and that they can't change their prison behaviour. There are several small but important adjustments in your practice you can make to help clients remain in treatment and have successful treatment outcomes:
- Time. Give the person support and time to make the cultural shift.
- Acknowledgement. Identify and acknowledge with the client the difference in environments.
- Emotional safety. Help them feel safe to share in your program.
- Motivation. Be conscious of how easy it is to interpret the 'culture clash' as a lack of motivation to participate in the program, rather than the process of adjustment to a setting with different expectations and rules.
Find out more
CRC (Community Restorative Centre) and NSW Department of Corrective Services (2008) Planning Your Release: NSW Exit Checklist, CRC &NSW Department of Corrective Services: Sydney.
CRC (Community Restorative Centre) & NSW Department of Corrective Services (2007) Getting Out: Your Guide to Survival on the Outside, CRC & NSW Department of Corrective Services: Sydney.
These resources were designed for people exiting prison in NSW, but you may find them useful when working with people who've recently exited prison or are planning to go from prison to your service.
For more information on supporting clients at court refer to:
- CRC (Community Restorative Centre) (2011) Court Support Information, CRC: Sydney
- NADA (Network of Alcohol and Drug Agencies) and Legal Aid NSW (2012) Supporting Your Client in Court: Tips for Drug and Alcohol Workers, CRC: Sydney.
For more information on criminal justice clients and the criminal justice system visit www.nobars.org.au. This website has a range of information on the criminal justice system, including about working people in prison and people who've left prison, as well as links to research and other resources.Back to top