Queensland Centre for Mental Health Research, Archerfield, QLD, Australia.
School of Public Health, The University of Queensland, Herston, QLD, Australia.
Aust N Z J Psychiatry. 2021 Jul;55(7):678-686. doi: 10.1177/0004867420985247. Epub 2021 Jan 21.
The relationship between psychosis and contact with the criminal justice system for Indigenous people living in rural and remote areas is not well understood. In this study, the authors examine patterns of incarceration among Indigenous people living with psychosis in Cape York and the Torres Strait over two decades.
Data were collated from a clinical database of complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients with a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Corrections Service database. Descriptive statistics were calculated to compare characteristics between those incarcerated and those not incarcerated during the study period and to quantify patterns of incarceration including types of offences, time spent in custody and frequency of incarceration. Multivariate Cox regression analysis was used to assess associations between reported variables and 'first incarceration'.
Forty-five percent of Aboriginal patients ( = 116) were incarcerated compared with 31% of Torres Strait Islanders ( = 41) ( = 0.008), and the proportion of males incarcerated (51%, = 141) was approximately twice that of females (24%, = 35; = 0.001). A cluster of first incarcerations were observed in close time proximity to diagnosis of psychosis. Individuals who had a history of both alcohol and cannabis use had approximately two times higher risk of being incarcerated following positive diagnosis compared to those without a history of substance use (hazard ratio = 1.85; 95% confidence interval: [1.08, 3.17]; = 0.028). Males accounted for approximately 85% ( = 328) of sentences. The most common most serious offence was causing physical harm to others (assault - = 122, 31%).
Our study found that for Aboriginal and Torres Strait Islander people with a psychotic disorder in North Queensland, criminal justice responses with resultant incarceration occurs frequently. Access to appropriate mental health services and diversion options for Indigenous Australians with psychosis should be a key public health and justice priority.
居住在农村和偏远地区的土著居民的精神病与与刑事司法系统的接触之间的关系尚不清楚。在这项研究中，作者检查了 20 多年来约克角和托雷斯海峡地区患有精神病的土著居民被监禁的模式。
从 1992 年至 2015 年的完整精神病记录临床数据库中收集数据，从偏远地区心理健康服务中提取所有患有精神病障碍的土著患者的数据，并与昆士兰惩教服务数据库相关联。计算描述性统计数据以比较研究期间被监禁和未被监禁的患者的特征，并量化监禁模式，包括犯罪类型、监禁时间和监禁频率。多变量 Cox 回归分析用于评估报告变量与“首次监禁”之间的关联。
45%的土著患者（ = 116）被监禁，而托雷斯海峡岛民的比例为 31%（ = 41）（ = 0.008），被监禁的男性比例（51%， = 141）约为女性的两倍（24%， = 35； = 0.001）。一系列首次监禁发生在精神病诊断的时间接近。与没有药物使用史的人相比，有酒精和大麻使用史的人在阳性诊断后被监禁的风险大约高出两倍（风险比 = 1.85；95%置信区间：[1.08, 3.17]； = 0.028）。男性约占 85%（ = 328）的刑期。最常见的最严重的罪行是对他人造成身体伤害（袭击- = 122，31%）。
我们的研究发现，在北昆士兰州，患有精神病的土著和托雷斯海峡岛民中，刑事司法反应导致监禁的情况经常发生。为患有精神病的澳大利亚土著人提供适当的心理健康服务和转移选择应成为公共卫生和司法的重点。
