What works for integration after prison release

Transcription

1 CARE Quality and continuity of care for drug users in prisons What works for integration after prison release Findings from a European study Heike Zurhold, Germany

2 2 Study design implemeted by Gergely Fliegauf (HU), Andrej Kastelic, Nusa Segrec (SI), Diana Castro (PT), Gerasimos Papanastasatos (GRE), Heike Zurhold (DE) Background Research indicates that integration after prison release is not associated with the length of time living in community Ongoing care and adequate preparationion for release has shown to facilitate community transition and prevent relapses Aim of the study To evaluate key interventions provided in prison and after release and their impact on integration To examine the living conditions after release and compare the prisoners stage of integration Inclusion criteria Method Adults (18 years old), have or had drugs problems related to opiates, cocaine or amphetamines Having been released from prison since the maximum period of 10 weeks Structured questionnaire for data comparison self administered or face to face Inclusion of 50 participants in each country basically in big cities, except Slovenia Data collection Over a period of one year ( to ) Access to participants through a variety of drug treatment programmes, social services for offenders or marginalised individuals, probation services

3 The participants 3 Greece Germany Hungary Portugal Slovenia Total Statistics Number of participants Gender (male) 28 (80%) 20 (74%) 32 (62%) 44 (88%) 24 (86%) 148 (77%) p<0.05 Age (mean) p<0.01 Days since prison release (mean) Lengths of last prison stay in months (mean) Frequency of imprisonments (mean) Overall duration of imprisonments in months (mean) p< p< p< p<0.05 The participants in the countries/cities differ significantly in their age, the period of release and their prison burden

4 Utilisation of drug treatment and harm 4 reduction (n=192) Drug treatment p<0.001 Harm Reduction p<0.05 Drug treatment = detoxification, OST, TC, individual drug counselling and outpatient treatment Harm reduction = psychosocial support, overdose prevention, relapse prevention, health education, NSP

5 Support for community 5 transition Greece Germany Hungary Portugal Slovenia Total Statistics Was prepared for release (n=189) Released on probation (n=188) Utilised probation service after release (n=75) 36% 30% 14% 18% 54% 27% p< % 31% 37% 30% 39% 40% p< % 100% 32% 47% 18% 39% p<0.01 Most drug users have not been prepared for release despite treatment participation Most of those being released on probation (n=75) did not use a probation service

6 6 Use of illicit substances since release (n=168) Heroin, cocaine/crack, amphetamines, crystal, non prescribed substances cannabis was not included Results for use at the 1. day of release are significant (p=0.001)

7 Offenses since release (n=192) 7 The country differences in offending are statistically significant (p<0.05)

8 Main source of income after release (n=172) 8 Legal only covers salary from employment, unemployment benefit and welfare benefit The country differences are statistically significant (p<0.001)

9 9 Three groups according to their stage of integration Integration criteria: substance use and offenses Group 1 integrated No substance use or only use of legal substances (prescribed benzodiazepines, OST and/or alcohol) and no offenses since release (n=47; 25%) Group 3 non integrated Use of illicit substances and offending since prison release. Offending does not include drug possession only but all other types of offenses such as drug selling, thefts (n=60; 31%) Group 2 undetermined All those drug using offenders who did not meet the criteria of group 1 or 3 (n=85; 44%)

10 Groups according to the countries (n=192) 10

11 11 Group comparison: Drug treatment utilisation Treatment utilisation seems not to be most important for the community integration

12 Group comparisons significant results 12 (p<0.005) (p<0.01)

13 Group comparisons significant results 13 (p<0.05) (p<0.001) All: (p<0.001)

14 14 Association with the stage of integration Significant correlations Having been prepared for release Having a legal income Having a stable housing Having a partner who not uses drugs Self assessment of having little drugs problems and legal problems having no major housing problems No associations found for Life time duration and frequency of imprisonments Having mental health problems Age of participants Age of onset of regular drug use Having a job, employment after release Utilisation of any drug treatment before/after release

15 Conclusions 15 Only a minority of the respondents can be regarded as successfully integrated (n=47; 25%) Proportion of non integrated is highest in Germany (41%) and Hungary (50%) Preparation for release is associated with better stage of integration (but not the utilisation of drug treatment in or after prison) Transition from prison to the community is strongly affected by economic and social stability Imprisonment often results in the loss of housing, the breakdown of relationships, and the loss of legal sources of income/welfare benefit Criminalisation of drug users is reflected in frequent imprisonments and long periods of prison stays The sample of the study was heterogeneous across the countries Selection bias especially in Slovenia and Hungary It was difficult to reach 50 participants according to inclusion criteria