On this page
What do we mean by breaking the cycle?
Who are we talking about?
'Roy' - a story
Why has it been so tough?
The research tells us
What's important for these people?
'Matthew' - a story
How we can make things better
I can get there
The idea of breaking the cycle isn’t limited to one type of person or one age group living one kind of mental health experience.
It’s about finding ways to remove barriers that stop any of us stepping off a path we’re stuck on that keeps compounding the risks we face. It’s also about making sure we can get onto a new path that lets us have hope and get what we need to build a better life.
Focusing on breaking the cycle gives us the opportunity to create integrated responses across community, mental health and social services and the justice system in ways that address the causes of the difficulties people experience.
Prevention and early intervention are important but so is finding ways for people already well down a difficult path to get off it and live successfully in the community.
Most people struggling to break the cycle have a background of deep social disadvantage, poverty, unstable parental relationships, and drug and alcohol misuse. This can start at the beginnings of life, for example with the impact of foetal alcohol syndrome.
Combinations of mental health and drug and alcohol issues plus antisocial or criminal behaviour are common features in the lives of children, young people and adults stuck on this path.
These issues often complicate and compound one another. Mental illness or drug or alcohol problems may increase the likelihood of offending and being apprehended, while offending behaviour diminishes positive social connections or access to services that could address the mental health or drug and alcohol issues.
Families are often direct victims of offending behaviour, for example, domestic violence. They can also suffer from the disruption and instability caused by the imprisonment of a parent, leading to insecure housing or homelessness.
Almost half of all NSW inmates are parents of a child younger than 16 and about 18% had a parent in prison during their childhood.
For a small but important cohort of children, the risk of future offending can be identified early as they are at-risk children known to social sector agencies.
It’s important to note that people with mental illness are disproportionately represented in the criminal justice system even though having a mental illness doesn’t mean you will offend.
Roy is a man in his early 20s whose behaviour began troubling his parents in his late teens. After completing high school he had the same job for a few years and seemed to be doing OK.
But he started missing work and was cautioned by his employer about his poor performance. He began drinking heavily and was three times charged with driving under the influence of alcohol, risking the loss of his licence and job.
Roy’s parents encouraged him to see the family GP to get help for his drinking. Roy declined. He was often argumentative and volatile with his parents, which made them concerned for his and their safety. They considered asking him to leave the house if he didn’t change his behaviour. He came to police attention again after hitting a stranger in the city in an unprovoked attack. He claimed the stranger had been saying bad things about him and was part of a conspiracy to ruin his life.
While in remand, a mental health assessment led to a diagnosis of paranoid schizophrenia and Roy was transferred to a prison hospital. His heavy alcohol use seemed to be a form of self-medication. Roy responded quickly to antipsychotic medication but there was concern he wouldn’t continue his medication or engage with services once back in the community.
The different, sometimes incompatible, philosophies of the health and justice systems, as well as the paucity of services bridging the two, make this a particularly tough journey.
While there’s been some progress in establishing diversion pathways for adults and in providing mental health services – including for treatment of severe mental illness for people on long prison sentences – there are significant gaps in addressing mental health issues among people on shorter sentences, people on remand, or the much larger population of people on community-based sentences.
Breaking the cycle is more complicated for people with entrenched or unresolved issues, such as unemployment or drug and alcohol misuse.
Illicit drug and high-risk alcohol use are the most important predictors of prosecution and imprisonment.
For those who end up in the justice system, there are other barriers to a successful re-entry to the community.
For example, prisoners – whose health tends to be worse than that of the general population – may not have access to appropriate medications, whether for physical or mental illness. There’s no continuity once they are back in the community.
Further, a pattern of offending and imprisonment can continue into the next generation because services may find it difficult to respond appropriately to children who have been involved with parents in criminal behaviour.
- 50% of men and 67% of women are unemployed in the 6 months before incarceration, with 30% of men and 44% of women unemployed for 5 years or more
- 63% of men and 40% of women were drinking alcohol at hazardous/harmful levels in the year before prison
- 60% of women and 37% of men in NSW prisons were emotionally, psychologically or sexually abused before the age of 16
- Nearly 1/3 of adult male inmates were placed in out-of-home care before the age of 16
- Almost half of all inmates are also a parent of a child under 16 years of age
- 18% of inmates had at least one parent in prison during their childhood
- 1 in 4 young indigenous males aged 10-19 are processed through the criminal courts every year.
- Best practice
- Breaking-the-cycle programs
- Continuity of health benefits
- Early intervention
- Mental health support
- Personal responsibility
- Support for drug and alcohol issues
Matthew is an Aboriginal man in his mid-20s who was born with foetal alcohol syndrome to very young parents. His mother became pregnant at 15 and she and Matthew’s father struggled with parenthood. His first contact with police was when his mother was the victim of domestic violence perpetrated by his father. She had taken out several apprehended violence orders against his father.
They lived in a house – with up to 10 relatives at a time – with his mother’s extended family. Alcohol misuse and violence brought the family into frequent contact with police and the criminal justice system. Matthew’s life was marked by disadvantage and unstable relationships.
Matthew started drinking at the age of eight. His school attendance was patchy and he fell behind in reading and writing. He was repeatedly brought to the attention of child protection services by police and teachers as he was frequently malnourished and had injuries from physical abuse. At times he was placed in out-of-home care.
He began offending and using drugs at 14 and had frequent contact with the juvenile justice system. He did not complete his school certificate.
Matthew enjoyed and was very good at sport and, in his early teens, was identified as having promise. But his unstable lifestyle meant this promise was never realised. Mental health difficulties were diagnosed at 18 when he was screened while on remand.
When he is in the community, he finds it difficult to maintain a support base because he does not have stable housing. He oscillates between being homeless and staying with family members.
We need co-ordinated and continuous health care from first point of contact with the criminal justice system through to successful reintegration into the community.
We must also address community-based stigma and attitudes to ex-offenders with mental health issues.
If we tackle early the complex mixes of trauma, depression, anxiety, developmental delay, cognitive or learning difficulties, intellectual disability and conduct disorder, we’re more likely to increase success in living, education and work and reducing the lifetime risk of offending.
With stronger connections among the social, health, education and justice sectors, and working with families and communities we could improve assessment and interventions for vulnerable young people.
Better access to mental health support will not by itself reduce antisocial behaviour and offending. We need a population-based mental health and drug and alcohol approach to help people gain skills and resources to keep their lives on track.
But we also need the justice system to embed ideas and practices that not only hold offenders to account but build a sense of personal responsibility, reduce the risk of harm or reoffending, and address and change antisocial behaviour.
If my problems are tackled early they won't get out of hand: Children and young people like me who are dealing with lots of issues need help as early as possible. Like me, Aboriginal children and young people, and families and children of prisoners and offenders on community sentences, need special support.
You need to know my whole story to understand my behaviour: If I’m going to be diverted from criminal behaviour then programs must be consistent and take into account not only my mental health and any drug or alcohol issues, but also the values, attitudes and thinking I grew up with.
If I break the cycle while in custody I'm less likely to offend again: If I can access programs that help me to break the cycle, as well as the mental health and cognitive care I need during short or community-based sentences, I’ll be able to get off and stay off the path of offending before I get into really serious trouble.
My antisocial behaviour began only after I became mentally ill: I’m not in the majority but people like me whose antisocial behaviour resulted from mental illness or from high-risk drug or alcohol use need diversion and treatment within our custodial or community sentences.
Just because I'm in jail doesn't mean I shouldn't get good support: We should have adequate access to mental health support and treatment of drug and alcohol problems, even if those being supported are in jail like I am.
When I leave jail I need to move into the community without stigma: So that I can move back into a stable community setting, the path that takes me there should meet my individual needs but should also address stigma and community attitudes to ex-offenders with mental health issues.
*This composite story describes what the experience of someone on this journey might look like.
Source material for content on this page is from the Living Well Report