The Relationship between Psychosis and Offending in New

The Relationship between Psychosis and Offending in New South Wales – A Data. Linkage Study Nabila Zohora Chowdhury Justice Health Research Program, Kirby Institute, UNSW Australia

Investigators • • • Professor Tony Butler-Kirby Institute Dr Stephen Allnutt-JH&FMHN A/Professor Peter Schofield – Hunter New England Health A/Professor Handan Wand - Kirby Institute Dr Armita Adily – Kirby Institute Dr Azar Kariminia – Kirby Institute Professor John Kaldor – Kirby Institute Mr Luke Grant- Corrective Services NSW A/Professor Don Weatherburn - BOCSAR Mr Olayan Albalawi – Ph. D Scholar, Kirby Institute

Presentation • • • Background Data Linkage Process Definitions Preliminary Findings Future Directions

Background • Psychosis is a feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or non-existent sense of objective reality • The most common psychotic disorder is schizophrenia affecting about 21 million people worldwide • Each year, approximately one in every five Australians will experience a mental illness • 1 in 100 people have or will develop schizophrenia during their lifetime

Background • Around 12, 000 hospitalisations occur for psychosis in NSW each year • Annual cost of treatment of psychosis in Australia is estimated at $79, 537 person • Psychosis is considered to be a risk factor for criminal offending, particularly violent offending

Background • A meta-analysis of 204 studies (Douglas, 2009) showed that psychosis was associated with a 49% to 68% increase in the odds of a conviction for violence, compared with the odds of violence in the absence of psychosis • A Swedish population based data-linkage study (Fazel, 2006) investigated the impact of psychotic disorders on violent crime over a 13 year period estimated that patients with severe mental illness commit one in 20 violent crimes

Background • Western Australian study (Morgan, 2013) examined the prevalence, type and pattern of o�ending in those born between 1955 and 1969 and diagnosed with any psychiatric illness between 1985 and 1996 and found that 20% of those convicted of violence had been diagnosed with a mental illness • Victorian study (Wallace, 2004) found that 21% of individuals with schizophrenia had been convicted of a criminal offence compared with 8% of controls over a 25 -year period (1975 -2000) • NSW study (Butler & Allnutt, 2003) found that prevalence of psychosis in NSW inmates was thirty times higher than in the Australian community

Background • No population based study investigating the relationship between psychosis and offending in New South Wales

Primary Objectives • Determine the association between psychosis and subsequent offending behaviour • Determine the population level impact of psychosis on offending behaviour • Determine the proportion of those diagnosed with psychosis for the first time in prison

Secondary Objectives • Examine the rates of re-offending among those diverted into mental treatment by the NSW Court Liaison Service • Compare the experiences of the offenders with and without psychosis while they are in prison • Find out what happens to people with psychosis who also received treatment for opiate dependence by Linkage of the PHDAS data with cases • Examining the rate and causes of post-release mortality in offenders with and without psychosis

Definitions • Psychosis cases: All individuals diagnosed with psychosis on admission for a hospital episode or on presentation to an emergency department • Admitted Patients data - 1 July 2001 – 31 December 2012 • Emergency Patients data - 1 Jan 2005 – 31 December 2012 • Controls: For each case, two controls without any record of a diagnosis of psychosis from several datasets matched by birth year and sex • Offence: All individuals who have committed at least one offence from the Re-offending dataset (ROD) between 1 July 2001 to 31 December 2012

Cases (People diagnosed with psychosis) Based on International Classification of Diseases, we have grouped cases into the following categories: 1. Schizophrenia and Delusional Disorder 2. Mood Affective Disorders 3. Psychotic Disorder due to psychoactive substance use 4. Other psychosis

Data Linkage Process CASES (Psychosis) 90, 036 Individuals & 343, 882 Records NSW Emergency Department Data Collection 1, 151, 295 Individuals & 6, 349, 233 Records NSW Admitted Patients Data Collection 1, 251, 277 Individuals & 8, 913, 496 Records

Data Linkage Process Linkage By CHe. Re. L Reoffending Database (ROD) 493, 042 Individuals & 1, 113, 481 Records Offender Integrated Management System & Pharmaceutical Drugs of Addiction Systems CASES (Psychosis) 90, 036 Individuals & 343, 882 Records Mental Health Ambulatory Data 292, 763 Individuals & 29, 022, 252 Records NSW Births, Deaths, Marriages

Approvals Timeline Protocol Preparation and Submission MAY 2014 NOV 2014 DEC 2014 – AUG 2015 Ethics Approval by Ethics Committee Data Quality Assurance SEP 2015 – APR 2016 MAY 2016 – PRESENT Started Receiving Data 15

Preliminary Results • Total psychosis cases – 90, 036 • Total psychosis records – 343, 882 • 57% Men • 6% Indigenous

Psychosis Records (N=343, 882) and Their Types Psychotic Disorder. Psychoactive Substance Use 8% Others 5% Mood Affective Disorders 9% Schizophrenia and Delusional Disorder 78%

Types of Psychosis in Recent Diagnosis Psychotic Disorder. Psychoactive Substance Use 13% Mood Affective Disorders 13% Others 7% Schizophrenia and Delusional Disorder 67%

Psychosis and first diagnosis • Median age at first diagnosis in cases 40 years (15 -90) • 97% were NSW residents at the time of first diagnosis

Types of Psychosis among Different Age groups at the time of First Diagnosis 70 60 50 Schizophrenia and delusional Disorder 40 Mood Affective Disorders 30 Psychotic Disorder Psychoactice Substance Use 20 Others 10 0 <20 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 50+ Years Years

Psychosis & Offending • 28% of people with psychosis had offended at least once § § 75% offenders - Male 11% offenders – Indigenous 78% had offended after being diagnosed with psychosis Median time difference between the first diagnosis of psychosis and first offence is around 3 years (range 0 -61 years)

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Preliminary Results • There is no big GENDER differences regarding the most common offenses; it appears to be true for Indigenous as well. 26

Future Directions • Merging additional datasets with cases and controls • Adjusting the cases by linking them with The NSW Registry of Births, Deaths and Marriages (RBDM) death registrations • Use the NSW electoral role for additional controls as it has very complete coverage of NSW residents? • Compare the experiences of the offenders with and without psychosis while they are in prison • Examine the experiences of Aboriginal people with psychosis before, during and after contact with the criminal justice system • Examine the utility of Court diversion/liaison schemes (CD/CL) for those with psychosis

Questions? 28

Thank You!