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ReINVEST: A pharmacotherapy approach for violence prevention

Reducing domestic violence through SSRI treatment

JHRP Investigators Prof Tony Butler, Prof Peter W. Schofield, A/Prof Jocelyn Jones, Bianca Ton, Lee Knight, Emaediong Akpanekpo

Background
Domestic and family violence affects 4.2 million Australian adults, with one woman killed every nine days by a current or former partner. Despite decades of investment, perpetrator programs show minimal impact and lack rigorous evaluation. ReINVEST tested whether a commonly used antidepressant (sertraline – Selective Serotonin Reuptake Inhibitor) could reduce violent offending in highly impulsive men with criminal violence histories, based on neurobiological evidence linking impulsivity, offending behaviour, and altered brain serotonin functioning.

Aims

• Evaluate SSRI (sertraline) effectiveness in reducing reoffending in impulsive, repeat-violent offenders
• Assess behavioural and mental health improvements
• Evaluate safety, acceptability, and feasibility in justice settings

Methods
Double-blind, placebo-controlled randomized trial in NSW with men aged 18+ having ≥2 violent convictions and Barratt Impulsiveness Scale score ≥70. Four-week active run-in phase followed by randomization to 100mg daily sertraline or placebo. Comprehensive psychosocial support provided by clinical team. Independent data safety monitoring board oversight throughout.

Key Findings

• 4-week run-in phase showed significant reductions: 20% impulsivity, 25% irritability, 35% labile anger, 28% direct assault, 44% psychological distress, 54% depression
• Sertraline showed 21% reduction in domestic violence reoffending at 24 months (28.2% vs 35.7%)
• 30% reduction among participants with higher adherence levels
• 52% additional risk reduction in participants with high psychological distress
• 44% reduction in recurrent domestic violence reoffending rate
• Partners/family reported 85% positive behavioural changes, 77% improved wellbeing, 54% increased safety

Significance and Impact
ReINVEST represents the first robust evidence for pharmacotherapy in domestic violence prevention. The trial demonstrated that medication, delivered with trauma-informed psychosocial support, can reduce reoffending. This challenges assumptions about clinical intervention limits in justice settings and provides a new evidence-based approach combining neuroscience, pharmacotherapy, and compassionate support.

Outputs

• 5+ peer-reviewed publications in BMJ Open, Australian & New Zealand Journal of Psychiatry etc.
• Policy contributions to NSW Government domestic violence discussions
• Clinical training programs developed for working with perpetrators
• Professional short course on therapeutic approaches with DV perpetrators

Beyond Violence: Transforming women's lives

An intervention to reduce violence and support rehabilitation for women

JHRP Investigators: Prof Tony Butler, A/Prof Jocelyn Jones, Dr Azar Kariminia, Prof Peter W. Schofield

Background
Women represent one of the fastest growing prisoner populations in Australia, with female incarceration for violent offenses increasing by 92% between 2010 and 2022. Aboriginal women's incarceration for violent offenses increased by 66% compared to 20% for non-Aboriginal women. Women who display violent behaviour are more likely than men to have experienced victimization, with sexual or physical abuse in early life constituting risk factors for perpetrating violence in adulthood. Beyond Violence is a gender-specific and trauma-informed intervention for women within criminal justice/legal settings who had violent offenses. It was developed in the US and adapted locally following research identifying no existing programs for women who use violence in Western Australia (WA) despite this being a parole requirement.

Aims
Evaluate the effectiveness of Beyond Violence in reducing recidivism among Aboriginal and non-Aboriginal women with current and/or historical convictions for violent offenses.

Methods
A before-and-after trial conducted over five years across three WA prisons. Control group recruited before intervention to avoid contamination. Intervention comprised 20 x 2-hour sessions over 10 weeks delivered by trained Aboriginal and non-Aboriginal facilitators. The trauma-informed, gender-specific program uses evidence-based therapeutic strategies including psycho-education, role playing, mindfulness, and cognitive-behavioural restructuring.

Key Findings

• Both Aboriginal and non-Aboriginal women had significant histories of adverse childhood experiences and intimate partner violence
• 63% reported head injury with loss of consciousness; 85% experienced multiple head injuries
• 77% of Aboriginal women and 80% of non-Aboriginal women reported 'fighting back' in intimate partner violence contexts
• Beyond Violence reduced reincarceration by 76.8%, lowering rates from 40% baseline to 9.3%—an absolute reduction of 30.7 percentage points
• Qualitative feedback highlighted program effectiveness in anger management, trigger identification, and providing coping tools

Significance and Impact
This represents the first rigorously evaluated violence intervention for women in Australian prisons. The dramatic reduction in reincarceration demonstrates the potential for trauma-informed, gender-specific program interventions. Results support scaling-up this approach across jurisdictions, with consideration for community-based booster programs.

Outputs

• Multiple peer-reviewed publications in progress, one published: Fischer, L et al. 2024. Exposure to Childhood Adversity and Intimate Partner Violence in a Sample of Incarcerated Women in Australia. International Journal of Offender Therapy and Comparative Criminology.
• Program materials adapted for Australian context, including training protocols developed for facilitators

Centre of Research Excellence: Profiling, Prediction and Prevention

JHRP Investigators: Prof Tony Butler, Prof Peter Schofield, A/Prof Adrienne Withall, A/Prof Jocelyn Jones, Dr George Karystianis, Dr Jane Hwang, Dr Patricia Morgan, Dr Patricia Taflan

Background
Violence perpetration remains a critical public health issue requiring comprehensive understanding of risk factors, population-specific patterns, and effective prevention strategies. Traditional approaches have been fragmented across disciplines, limiting effectiveness of interventions.

Aims
Apply a public health approach to violence perpetration through 11 research projects examining violence in key populations, identifying risk factors, and developing evidence-based prevention tools.

Methods
Multi-project program spanning quantitative and qualitative methodologies including longitudinal cohort studies, intervention trials, systematic reviews, and policy analysis across diverse populations and settings.

Key Findings
Projects ongoing with emerging findings across multiple violence domains and populations.

Significance and Impact
This CRE establishes Australia's first comprehensive research program focused specifically on violence perpetration, moving beyond victim-focused approaches to evidence-based perpetrator interventions and primary prevention.

Outputs

Expected 2026-2028.

Towards a National DFV Surveillance and Monitoring System

JHRP Investigators: Dr George Karystianis, Wilson Lukmanjaya, Prof Tony Butler

Background
Current DFV surveillance relies on hospital data, court outcomes, and surveys that miss key populations and abuse types. Police are first responders recording rich details in unstructured narratives containing untapped information. This project uses advanced text mining to analyse this data at scale, offering transformative population-level DFV monitoring.

Methods
Traditional and advanced computational techniques including NLP and machine learning to extract information from police-attended DFV narratives from four jurisdictions (NSW, QLD, WA, TAS). Continuous stakeholder consultation ensures contextual relevance and ethical grounding. System evaluation demonstrates >90% accuracy.

Aims:

• Describe the extend of DFV and abusive behaviour extracted from police narrative.
• Describe forms of DFV (e.g., emotional abuse, physical abuse, sexual abuse, cultural abuse)
• Develop mobile application for frontline police.

Key Findings

• Over 1 million police narratives processed linked to DFV and stalking/harassment offences
• Mental illness identified in 16% of DFV events (79% in perpetrators)
• Common abuse types: verbal abuse, hands-on abuse such as punching, kicking, intimidation, coercive control 
• Unique patterns identified in DFV involving key settings/cohorts. For instance, older age, mental illness, and substance use were linked to a lower likelihood of receiving support, while having autism, a history of self-harm, and higher socioeconomic status were associated with increased access to services
• Predictive models achieving 70% accuracy for future DFV offenses

Significance and Impact
World-first application of text mining to DFV police data at large scale. Findings informed NSW coercive control legislation, improved police risk assessment tools, and enabled development of frontline police mobile application for crisis de-escalation.

Outputs

• 14 peer-reviewed publications in JMIR, Crime Science, Frontiers journals, etc.
• 4 government reports including BOCSAR and Criminology Research Advisory Council
• Integration into NSW Police CHIMERA system
• Mobile application developed with IBM for frontline police
• Multiple policy impacts including coercive control legislation
• International conference presentations and media coverage

Automated analysis of child protection narratives

Funder: NHMRC, Australian Centre for Child Protection

JHRP Investigators: Wilson Lukmanjaya, Dr George Karystianis, Prof Tony Butler

Background
Child protection reports contain rich narrative information beyond structured data fields, but manual review limits population-level insights. Text mining can automate narrative coding at scale, providing comprehensive surveillance of child abuse patterns. This represents the first test of text mining feasibility on Australian child protection records.

Aims

• Test feasibility of text mining for identifying clinical characteristics, risks, and needs in child protection narratives
• Assess computational text analysis utility within child protection systems
• Explore machine learning potential for identifying/predicting children's needs

Methods
Modified text mining methodology adapted from successful police records analysis, applied to child protection narratives with stakeholder consultation ensuring ethical and practical relevance.

Key Findings
Project entering data collection phase.

Significance and Impact
Could revolutionise child protection surveillance by unlocking narrative data at population scale, informing early intervention and prevention strategies without small sample limitations.

Outputs
Lukmanjaya et al. 2025. Leveraging AI to Investigate Child Maltreatment Text Narratives. JMIR Pediatrics and Parenting

Other outputs expected 2026-2027.

Psychosis and Offending

Unpacking mental health services and criminal justice outcomes for people with serious mental illness

JHRP Investigators: Prof Tony Butler, Dr Armita Adily, Dr Azar Kariminia, Dr Nabila Chowdhury, Dr Paul Simpson, Prof Peter W. Schofield

Background

Individuals with psychosis are dramatically overrepresented in the criminal justice system, with approximately 30% having at least one criminal conviction compared to 6% in the general population. Despite clear evidence that mental health treatment reduces reoffending, significant barriers exist in service access and engagement. This program represents the largest longitudinal examination of psychosis and offending patterns in Australia, linking health and justice data across 15 years to understand service utilization impacts and develop optimal care models.

Aims

• Examine associations between mental health service contact and reoffending in individuals with psychosis
• Identify barriers to treatment access and engagement across demographic groups
• Evaluate effectiveness of court diversion programs versus punitive sanctions
• Define optimal models of post-prison care through expert consensus
• Investigate early intervention impacts on criminal justice outcomes

Methods

Comprehensive data-linkage studies combining health, justice, and mortality datasets in NSW, Australia. Multiple methodologies including longitudinal cohort studies of >7,000 individuals with psychosis, survival analyses, multi-state modelling, and Delphi consensus methodology. Follow-up periods extending 14+ years enabling examination of long-term trajectories and service utilization patterns.

Key Findings

• Offenders with no clinical contact had over 5 times the risk of reoffending compared to those with highest service engagement (adjusted hazard ratio = 5.78)
• Early mental health contact within 30 days post-offense reduced reoffending risk by 30% in male offenders
• Court diversion showed 12% lower reoffending rates (38% vs 50%) compared to punitive sanctions
• Disengagement from treatment increased reoffending risk threefold, with 67% reoffending within one year
• Indigenous defendants significantly less likely to be diverted into treatment, highlighting equity gaps
• Substance-related psychosis associated with higher reoffending rates and reduced service engagement
• Optimal care model identified 33 key attributes across pre-release planning, community treatment, diversion, and evaluation

Significance and Impact

This program provides the first robust Australian evidence demonstrating that mental health services can dramatically alter criminal justice trajectories for individuals with psychosis. Findings directly challenge assumptions about intervention limits in justice settings and provide evidence-based frameworks for service delivery reform. The research has informed NSW policy development, court diversion program expansion, and optimal care model implementation across jurisdictions.

Outputs

• 10+ peer-reviewed publications in Australian & New Zealand Journal of Psychiatry, Frontiers in Psychiatry, Psychiatry Psychology and Law, Social Psychiatry and Psychiatric Epidemiology, Criminal Justice and Behavior
• Policy contributions to NSW Premier's priority on reducing reoffending
• Clinical practice guidelines for post-prison mental health care
• Court diversion program evaluation frameworks adopted across multiple jurisdictions
• Training materials for mental health professionals working in justice settings

Linking health and justice data for justice-involved youth

JHRP Investigators: Emaediong Akpanekpo, Prof Tony Butler, Dr Azar Kariminia, A/Prof Jocelyn Jones, Prof Peter W. Schofield

Background
Justice-involved youth experience >80% prevalence of mental ill-health, far exceeding general youth population rates. Despite clear needs, significant gaps exist in service provision and long-term research. Most existing studies are cross-sectional, limiting understanding of developmental pathways and long-term consequences.

Aims

• Examine long-term mental health outcomes following supervision
• Investigate relationship between mental health service contact and reoffending risk
• Analyse how mental health disorders and adverse childhood experiences influence reoffending patterns
• Develop and validate risk prediction tool for violent reoffending

Methods
Large-scale data linkage combining health survey data with administrative collections (justice, health, mortality) for youth supervised in custody or community in NSW. Longitudinal dataset enabling examination of trajectories from adolescence to adulthood.

Key Findings

• Adolescent custodial supervision associated with significant subsequent psychiatric morbidity
• Mental health treatment reduced reoffending risk in males but not females
• Personality disorders and adverse childhood experiences predicted accelerated reoffending
• First offense before age 14 strongly predicted adult incarceration
• Adolescent incarceration conferred fivefold increased risk of adult imprisonment
• Risk prediction models maintained good discrimination across supervision contexts

Significance and Impact
Provides crucial evidence on developmental pathways from youth justice involvement to adult outcomes. Findings inform early intervention strategies and highlight critical periods for prevention efforts.

Outputs

• 5 peer-reviewed publications in Justice, International Journal of Law and Psychiatry, Psychiatric Services, Journal of Criminal Justice, BMJ Mental Health
• Conference presentations at ANZAPPL Congress, Health Care in Secure Settings
• Media coverage in The Conversation
• Risk assessment tool development for policy implementation

Second Survey on Sexual Health and Attitudes of Australian Prisoners

JHRP Investigators: Dr Paul Simpson, Prof Tony Butler, A/Prof Jocelyn Jones, Dr Azar Kariminia

Background
People in prison are priority populations in National STI and HIV strategies but routinely excluded from community surveys. SHAAP-1 [REF/LINK TO IMPACT SECTION] represented the largest global prison-based sexual health survey, significantly impacting policy and practice. Ten years later, population demographics and correctional operations have changed, necessitating updated evidence.

Aims

• Conduct representative prevalence study of sexual health, attitudes and behaviours in NSW prisons
• Examine sexual and reproductive health of subgroups in NSW prisons

Methods
Population-based survey methodology building on SHAAP-1 approach, adapted for current correctional context and demographic changes.

Key Findings
Data collection ongoing.

Significance and Impact
Will provide updated evidence base for sexual health policy and practice in Australian correctional settings, informing national strategies and international guidelines.

Outputs
Expected 2026-2027.

Understanding barriers and enablers of HIV treatment and care after prison release

JHRP Investigators: Dr Paul Simpson, Prof Tony Butler

Background
Although HIV treatment during incarceration achieves high viral suppression rates, benefits may not continue post-release due to care engagement difficulties. People living with HIV leaving prison are consistently prioritized in HIV strategies as at risk of 'loss to follow up,' yet no Australian research has examined their care experiences.

Aims

• Understand People Living with HIV care and treatment journey from prison to community
• Identify barriers and enablers of engagement in HIV treatment and supports
• Provide recommendations on best practice supports after release

Methods
Longitudinal qualitative approach capturing individual journeys over 12 months post-release, examining care, treatment, and support engagement experiences.

Key Findings
Seeking ethical approvals – data collection expected to commence October 2025

Significance and Impact
Will inform HIV care continuity policies and practices, addressing critical gap in post-release health service provision for priority population.

Outputs
Expected 2026-2027.

Whole-of-setting model of care for trans and gender diverse people in prison

JHRP Investigators: Dr Paul Simpson, Prof Tony Butler, A/Prof Jocelyn Jones, Ms Jess Wilson

Background
Trans and gender diverse people in prison are among the most vulnerable and disadvantaged groups. Correctional and prison health systems have struggled to address their needs effectively due to lack of research and integrated care approaches.

Aims
Establish an evidence base to co-design an integrated 'whole-of-setting' model of care, and policy guidelines for trans people in prison.

Methods
Phase 1: international case studies, national policy review, lived experience interviews, medical and custodial records review. Phase 2: co-design using deliberative and Delphi methods. Phase 3: policy guideline development with diverse stakeholders.

Key Findings
Project at protocol and ethical development stage. Data collection expected to commence early 2026.

Significance and Impact
Will establish first comprehensive evidence-based model of care for trans people in Australian prisons, addressing critical human rights and healthcare gaps.

Outputs

• Simpson PL, et al. (2024). Routledge - Community-led policy revision case study
• Brömdal A, et al. (2024). International Journal of Transgender Health - Transformative research perspectives
• Additional outputs expected 2026-2027 following main data collection.

Audio App-Delivered Screening for Cognition and Age-Related Health for older people in prison

JHRP Investigators: A/Prof Adrienne Withall, Prof Peter Schofield, Dr Jane Hwang, Dr Natasha Ginnivan, Prof Tony Butler, Dr Arthur Montalto, Mr Rhys Mantell

Background
Nearly 1 in 5 people in custody are aged 50+, experiencing significantly worse physical, mental, and cognitive health than community counterparts. Routine screening for age-related health needs is rare in prisons. ASCAPE addresses this gap through a digital, self-administered screening tool tailored to older incarcerated individuals.

Aims

• Develop and validate digital health screening tool for older people in prison
• Improve early detection of cognitive decline, frailty, and age-related health issues
• Enhance justice system capacity for routine, scalable, culturally safe health assessments

Methods
Three-phase mixed-methods approach: Phase 1 co-design with older people in prison and health professionals; Phase 2 community testing with marginalised older adults; Phase 3 validation study with 150 older people in NSW prisons comparing ASCAPE App (health screener and cognitive mini-games) with traditional assessment methods.

Key Findings

• High prevalence of unmet health needs among older people in prison
• ASCAPE digital tools demonstrate high usability and acceptability in the marginalised community sample
• Trauma-informed and culturally appropriate design are essential for psychological safety and overall acceptability of ASCAPE
• Implementation success depends on broader correctional environment and staff capacity barriers and enablers (resource issues, care vs custody culture etc.)

Significance and Impact
ASCAPE offers a scalable, cost-effective and engaging digital health screening solution for the growing population of older people in prison. Potential applications extend to community settings, remote areas, and international correctional systems.

Outputs

• Mantell et al. (2023). JMIR Serious Games - Design preferences study in prison
• Mantell et al. (2025). JMIR Aging - User experience systematic review
• Mantell et al. (2025). SSM Qualitative Research in Health - Critical realist analysis
• Conference presentations at ICPA Technology in Corrections, PHAA Preventive Health conference, IACR conference, AAG conference etc…
• ASCAPE App developed with cognitive mini-games and health screener

Health and frailty trajectories of older people in prison

JHRP Investigators: Prof Tony Butler, A/Prof Adrienne Withall, Prof Peter Schofield, Dr Jane Hwang, Dr Amanuel Kidane Hagos, Dr Arthur Montalto

Background
Older people are the fastest growing prison population group globally, creating unexpected challenges for health, justice, and welfare systems. Despite being medically and socially vulnerable, no studies have observed age-related health status over time for older people in prison.

Aims

• Determine the prevalence of frailty and key indicators of age-related health status of older adults in prison compared to older adults in the general population.
• Examine the extent of age-related health decline (or improvement) that occurs for older adults in prison over time compared to older people in the general population.
• Identify whether there are distinct subgroups of older people in prison in terms of frailty trajectories, based on a range of individual health factors and social determinants as well as broader systemic factors.

Methods
Longitudinal study assessing 650 older people in prison and 400 community controls using self-administered, face-to-face and online surveys plus medical records across three timepoints over 30 months.

Key Findings
Ethics review stage – data collection expected to commence late 2025/early 2026.

Significance and Impact
The findings from the study will provide much-needed evidence regarding the health status and care needs of ageing prisoners, how prison affects health in older people, and whether different subgroups are at risk of varying levels of health decline (or improvement). Knowledge gaps will be filled for older women and Aboriginal and Torres Strait Islander Peoples who are the fastest growing of the older groups in prison and for whom data is lacking. This work has vital implications for practice and policy changes that respond to the changing prison demographic, the resourcing required to support this high-needs group both in prison and after release. 

Outputs
Expected 2026-2027.

Investigating older people's reintegration experiences

JHRP Investigators: Dr Jane Hwang, Prof Tony Butler, A/Prof Adrienne Withall, Dr Amanuel Hagos, Mr Rhys Mantell

Background
Unprecedented numbers of individuals are being released from prison in later life with complex unmet needs. Significant gaps exist in understanding reintegration for older people and related support tools for this growing population.

Aims

• Set research, practice and policy priorities for older people released from prison
• Understand needs, experiences and impact of health/digital literacy
• Co-design appropriate interventions
• Develop conceptual framework of 'successful' reintegration

Methods
Mixed-methods program including interviews, focus groups, co-design workshops, and online surveys across multiple linked studies.

Key Findings

• Strong multi-sector consensus on 36 recommendations emphasising improved systems, targeted release preparation, community advocacy, and extended program funding
• Older people experience highly demanding, chaotic transitions with urgent needs overshadowing health management
• Digital divide exacerbates social exclusion; low digital literacy due to restricted prison technology access
• 'Place-finding' framework emphasizes holistic, strengths-based approach to reclaiming societal place

Significance and Impact
Establishes foundational evidence base for understanding and improving reintegration outcomes for older people leaving prison, informing policy and practice across multiple sectors.

Outputs

• 4 peer-reviewed publications in Health and Justice, PLOS ONE
• Australian Association of Gerontology background paper
• Multiple media articles in The Conversation, MJA Insight, Australian Ageing Agenda

Medicare and Aboriginal Community Controlled Health Organisations in Prisons Project (MAPP)

JHRP Investigators: Prof Tony Butler, Dr Paul Simpson, A/Prof Jocelyn Jones, Ms Freya Stephenson

Background
Aboriginal and Torres Strait Islander people are significantly overrepresented in prisons and experience disproportionately poor health outcomes. Despite known benefits of culturally safe ACCHO care, these services are absent from prisons due to suspended Medicare access for incarcerated individuals.

Aims
Assess feasibility of ACCHOs delivering selected MBS items in prisons through ministerial exemption as sustainable funding model for culturally appropriate healthcare.

Methods
Multi-site, mixed-methods demonstration project co-designed with ACCHOs and Lived-Experience Advisory Group. Delivering four key MBS items across three jurisdictions (NSW, WA, SA) with comprehensive feasibility evaluation.

Key Findings
Project in stakeholder consultation phase.

Significance and Impact
First Australian study testing Medicare-funded ACCHO services in prisons. Success could enable national policy reform supporting Closing the Gap targets and healthcare equivalence principles.

Outputs
Expected 2026-2027.

Understanding mortality in adults and young people in contact with the criminal justice system in NSW, Australia

JHRP Investigators: Tony Butler, Azar Kariminia, George Karystianis, Paul Simpson Emaediong Akpanekpo 

Background

Mortality data is a vital measure of health and safety in prison population. Our previous research conducted in NSW demonstrated very high mortality among people exposed to imprisonment compared to the general population. Over the past 20 years, changes have occurred in the demographic structure of the NSW prisoner population, and in correctional facility operations in NSW. There has also been improvement in the standard of care provided to prisoners and greater awareness of their health needs. This necessitates the needs for current evidence on mortality in NSW prisoners. 

Aims

• Determine the relative importance of both disease-related and external causes of death during imprisonment, after release, after receiving community-based sanctions, and quantify excess mortality compared to the NSW general population.
• Identify risk factors for all-cause and cause-specific mortality including disease-related and external causes of death. 

Methods

A retrospective population-based data linkage cohort study using administrative data collections in NSW.

Key Findings

Data linkage in progress by The Centre for Health Record Linkage (CHeReL).Ìý

Significance and Impact

Will provide up-to-date and expanded evidence of mortality among justice-involved people—particularly among under-research subgroups. This will inform service delivery, policies and programs in the NSW criminal justice, health and social service sectors.

Outputs

Expected 2027-2029.

Improving health information flow across the justice system

JHRP Investigators: Dr Jane Hwang, Prof Tony Butler

Background

Timely health information flow is critical throughout the justice system, yet preventable deaths highlight consequences of absent or delayed health information for this marginalised population. This represents the first Australian study exploring health information sharing experiences from the perspective of people with lived experience of the justice system.

Aims

Explore current experiences, challenges and potential solutions for sharing health records across the justice system in NSW.

Methods

Qualitative interviews with 13 participants (12 with lived experience, 1 professional staff) recruited from NSW community support organisations.

Key Findings

• Inconsistent and incomplete medical records led to delayed and disrupted care
• Communication barriers from emotional strain, lack of secure environments, and stigma
• Mixed views on privacy—some comfortable with sharing, others felt violated when correctional staff accessed sensitive information
• Inadequate information sharing created cascade effects: care delays, medication access issues, worsening health

Significance and Impact

Provides foundational evidence for improving health information systems across justice settings, informing streamlined decision-making and integrated care pathways.

Outputs

Master of Global Health thesis; academic manuscripts in preparation

Understanding pathways and improving outcomes for people with intellectual disability in the justice system

JHRP Investigators: Dr Jane Hwang, Prof Tony Butler

Background

People with intellectual disability (ID) are substantially more likely to be imprisoned than those without ID, yet are often under-identified in the justice system. While post-release disability support services reduce reoffending risk, only 27% of people with ID receive these supports.

Aims

Examine incarceration trajectories and service utilization patterns among people with ID, and identify predictors of receiving post-release disability support services.

Methods

Data linkage studies using NSW administrative datasets examining 1,868 individuals with ID released from custody 2005-2015. Cluster analysis and predictive modelling combined with systematic literature review.

Key Findings

• Three distinct trajectory groups identified: Descending (improving outcomes), High (persistent incarceration), and Moderate Descending
• Only 49.1% received disability support within one year of release
• Aboriginal and Torres Strait Islander people more likely in high-risk persistent incarceration group
• Early disability support access linked to better long-term trajectories
• Reincarceration rates 41-92% across studies, with multiple disadvantages post-release

Significance and Impact

Establishes evidence base demonstrating heterogeneity among people with ID and critical importance of early disability support access. Findings highlight need for culturally appropriate support and improved service coordination.

Outputs

Three manuscripts under review; MPH student project completion