Kerryn Drysdale and Rochelle Aylmer1
Preventing recidivism is of concern for all people who are incarcerated and is a key focus in human rights approaches to carceral social justice. People who inject drugs constitute up to 58% of the prisoner population2 and are subject to higher reincarceration rates compared with all people entering prison.3
Challenges associated with transitioning from prison to community post-release are heightened for people with a history of injecting drug use. The criminality of illicit substance use adds an additional layer of complexity to the challenges people face post-release, including their engagement with services, and in experiences of stigma and discrimination.4
Structural and systemics factors, such as poor access to treatment and other health services, unstable housing, financial and relationship stress, create further barriers to accessing and engaging with services. Without adequate resources and social support, the cycle of release and re-arrest becomes increasingly difficult to break.
There is a compelling need to intervene in this cycle of recidivism. Stigma is recognised as a deeply entrenched social and cultural phenomenon, and lies at the root of many human rights violations. The human rights of incarcerated people is increasingly the subject of international campaigns, including advocacy at level of the United Nations.5 Effective measures to reduce stigma and provide pathways to accessing health and social services and support are urgently required.
While the transition from prison to the community offers a key intervention point, there has been little progress in serving the pre- and post-release needs of this population. As such, it is necessary to unpack the trajectory of prison-community-prison by turning attention to how people newly released from prison negotiate a complex post-release world in which health, social, structural, and criminogenic factors intersect.
The research designed to respond to a human rights issue
The ‘identifying factors that improve the health of prisoners who inject drugs’6 research project draws attention to the difficulties of daily life and the systems-related challenges that people with a history of injecting drug use must navigate when they are newly released from prison. The project was funded by the National Health and Medical Research Council (NHMRC), and participants were recruited from the SuperMIX project7 which is a longitudinal cohort study in Victoria. By focusing specifically on the intersections between incarceration, injecting drug use and housing, the research team aimed to draw public attention to the barriers to successful community integration and to raise awareness of these issues in order to improve health outcomes and reduce recidivism.
Forty-eight in-depth qualitative interviews were conducted with participants who had served sentences of more than three months (so as to capture experiences related to loss of tenancy in social housing) and were released from prison within the previous 12 months (a proximity to allow exploration of their experience in an immediate post-release context). The interview guide examined participants’ perceived health and social needs, their adoption of informal strategies, and health/social services utilised, in response to those needs. Following inductive thematic analysis, three themes were generated, which then became the subject of a novel form of research dissemination.
Collaborative translation for and by community
Effective research translation requires engagement with target audiences in ways that are authentic and resonant. In response to findings from the project, researchers and community members collaborated to produce forms of research dissemination that could cut through the crowded space of competing public health priorities and, in doing so, making heard the voices of those most deserving of human rights advocacy. The research team convened an advisory group of members with lived experience of incarceration and injecting drug use, and their guidance was continually sought throughout the process to guide this work. With their insights, three overarching themes were identified: exhaustion, structural competency,8 and trust.
Three artists who were sensitive to these themes were commissioned to produce written artistic interpretations by drawing on excerpts from blended anonymised transcriptions following an iterative process incorporating feedback from these community advisors. The outcome was three written pieces that conveyed these themes by drawing on the experiences of research participants, publishable9 in their own right as a product of artistic endeavour. Next, we put out a call for community members with lived experience of these themes to participate in the process of bringing these written pieces to life.
Four people were then invited to participate in rehearsals with award-winning theatre director Liza-Mare Syron10 before performing these pieces in our UNSW recording studios. Caroline Craig,12 voice of the well-known Underbelly11 series, hosted the three-part series, providing further explanation of the themes by drawing on relevant literature that underpins them.
The results were evocative and compelling narratives to illustrate the difficulties faced, and strategies to aid successful reintegration back into community. We hope these narratives can also be used as an effective resource for services and incarcerated people alike by offering hope and relevant strategies that people can employ to help mitigate these substantial challenges in the post-release context.
Putting research dissemination to the test
General public attitudes that perceive drug problems as an issue of personal irresponsibility have been linked to the endorsement of discriminatory restrictions on people who use drugs.13 Community attitudes contribute to experiences of stigma and social exclusion for people with prison and injecting drug use histories,14 and are theorised to impede policies and programs to reduce recidivism that include the provision of adequate housing, drug treatment, and therapeutic supports15 Identifying interventions that can positively impact community attitudes towards prisoners and post-release programs may be an important step in strengthening the effectiveness of efforts to reduce recidivism.
While it is our hope that this three-part series can change detrimental opinions of formerly incarcerated people with drug use histories, as researchers we look to the evidence to make our claims to efficacy. And so, we devised means to explore attitudes of the general public in relation to the post-prison experiences of people with a history of injecting drug use in a controlled trial and among a sample of the Australian general public. We asked: Would exposure to a performed narrative of the experience of leaving prison positively impact attitude measures after intervention and would these changes be sustained at two months follow up?
This survey is about to commence.
What have we learned through this process?
The complexity of intersectional disadvantage confronting people who inject drugs pre- and post-release means that individual issues cannot be addressed with a single program or intervention. Adopting greater flexibility and responsiveness in their approach will allow services to better assist people with achieving their post-release goals. Additionally, people with lived experience of drug use and incarceration should be included in broader public health efforts to improve access to, and quality of, services.
Ensuring that people are adequately supported in their transition from prison to the community has significant health, human rights and social justice implications. Reducing the use of incarceration as a response to drug-related offenses and managing drug dependency and possession through health and social services rather than criminal sanctions is a necessary step towards respecting, protecting, and fulfilling the health and human rights of people who inject drugs.
The attitudes of the general public, media and workers in important services can be negative towards people who inject drugs who have been in prison. This project sought to go further with research outputs, to produce something that was useful in addressing these negative attitudes and advocating for change in services and systems. While we await the results of our formal trial of the efficacy of these artistic narratives in changing public opinion, we see these pieces as highly important in giving voice to people who can find it difficult to have their experience heard.
On behalf of the team: Timothy Broady (Centre for Social Research in Health, UNSW Sydney), Loren Brener (Centre for Social Research in Health, UNSW Sydney), Sophia Schroeder (Behaviours and Health Risks Program, Burnet Institute, Melbourne), Lise Lafferty (Centre for Social Research in Health, UNSW Sydney), Alison Marshall (Centre for Social Research in Health, UNSW Sydney), Peter Higgs (Behaviours and Health Risks Program, Burnet Institute, Melbourne & School of Psychology and Public Health, La Trobe University, Melbourne), Eileen Baldry (Law and Justice, UNSW Sydney), Mark Stoove (Behaviours and Health Risks Program, Burnet Institute, Melbourne), Paul Dietze (Behaviours and Health Risks Program, Burnet Institute, Melbourne & National Drug Research Institute, Curtin University, Melbourne) and Carla Treloar (Centre for Social Research in Health, UNSW Sydney)
Reekie J et al. Trends in HIV, hepatitis B and hepatitis C prevalence among Australian prisoners - 2004, 2007, 2010. Med J Aust. 2014;200(5):277-80.
Zhang, J, Webster A. An analysis of repeat imprisonment trends in Australia using prisoner census data from 1994 to 2007. Canberra: Australian Bureau of Statistics, 2010.
Carla Treloar, Sophia Schroeder, Lise Lafferty, Alison Marshall, Kerryn Drysdale, Peter Higgs, Eileen Baldry, Mark Stoove, Paul Dietze, Structural competency in the post-prison period for people who inject drugs: A qualitative case study, International Journal of Drug Policy, Volume 95, 2021, https://doi.org/10.1016/j.drugpo.2021.103261
Van Boekel LC, Brouwers EPM, Van Weeghel J, Garretsen HFL. Public opinion on imposing restrictions to people with an alcohol- or drug addiction: A cross-sectional survey. Soc Psychiatry Psychiatr Epidemiol. 2013;48(12):2007-2016.
Moore KE, Tangney JP. Managing the concealable stigma of criminal justice system involvement: A longitudinal examination of anticipated stigma, social withdrawal, and post-release adjustment. J Soc Issues 2017;73(2):322-340.