The extent to which the evaluation can determine how much the program has directly affected participants’ health has to some extent been confounded by the methodological difficulties described at the beginning of this Section, especially the fact that both first and second round interviews were carried out at different stages of involvement with the program for different participants. Nevertheless, some useful information emerged from the interviews. It should be noted that the evaluators were not in a position to carry out direct assessment of participants’ health and the results below are based on self-reporting.
Physical health
Table 5.15 shows that more than half the first round interviewees (18 or 55 per cent) rated their general health as excellent or very good, with a further 11 rating their health as good (33 per cent). Thus in total, 29 rated their health as excellent, very good or good (88 per cent). Four rated their health as fair or poor (12 per cent). These results can be compared to results obtained from the (Australian) National Health Survey of 1995, where 83 per cent of the Australian population over 15 years of age rated their health as excellent, very good or good (ABS, 1995).
By the second interview round, 13 reported their health as excellent, very good or good (72 per cent). Five rated their health as fair or poor (28 per cent). Comparing the responses just for those who were in both rounds of interviews, 17 said their health was excellent, very good or good (94 per cent) and only one said their health was poor (six per cent). While there was a decrease in those reporting good health and an increase in those reporting fair to poor health from first to second interviews, these differences were not statistically significant.
Table 5.15: Participants’ general health
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent
Excellent 6 18.2 3 16.7
Very good 12 36.4 6 33.3
Good 11 33.3 4 22.2
Fair 3 9.1 3 16.7
Poor 1 3.0 2 11.1
Total 33 100 18 100
In the first interview round, three of the young people reported that they had contracted Hepatitis C and one of these people also reported they were HIV positive (this is not surprising for a group reporting frequent needle use). However, only one of these people reported that their health at the time was ‘poor’, with the other two reporting their health was ‘fair’ and ‘very good’ respectively.
The relatively high level of self-reported good health amongst the first interview group is perhaps surprising, given their significant levels of drug use in the recent past. The evaluation of the NSW Adult Drug Court found that both male and female participants had poorer health at baseline when compared to Australian population norms (Lind et al, 2001:15). It may be that many of the young people in the first YDC interview group had not been using drugs long enough to experience significant detrimental effects to their physical health and their young age made them still relatively resilient. However, the change in self-reported good health from first to second interviews (amongst those in both interview rounds), while not statistically significant, suggests that this group’s good health might not be maintained post-program, on average.
It is also likely that some participants had benefited from short-term health improvements through being on the program. Twenty-four of the 32 young people in the first interview round (one interview with a participant had to be terminated before the remaining health questions could be answered) rated their general health as much better than six months previously (73 per cent). Six rated their health as a bit better or about the same as six months ago (18 per cent) and three (nine per cent) felt their health was worse or much worse than six months ago. This can be compared to results from the second interview round where seven of the 18 young people reported their health was much better than six months before (39 per cent), another seven reported that their health was a bit better or about the same, and four (22 per cent) reported their health was a bit worse than. (Table 5.16).
Results were similar when comparing just those who took part in both interviews.
Thirteen (72 per cent) rated their health as much better than six months ago, four as a bit better or the same (22 per cent) and one as much worse than six months ago (six per cent). While the apparent decrease in the extent of health improvement over the two previous six-month periods is marked, it is still not statistically significant.
It seems likely that reported improvements in health in the first interview round can at least partly be attributed to health benefits gained from decreased drug use, their minor health problems being addressed by the program (such as dental work or eye examinations), better sleeping patterns, and regular eating while in custody,
rehabilitation facilities and other program-organised accommodation. Four of the young people commented on the difference in their physical health since being on the program:
The program has really helped with physical stuff as I’ve been off the drugs. I’m eating properly again.
I came into custody weighing 50 kilos. Now I weigh 80. My health is much better now. Some days I wouldn’t eat at all. Some days I may eat at five in the morning … Drug Court has also got my teeth fixed.
Have put on 15 kilos since coming into custody. Before I had no weight. Not eating. At one stage I was lying on the floor and couldn’t make it to the kitchen because of cramps from not eating for three weeks. Now I like my food.
Every time I’ve come in this year I’ve always been able to go to sleep. Before I was always hanging out when I was coming down and feeling like shit. I haven’t been sitting up pulling at hair, ripping at my hair, sweating, shaking. That’s the best thing, being able to say that I slept last night.
Table 5.16: General health compared with six months before
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent Much better 24 72.7 7 38.9 A bit better 3 9.1 3 16.7 About the same 3 9.1 4 22.2 A bit worse 1 3.0 4 22.2
Much worse 2 6.1 0 0.0
Total 32 100 18 100
Experience of physical pain
Nineteen of the 32 participants in the first interview round reported not having experienced any physical or bodily pain over the previous four weeks (59 per cent), with a further six reporting they had experienced only mild or very mild pain (19 per cent). This result is in keeping with the general good physical health of the first interview group. However, five young people reported moderate pain (16 per cent) and two said they had experienced severe or very severe pain (Table 5.17). Of those who experienced moderate pain, two participants had back pain, one had pain in the legs, one had pain in the hips and one participant did not comment on the source of their pain. YDC staff had arranged for the participants with leg and hip pain to see a doctor, but in both cases no obvious cause was found. The participant who reported severe pain commented that it came from sporting injuries acquired before time on the program. The participant who reported very severe pain had a back problem that caused ‘chronic back pain’. Thus this reported bodily pain does not necessarily seem to be directly related to drug use.
Nine out of 17 people in the second interview group13 reported not having experienced any physical or bodily pain over the last four weeks (53 per cent), with a further six reporting they had experienced only mild or very mild (35 per cent). Two people (12 per cent) said they had experienced severe pain (Table 5.17). For the same young people in the first interview round, 11 reported not having experienced any physical or bodily pain over the last four weeks (61 per cent), with two people reporting they had experienced only mild or very mild pain (19 per cent). Four young people reported moderate pain (22 per cent) and one person said they had experienced severe pain. While there was an increase in the proportion of young people reporting some kind of bodily pain from first to second round interviews, this result was not statistically significant. As with the first interview round, this reported bodily pain was not directly related to drug use.
Table 5.17: Extent of physical or bodily pain over the previous four weeks
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent
None 19 59.4 9 52.9
Very mild 4 12.5 3 17.6
Mild 2 6.3 3 17.6
Moderate 5 15.6 0 0.0
Severe 1 3.1 2 11.8
Very severe 1 3.1 0 0.0
Total 32 100 17 99.9
Health and social activities
Twenty-two young people in the first interview round reported that their physical or emotional health had not interfered with their social activities at all or only a little (69 per cent). However, two reported that their physical or emotional health had interfered with their social activities ‘quite a bit’ and one ‘extremely’ (nine per cent). The latter commented that this was due to emotional problems, while the two people that reported ‘quite a bit’ of interference did not elaborate on their responses (Table 5.18).
In the second interview round, 11 people reported that their physical or emotional health had not interfered with their social activities at all, or only a little (61 per cent).
However, four young people (22 per cent) reported that their physical or emotional health had interfered with their social activities ‘moderately’ or ‘quite a bit’ (Table 5.18). Out of the same group of young people in the first interview round, 14 had said that their physical or emotional health had not interfered with their social activities at all, or only a little (78 per cent) while two reported ‘moderate’ interference and one
‘extreme’ (17 per cent). While more were participants reported that their physical or emotional health was interfering with their social activities in the second interview round compared to the first, this result was again not statistically significant.
13 One young person did not wish to answer this question.
Table 5.18: Extent to which physical health or emotional problems interfered with social activities over the previous four weeks
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent Not at all 12 37.5 10 55.6 A little bit 10 31.2 1 5.6
Moderately 3 9.4 1 5.6
Quite a bit 2 6.2 3 16.7
Extremely 1 3.1 0 0.0
No answer 4 12.5 3 16.7
Total 32 99.9 18 100.2
Mental health
The five questions shown in Table 5.19 to Table 5.23 are standardised mental health measures taken from the Short Form (SF) 36, a health and quality of life survey used widely within health and related disciplines. The SF 36 has a number of sub-scales including mental health. It is possible to calculate a standardised mental health score for each participant in the evaluation, and from these individual scores calculate a scaled score (0 to 100). The mean scaled score can then be compared to Australian population norms.
The mean scaled mental health score for the 32 participants in the first round of interviews was 63.8 (64.2 for the young men and 62.3 for young woman). The mean scaled mental health score for the 18 participants in the second round of interviews was 68.7 (68.0 for the young men and 71.0 for young woman). The same group of young people in the first interview round had a mean scaled mental health score of 60.2 (59.1 for the young men and 64.0 for young woman). While the mean scaled mental health score for these interviewees had improved from first to second interviews, it was not statistically significant.
While there are no SF 36 data available for people under the age of 18 years, the Australian population norm for the SF 36 mental health sub-scale for 18 to 24 year olds is 75.2 (77.5 for young men and 72.8 for young women) (ABS, 1995: 11). The mental health of the young people participating in the evaluation interviews, particularly first round interviews, was thus poorer than the mental health of 18 to 24 year olds in the population as a whole. This finding is consistent with the NSW Adult Drug Court evaluation, where it was found that both male and female participants had poorer mental health sub scale scores at baseline than Australian population norms for 18 to 24, 25 to 34, and 18 to 42 year olds (Lind et al, 2001:8). However, of the people participating in the second round of interviews, the mean scaled mental health score of the young women was close to the Australian population norm for 18 to 24 year olds. The young men in the group still had poorer mental health than Australian norms for 18 to 24 year old men. This result may in part be due to the six young men interviewed whilst in adult prisons. These young men had a mean scaled mental health score of 59.3 at the time of the second interview, but, interestingly, an even lower mean score at first interview of 46.0, when they were not yet in adult prison.
The mental health score for unemployed Australians taking part in the National Health Survey was 70.0 (72.2 for men and 67.8 for women) (ABS, 1995:15). Many of the people participating in the YDC evaluation were also unemployed, but
comparison based on these figures still indicates that the YDC interview group had poorer mental health than unemployed Australians generally. The mental health sub-scale scores of YDC participants were also analysed by ethnic background. While the numbers of people in each sub-group are too small to make any definitive statements, it is worth noting that the mean mental health score was 53.3 for Indigenous Australians, 64.7 for non-indigenous Australians, 68.0 for Polynesians, and 77.6 for people of Southeast Asian background. It would appear that the Indigenous Australians in the YDC program suffer from poorer mental health than their non-indigenous peers, while participants from Polynesian or Southeast Asian backgrounds have better mental health than the group as a whole.
It is also worth noting that the mean mental health score for people completing the program and graduating was 70.9, while for those who chose to terminate their participation it was 57.2 and for those terminated by the Court it was 61.0. Once again, the numbers are too small to make definitive statements about these differences, but it would appear that participants who completed the program experienced better mental health than those who did not.
Table 5.19: Time spent in the previous four weeks being ‘a nervous person’
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent All of the time 2 6.3 0 0.0
Most of the time 4 12.5 1 5.6 A good bit of the time 4 12.5 1 5.6 Some of the time 7 21.9 6 33.3 A little of the time 10 31.3 5 27.8 None of the time 5 15.6 5 27.8
Total 32 100.1 18 100.1
Table 5.20: Time spent in the previous four weeks feeling ‘so down that nothing could cheer you up’
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent All of the time 2 6.3 0 0.0
Most of the time 3 9.4 2 11.1 A good bit of the time 1 3.1 0 0.0 Some of the time 8 25.0 1 5.6 A little of the time 14 43.8 6 33.3 None of the time 4 12.5 9 50.0
Total 32 100.1 18 100
Table 5.21: Time spent in the previous four weeks feeling ‘peaceful and calm’
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent All of the time 3 9.4 0 0.0
Most of the time 10 31.3 4 22.2 A good bit of the time 8 25.0 6 33.3 Some of the time 5 15.6 4 22.2 A little of the time 5 15.6 2 11.1 None of the time 1 3.1 2 11.1
Total 32 100 18 99.9
Table 5.22: Time spent in the previous four weeks feeling ‘down and depressed’
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent All of the time 2 6.3 2 11.1 Most of the time 5 15.6 2 11.1 A good bit of the time 0 0.0 1 5.6 Some of the time 7 21.9 0 0.0 A little of the time 11 34.4 6 33.3 None of the time 7 21.9 7 38.9
Total 32 100.1* 18 100
Table 5.23: Time spent in the previous four weeks being ‘a happy person’
Rating 1st Interviews 2nd Interviews
Number Per cent Number Per cent All of the time 2 6.3 1 5.6
Most of the time 20 62.5 9 50.0 A good bit of the time 4 12.5 6 33.3 Some of the time 1 3.1 1 5.6 A little of the time 4 12.5 1 5.6 None of the time 1 3.1 0 0.0
Total 32 100 18 100.1