Get Real: Talking mental health & disability

The Aussie Psychologist who ended up running a New Orleans Prison

• The team at ermha365 • Season 5 • Episode 114

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Dr Astrid Birgden is a consultant Forensic/Clinical Psychologist and NDIS Behaviour Support Specialist who has years of experience working in corrections and disability settings. 

Astrid's career is quite extraordinary. She is a trailblazer in behaviour intervention support in Australia and worked overseas on international projects. She has even been an assistant sheriff/warden of a remand centre in New Orleans.

We caught up with Astrid at the Complex Needs Conference in March 2025 where she was part of a panel discussion on Integrating mental health, disability, and human rights for comprehensive support.

ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.

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Welcome to Get Real, Talking Mental Health and Disability. Brought to you by the team at erma365. Join our hosts Emily Webb and Karenza Louis Smith as we have frank and fearless conversations with special guests about all things mental health and complexity. We recognise people with lived experience of mental ill health and disability as well as their families and carers. We recognise their strength, courage, and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together.

Emily Webb:

Dr. Astrid Bergden is a consultant, forensic and clinical psychologist and NDIS behaviour support specialist who has years of experience working in corrections and disability settings. Astrid's career is quite extraordinary. She is a trailblazer in behaviour intervention support in Australia and worked overseas on international projects. Astrid has even been an assistant sheriff slash warden of a Romand Centre in New Orleans. And we'll find out more about that in this conversation.

Astrid Birgden:

Found it very interesting because some of us have said like we meet slices of professionals at different conferences, like Lawrence Psychology or Strait Psychology. And here it's been a whole combination. We're seeing all the people we know at once in one conference.

Emily Webb:

So it's very much a social gathering as well.

Astrid Birgden:

Yeah, and it's good for networking.

Emily Webb:

So Astrid, can you tell me about your professional experience and what you do?

Astrid Birgden:

I'm a forensic and clinical psychologist. And so I started working with child sex offenders at Adelaide Jail at the age of 21. And I've ping-ponged since between corrections and disability services. So at 22 I started working with people with intellectual disability and I started to pick up clients that were in trouble with the law. So later on, I started a forensic master's degree. So I moved to Melbourne from Adelaide in 1990, and we were the first forensic masters group in Australia. So that was under Don Thompson. So then I went into disability. I set up one of the first behaviour intervention support teams, one of the first four. So that was in 1990 in Melbourne. And then later on I went to corrections and set up the sex offender treatment programs. Then I went off to Puerto Rico for six months and studied two law subjects. That was in 2000, on something called therapeutic jurisprudence that I'm interested in.

Emily Webb:

Wow, what does that mean?

Astrid Birgden:

So, like it or not, the law's going to have an impact on people. So you might as well make that impact positive rather than negative or at least neutral. So out of that have come the problem-solving courts like the drug courts, the mental health courts, which are kind of a part of that process. And when I came back from Puerto Rico, Corrections Victoria had received a lot of funding to rejig itself. So I developed the reducing reoffending framework. And I'm pleased to say that 24 years later, somebody at this conference was present presenting on disability and in corrections. They're setting up a whole bunch of programs, but she mentioned offence-related and offence-specific programs. So I thought that model has stuck 24 years later because that's what we set up. And so I did that for four years and set up all the programs across public and private prisons and community corrections. And then I went to the courts and I was involved in setting up the family violence courts. We're now moving into 2005, and I got a phone call from a recruitment agency saying, why didn't I apply to run that compulsory drug treatment prison in Sydney? And I said, first of all, I don't know anything about it. And secondly, I'm a psychologist and a civil libertarian. Why would I run a compulsory drug treatment prison? Then they gave me the legislation. So I had my own act and it meant I could run it as a psychologist, not as a tin soldier in a uniform. And so I set that up. It was a four-year pilot, it's now in its 16th year. So we had a reunion last year with the staff at Parramatta Pub. And then in 2011, I became a free-range chicken. So I've been a consultant ever since. And through that, NDIS formed. And so it was a logical match for me to start picking up NDIS forensic disability clients because I've ping-ponged between corrections and disability services. But I just wanted to add in I have come back a year ago from running a 1200-bed jail in New Orleans. So I was the warden slash assistant sheriff. So that was like another planet. But I got back in November last year. So although I've been a free-range chicken doing consultancy work, I had that little moment where I went back to doing a nine to five job where you had to get up every morning when the alarm went off, and I decided I'm not really keen on that anymore.

Emily Webb:

I'm sorry, how do you end up getting up getting a job doing that in New Orleans?

Astrid Birgden:

I call myself the accidental tourist, so just weird things happen. So my housemate from Puerto Rico, she was doing law along with me, so she became a lawyer. She was from New York, but then she moved to Puerto Rico to become a deputy police monitor. So the police force were the most corrupt in the US and they had to be monitored. So she was the deputy monitor, but her boss was the chief monitor. Her boss unexpectedly got elected as the sheriff. So she rang me, she knew because for four years I'd been in and out of New Orleans three months of the year, setting up a citizen police mediation program, which is an alternative to the police shooting complaining citizens dead. So we created what was described as the most community-based program in the US in the end, but it took me four years, three months a year going there voluntarily, unpaid to set it up. And so she rang me and said, Would you come and run the jail? And I said, I'll do it for six months till you found someone. So in the end, I was there for 18 months.

Emily Webb:

Wow.

Astrid Birgden:

Then I thought it was time to come back.

Emily Webb:

What was that like running that jail?

Astrid Birgden:

I could have laid my 1980s face on the executive desk. That's what I told people. I felt like it was the same conversations we had in the 80s, where people would argue staff safety was more important than prisoner programs. There was maggots in the food. It was appalling and really under-resourced. So she's trying the best she can to create a humane jail. But I think they've reverted back to a warden that's more the dude with the moustache style. Something I did do that I don't think would happen anywhere else in the US was I would meet fortnightly with the pod representatives. There were 60 men in each pod, two representatives from each pod, because there would be 1,200 grievances a week. And so I would meet with them every two weeks, the representatives to hear their grievances and then try and sort out systemically how we could solve the problems that they were raising. But basically it was a thousand men in orange jumpsuits just stabbing each other all day. An architect from Australia came and had a look. She said it was a cookie-cutter McDonald's prison, cheaply built with aluminium everywhere. So they're just unpicking the aluminium and stabbing each other because there's a lot of uh gang stuff that goes on. And there was 200 women there. And you can sit for six years in a jail not designed for it's a Roman prison. So you could be there six to eight years waiting for your court case. And 50% of those prisoners, or we called them residents, which I think has stuck. So because I said they're not yet offenders because they haven't been convicted. So 50% of them are on prescribed psychotropic medication. There were three psychiatrists working in there, but no other programs at all. So we started trying to bring programs in through grants. I learned to say grants instead of grants. So I just said to the sheriff, let's assume that every single person in the building is drug addicted, has a mental illness, and is traumatized. And then, unless they can prove they're not one or none of those things. So we're just going to assume that that's where everyone is coming from. It's a very traumatized city. Lots of poverty and drugs and violence.

Emily Webb:

Yeah, has really wow, that is your career experience is wild. Like it sounds amazing. So just before we actually start talking about what you were speaking about actually at this conference, which is forensic disability clients who move between the disability and corrections systems. I want to go back to when you mentioned you were 21 in Adelaide working with sex offenders. Now, how did that happen? And also, I mean, that's going to either kind of make or break you.

Astrid Birgden:

Yeah, so I did politics and psychology at uni, and I have to say politics is way more interesting. You know, in psychology, you could smell the rat lab as you came into the building. So it was a very behaviourist department. But then I thought I'll never get a job with politics, so I better stick to psychology. And then back in those days, you had to have four years' supervision to get registered, but nobody's going to employ a 21-year-old with no experience looking for registration. So the senior psychologist was uh specialising in child sex offenders, and he had the theory back then, we're talking about mid-80s, that they lack social skills. So if you taught them social skills, they're less likely to re-offend. So we know that's not a very sophisticated treatment option these days, but that's what you know we were known back then. So I would work with him in the afternoons to get supervision for registration, and in the mornings I'd work at a psychiatric hospital as an occupational therapy aide, working with what was called back then psychogeriatrics. And they weren't allowed to leave the hospital grounds. So I used to walk them right around the edge. So they felt like at least they're going out in the community. So that's all changed now, too. And then my future manager, she came along because she had to do a placement as a psychologist, and she said, Do you want to come and work with intellectual disability? And I said, Well, I don't really know about that area. So I went to the job interview. And so after about a year, I think I moved into full-time employment in Intellectual Disability Services Council, it was called back then. And then whenever I went and moved to mainstream work, I would always keep uh people with disability in mind, even if I was in a mainstream job, to try and set up services for them. But I guess I just went in the deep end and just coped with it.

Emily Webb:

Yeah, you certainly went in the deep end. That's uh that's the absolute truth. It's no understatement.

Astrid Birgden:

But I think what that's done is I've always picked up the clients that people don't want to work with. So it's kind of been my attitude that somebody's got to work with very difficult clients. So I haven't been fearful of working with them.

Emily Webb:

Yeah, and this at this conference, there are hundreds of people here who work in that space, so it's pretty amazing. And so you're you're talking about you know, forensic disability clients and moving between the disability and correctional system. So why are you wanting to tell the delegates at this conference about that? And and I guess is this being built up through all your experience in what you've done?

Astrid Birgden:

Uh yeah, so I think it's a natural merger because what happens is behaviour support practitioners might not necessarily want to work with offenders, particularly sex offenders, violent offenders, because that's my area, and drug-related offenders. So they won't know much about substance use. And then people working in the correctional system don't want to work with people with cognitive impairments. So NDIS will say a drug-related NDIS client, their drug issues should be provided by mainstream services. But then you've got to find the mainstream services for the client. So it becomes, I've called it a wicked problem because it's circular. And meanwhile, you've got the client running amok in the community out of it on amphetamines, smashing the house to bits, threatening the staff. So for me, that's probably the hardest group to work with are those substance users. And so I think they've fallen through the gap, but now there's probably more people getting experience in the forensic disability sector. But I think it's at first it was a shock because I started at the pilot in Geelong. I think that was back in 2019. So there wasn't really the capacity around to pick up forensic disability clients.

Emily Webb:

When we talk about forensic disability, what does that look like?

Astrid Birgden:

So I describe them. I did a master's, I mean, I'm hypomanic, I'm sure, right? So I did a master's in You can't help yourself. I did a master's in mental disability law after I'd done master's and PhD in psychology, like as if I'd do more study through New York Law School. And then I was out and about, you know, nightclubbing with my friends and suddenly realized I had a thesis due in 10 days, because it's the story of my life. I never look in my diary properly. And I just churned this thing out about Supreme Court cases and discrimination against people with disability in prisons. But I came up with a human rights framework. So what I said is that forensic disability clients are both a person with a disability and they are a person who's offended. And so what you have to do is balance the two of their rights. So they have rights as a person, but they also have rights as an offender. But they also can't be impinging on the rights of others. So with rights come responsibilities, and then we, the workers that work with people like that, are duty bearers. So we have to ensure that we're meeting people's human rights. So that's how I view my clients, both as a person with a disability, but also a person who's offended. And then that draws in where you give someone dignity of risk versus duty of care, because it's not okay that they go around violating other people's rights. So NDIS will talk about choice and control, but there should be a limit to choice and control if you pose a risk to yourself or others.

Emily Webb:

Yeah, and I was going to bring up the the thought, and I've spoken about this a lot to other people we've spoken to for the podcast, you know, with the cohort of people that are supported in complex needs, you know, there's not a lot of goodwill towards them, sympathy, and people may say, well, who cares about their human rights? They're like running a marked sometimes doing really violent, scary things. But it is important that people work with people with complex needs because then what's the alternative?

Astrid Birgden:

Yeah, because my PhD looked at high-risk offenders, and those I ultimately said if they refuse rehabilitation, they don't want to change. You know, in my thesis, I argued there's a I didn't say it like this, but there's a group of people that swim upstream from humanity and they just will not do a U-turn and go with the flow. And you can see for 30 years, people have been trying to get them to do a U-turn and it's not working. So at the end of the day, there are some high-risk violent people who do need to be incapacitated by being placed in a secure setting. But it's only a very small group, and I think we're putting way too many people into prison than we ought to. Because there are a lot of people being incarcerated that don't need to be for protection of the community. It shouldn't be about punishment. And that's what I used to say to the officers in the drug treatment prison I ran. I said, you might shout and swear at prisoners anywhere in the state of New South Wales, but you're not doing it in this jail. And we're using a reward system, not a punishment one. We're never locking them up, we're never taking the TVs off them. The union said there'd be riots. Well, there never was. And I tried to give that same messaging in New Orleans, but the attitude, it was so based there. It's Maslow's hierarchy, you're just trying to get food in with no maggots. So I didn't have much success there explaining or getting the staff to understand or agree, let's say agree, that punishment is loss of liberty and nothing more than that. All it should be is loss of liberty. It's not about them putting the boot in once they got the person, and we're running a Raman jail anyway. So these guys aren't convicted.

Emily Webb:

That's interesting because it it there's been a bit come up about this today for me. And early this morning I was listening to the 7am podcast, and it was about the how punitive, more punitive bail laws in Australia, in Victoria are getting. And and it just was really shocking to me that yeah, like it's not targeting the people who need to be targeted, the people who are, you know, maybe doing some minor offenses, First Nations people, women. It's just having devastating, unintended consequences.

Astrid Birgden:

Yes, because I started listening to that as I walked here to the conference with Marilyn McMahon, and I so I didn't quite finish it uh listening to it, and I was going to after the end of this. But the trouble is it's net widening, but the net gets wider, it gets deeper, you know, it scoops people up. And then who's gonna fund holding all those people? You've got a building then full of reluctant customers, I call them. And so then you're trying to work with people who are very resistant because they don't want to be in a confined space and then might not, you know, and they're bailed and haven't yet been found guilty of the offence. Yeah.

Emily Webb:

I find it just not great, not ideal that you can be in jail. You haven't been convicted yet. It depends on what what's been done, okay, right. But yeah, it could be something super minor in the scheme of things. I just think it's outrageous.

Astrid Birgden:

Because the bit I caught was where she was saying bail originally was to ensure that you got to court. So if you look like you'd be unreliable, then you wouldn't get bail. But now it's a tough-on crime. It's telling, you know, we've got the toughest bail laws in the state. And then look what happens with juvenile justice when it gets filled up. They end up on the roof, you know, lighting fires. Yeah, and then Northern Territory. It sounds pretty bad up there now.

Emily Webb:

Yeah, it's uh getting pretty hectic. So with your presentation at the conference and why you've come, Astrid, what are you wanting the people in the room to understand? What do you want to convey to them?

Astrid Birgden:

I guess the main thing is that with these complicated clients, we need interagency coordination. So it's not enough to handball substance using people with cognitive impairment into mainstream treatment. So I always argue that people engage in these offending or violent behaviours because of their cognitive impairment to begin with, because they're not thinking through the consequences properly. So I've always hooking it back to the disability. Because even I've got a client who's very violent when drunk, but she is now demonstrating some of those behaviours while not drinking. So it tells me it it reinforces you bring it back to the disability. At the conference, Victoria seems to be way ahead. I have to say, in the 80s, when we'd be designing things in Adelaide, we'd always ring Victoria first to see what Victoria was doing. So it's always been the leader, and somebody once said it's because the number of NGOs that have been historically existing in Victoria that it's more innovative. So I'm here because I thought we've got a good example of interagency coordination. It's nothing in comparison to what Victoria is doing because Victoria is fully systemic. You know, it comes from the top between the government departments. So I think that's important. I think it's uh important to have an understanding of the framework where the line is drawn between duty of care and dignity of risk, so that everyone agrees where that line is drawn. And I think the third part is to capacity build these support agencies, the supported living, the SEAL providers, because those support staff, the behaviours that they have to put up with. And, you know, often with my clients, because they're violent, there's a bunch of blokes in there. And I just wonder how much training they've got through the certificate three. I don't think it gives them capacity. Back in the day in Victoria in the 90s, we had IDSOs. So they were specifically trained to work with people with disability. They knew how to do a task analysis to teach a skill, backward and forward chaining, all those sorts of things. Now the certificate three courses just seem to be some generic thing. And I've I've got to go and find out what the content is, but it certainly doesn't help me as a behaviour support practitioner. So I think really those support staff really need to be capacity built to manage very difficult behaviours.

Emily Webb:

So when we're talking about um forensic disability, so uh people who have got a disability, they are also in the correction system. So that can include, I guess, not just substance use, which then influences behaviour. What else can that include? So you you've worked with sex offenders. Is there a representation of sex offenders with disability?

Astrid Birgden:

Not so much. I know I looked at my caseload about six months ago, and I'd say a third of them are of my clients are indigenous, a third substance users, and not so much sex offenders. So, because they're a small percentage anyway, but the other area is dual diagnosis. So a lot of my clients would have, and I think it was a third dual diagnosis, so they'll have a mental health issue as well as um a cognitive impairment. And sometimes the psychiatric system is still finding ways to undiagnose them, get rid of those psychiatric diagnoses and shove them into NDIS problematic because there's some behaviours which are clearly not the result of intellectual disability. And so I think there's still a bit of work to do there. My uh master's thesis, the forensic one, was on dual diagnosis and psychotropic or psychoactive medication. So that includes uh anti-convulsants being applied to manage behaviours. So that's what the NGIS is so concerned with the restrictive practices you have to really show. But you've got to go to the doctor and say, sign this form, is it for treatment or behavior management? And the doctors say, look, that's not my job. So there's still a bit of tension going on there. You know, the local GPs say we just don't have time to be filling out these forms. And then in that area, you also get the interactive effects of medication. So the person might be on six or seven medications, they're never reviewed, they just you know, continue to be prescribed, and you don't know what interactive effects, and it's really pharmacologists that understand that more. But I would say most of my clients tend to be more violent as a means of communication. And there's I they come to me because they're sex offenders, because I'm probably one of the few people working in that area. But then sometimes I say it's just external management. This person doesn't have the capacity to internalize or motivate themselves not to re-offend, so it's going to have to be an external management process for the rest of their life. And does that mean prison or what does that mean? Oh, that's living in the community, but being supervised when out in the community.

Emily Webb:

I always ask this question. What's Astrid's magic wand solution? If there's something that you think, oh, if we could only do this, things would be so much better. What would be your, you know, big ticket item?

Astrid Birgden:

I think really training the support staff properly, I really think it would make a difference. I'm very concerned for their occupational health and safety and doing that balance. And I know NDIS, from what I understood, didn't ever fund staff training. So when I do the training with the staff, the organisation has to find the money for it. The other thing that would have been super helpful is if we're doing positive behaviour support, that means rewarding people. You're asking people to do things rather than telling them what not to do. And to do that, you use reinforcement just like I did in the drug treatment prison, but there's no budget to give them. You have to give them a reward over and above what they'd ordinarily have access to. And somebody should have worked that out early on in NGIS that there should have been a bucket of money for rewards because that's a tenant of positive behaviour support.

Emily Webb:

I guess the thing is, you know, there is a lot of misunderstanding about the NGIS and the way it's reported on, and people who don't access it think it's a wrought. Yeah, we know that it's not perfect, but I I don't know what uh people would think if they're like, oh, rewarding people, but it obviously works. It's evidence-based, and I think there's just so much misunderstanding about why there needs to be these approaches for people with complex needs. But I've heard so many people talk about the ripple effect is immense for the community, for the families of the people that are supported. Like it's if you can get this right, I guess I don't know if that's the right word, it's got massive benefits.

Astrid Birgden:

Yeah, well, certainly it's cheaper than institutionalization. And so I'm old enough that I worked in those institutions. So I've seen them, Laurundel Hospital here. I did a placement one day a week as a master's student. I found 15 people with intellectual disability in the backwards. I started assessing them and sending them through to DHS to be registered. And they said, Astrid, could you please stop? And I said, No, I'm not. So I got 15 people out. They'd been sitting there for a couple of decades, probably.

Emily Webb:

Well, that is heartbreaking, but also go you. Like that that actually, yeah, it it's really hard to think about that stuff, isn't it?

Astrid Birgden:

And I think the risk of institutionalized abuse is more likely in large institutions because a lot of my clients are living on their own. They're quite verbal, they're quite high functioning with autism and acquired brain injury, but they could express if something was going on, you know, not so much for the very non-verbal people with greater levels of disability might be at risk. But I think just not having institutionalized care is a big step forward. It's taken a long time to get there.

Emily Webb:

And Astrid, thank you so much for your time because I know you want to get out and about at the conference. Have you got any final thoughts or anything that you want to leave listeners with or something to maybe think about to keep people interested, keep the conversation going?

Astrid Birgden:

I think NDAS is the most amazing, fantastic thing. Like really, I understand it was originally proposed in the UK and it got shot down, I think. I just read that somewhere, but that for Australia to pull that off. I mean, after being in America where they don't even have health care, and I can go off and have an x-ray and you know, things, and then I go to pay and they say don't worry about it, like here, in comparison. And so I think NDIS is just an amazing thing. So I think it will just take a while to uh work out how it rolls, you know, because I'm still a bit confused about the rules, I have to say. I'm supposed to be a behaviour sports specialist and I supervise other people, and so some of us are wandering around a bit in the dark. So eventually it should iron out itself out because it's a massive project.

Emily Webb:

Yeah, I agree. And yeah, it is confusing. I mean, I don't have firsthand use in the space of NDIS, but I have to understand bits of it for my work and like we should have these things and the pharmaceutical benefits scheme. I mean, America, look, it just seems so punitive and so hard. I am grateful for some of the things we have in Australia. Astrid, you are so fascinating, and I really want to catch up with you again. But thank you so much for your time and just the work you do. Thank you.

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You've been listening to Get Real, talking mental health and disability, brought to you by the team at Irma365. Get Real is produced and presented by Emily Webb with Carenza Louis Smith and special guest. Thanks for listening, and we'll see you next time.

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