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New report sheds stark light on prisoner health

A third of all Australian prisoners were homeless before their incarceration and 40 percent have a diagnosed mental health condition, with one in three suffering a chronic illness and data showing they are two to four times less likely than the broader population to have seen a GP in the past year.

These were some of the findings presented in a new report, The Health of Australia’s Prisoners 2018, which was published Thursday by the Australian Institute of Health and Welfare (AIHW).

Released as prisoner health makes headlines with the terminal cancer diagnosis of serial killer Ivan Milat, the report presents a stark picture of disadvantage among Australian prisoners.

AIHW spokesperson Anna Ritson said:

Many adults entering prison came from disadvantaged backgrounds, with just over half of those surveyed reporting that they were unemployed and 1 in 3 homeless in the 30 days prior to being incarcerated.

Education levels were also very low, with one-third of prison entrants having completed Year 9 or under at school; by comparison, only 6.5% of Australian adults fail to complete Year 10.

We also found prison experiences that cross generations. Almost 1 in 5 (18%) prison entrants had at least 1 parent or carer who had been prison during their childhood and 2 in 5 had children dependent on them.”

According to the report, people entering prison, generally:

  • Were repeat offenders: 73% had been in prison before — 45% within the past year — and 35% of male prisoners (15% of females) had been incarcerated 5 times or more, with levels much higher among Indigenous prisoners (43% at least 5 times) than non-Indigenous (25% at least 5 times)
  • Had a family history of incarceration: 1 in 5 said one or more parent or carer had been in prison when they were a child (31% for Indigenous inmates), and this was a cycle repeating itself, with 38% of inmates reporting dependent children of their own (47% of Indigenous prisoners). The majority of women in prison (85%) had been pregnant at some point in their lives; 2% were pregnant at the time of detention. See below for a breakdown of key findings regarding female prisoners, and here and here for our other recent coverage of this issue
  • Did not complete school: 1 in 3 reported Year 9 or below as their highest level of education, with 17% not progressing past Year 8 (24% of Indigenous prisoners)
  • Were more likely to be unemployed or homeless: 1 in 3 were homeless in the month before entering prison (5% sleeping rough) and more than half (54%) said they expected to be homeless upon release. A similar proportion — 54% — were unemployed in the month before their incarceration

Significant and complex health needs

The report said people in prison had “significant and complex health needs, which are often long-term or chronic in nature”:

They have higher rates of mental health conditions, chronic disease, communicable disease, acquired brain injury, tobacco smoking, high-risk alcohol consumption, recent illicit drug use, and recent injecting drug use, than the general population.

Improving the health and well-being of people in prison, and maintaining those improvements after prison, benefits the entire community.

In terms of their health, prisoners were:

  • Likely to have a chronic illness: 1 in 3 had at least one chronic condition (arthritis, cancer, cardiovascular disease, diabetes or — most commonly — asthma), and this was much higher among women (45%). Alcohol and other drug use (29%), dental conditions (25%) and mental health (21%) were the most common diagnoses reported by inmates
  • At increased risk of mental health conditions (40% had been diagnosed at some point in their lives, 23% were taking some form of medication for this diagnosis), distress (26%) and self-harm (1 in 5 had a history of self-harm, and 5% reported an act while in prison). These figures were all higher among female inmates compared to males, while self-harm was more prevalent among younger prisoners
  • More likely to have an acquired brain injury: 1 in 3 had experienced head trauma severe enough to injure their brain and 10% had ongoing symptoms
  • Experience greater disability (26% vs 8%, age-adjusted, in the community)
  • Unlikely to have seen a medical professional in the past year (2 in 3 prisoners, compared with 15% of the broader population); when adjusted for age, prisoners were 2-4 times less likely to have seen a GP in the preceding 12 months than people in the community
  • Five times more likely to smoke (75% of prisoners), at increased risk of hazardous drinking (34%, with patterns of both abstinence and binge consumption higher than population averages)
  • More likely to have used illicit drugs (two thirds in the past year) and, if injecting, to share needles (25%)
  • 22 times more likely than those in the community to have been infected with Hepatitis C

Waitlists (30%), priority (29%) and expense (14%) were the main reasons given by prisoners for not seeing a doctor when needed in the community. Once in jail, priority (63%) was the main issue, followed by expense (38%), being affected by drugs/alcohol (38%), or transport/other access barriers (28%) for not seeking treatment.

The report said of 115 deaths reported in custody between 2013-14 to 2014-15, one quarter were the result of self harm or suicide, with the remainder from natural causes. The average age at death was 54.8 years.

The data comes from surveys of some 1,100 prisoners (803 entering detention and 335 due for release in the following month) at 62 facilities across Australia, excluding NSW.

Sustaining health gains

When leaving prison, the report found inmates were at a sixfold increased risk of suicide compared to the broader population, and more than half (54%) expected to be homeless at their release.

However, most also reported that their health either stabilised (32%) or improved (54%) while in prison. Indigenous prisoners were more likely than their counterparts to say their health had improved significantly while incarcerated (35% vs 28%).

Whilst in prison, detainees were more likely to seek treatment — particularly for alcohol and other drug problems — than in the community (see below).

One quarter of prisoners said they received a new diagnosis while in prison, most commonly cardiovascular disease (39% of all diagnoses were given for the first time in prison), musculoskeletal conditions (30%), diabetes (28%) and communicable diseases (26%).

Explained the AIHW’s Ritson:

For some people from disadvantaged backgrounds, prison can provide better access to health care and health professionals than they experienced in the community.

Prison clinics can greatly help people in prison take steps to improve their health, such as quitting smoking or getting help with mental health issues.

However, these health improvements can be lost after people are released, especially if health care and support services are not available during their transition to and within the community.”

If this topic is of interest, don’t miss Gideon Meyerowitz-Katz’s award-winning Gavin Mooney Memorial Essay on prisoner health, published earlier this year.

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#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017