The new Australian Institute of Health and Welfare Report on prisoner health is a sobering read.
The study shows that people in prison are more likely to suffer from mental disorders, chronic diseases, infectious diseases, and acquired brain injuries. The prison population is relatively younger.
This is a serious problem that affects everyone. Research indicates that mental health interventions and engagement help to reduce offenders with serious mental illnesses.
It is not just the patient who benefits from good health care. Reduced crime helps the community.
Read more: Good mental health care in prisons must begin and end in the community.
The new report
In 2022, data were collected from 371 prisoners who entered prison in two weeks and 431 others who were scheduled to be released in that period or the four weeks following. The report contains information from 73 out of 87 Australian prisons (excluding Victoria, which did not participate in this survey).
Researchers also collected data on 4,500 prisoners who visited the prison clinic and 7,100 others who received medication while in prison.
Data shows that around one out of two prisoners who enter prison have a chronic health condition.
A mental illness is diagnosed in one out of two prisoners who enter prison. Nearly one-fifth are currently on mental health medication.
One in five prisoners who enter prison has a history of self-harm.
The self-reported level of distress was high.
The report revealed that:
- Two-thirds (two-thirds) of prisoners who enter prison have previously served time in prison
- Around two out of five young prisoners reported a history of imprisonment in their family.
- Around two-thirds of prisoners who enter prison have dependent children living in the community
- Nearly one-third of prisoners who entered prison reported that their highest education level was year nine or below
- Almost one-half of all prisoners released from jail expect to be homeless upon release
- On a typical drinking day, almost one-third of prisoners reported drinking at least seven standard alcoholic drinks
- Nearly three-quarters of prisoners who are currently in prison said that they smoke cigarettes.
Unsurprising but shocking
These grim findings were not surprising to me as someone who has been working in prisons for over 30 years and researching prisoner health. The results are consistent with past reports and confirm that people in custody need special health care.
While people are in prison, it’s easy to forget about their health.
Most people who are in prison have been remanded until their trial. Once they are sentenced, most of them are released into the community fairly quickly.
Most people who are sentenced to prison spend a relatively brief time behind bars, especially those who have committed low- or medium-risk offenses.
After being released, a high percentage of people return to prison. Very little continuity exists between the health care provided in prison and that in the community. The system’s failures contribute to the replication of disadvantages and make the community as a whole worse.
Why are prisoners, in general, so ill?
Prison entrants tend to be poorly educated and impoverished. They may also come from families that have a history of incarceration or experience homelessness.
These individuals are more likely to be unemployed, have a poor work history, and have been victims of child abuse.
A disproportionate number of prisoners are Aboriginal or Torres Strait Islanders. This group is generally in significantly worse health than the rest of society.
Recent evidence shows that many prisoners have lower levels of health literacy compared to people living in the community. They may also struggle to understand and apply information in order to make the best health decisions.
Why is this an issue for us all?
Most people are only incarcerated for a short time. Prisons are an integral part of our society. We can reduce healthcare costs by improving the health of prisoners and ensuring continuity in the community. Early investments in improving the health of prisoners can save taxpayers a great deal of money.
Better health care can also help improve public safety, as certain mental health conditions may be linked to an increased risk of offending.
Read more: Victoria’s prison health care system should match community health care.
What needs to be done?
We must rethink how we view prisons and the people who are detained there.
We can target those entering prisons in order to improve their health literacy and care. The importance of health care and mental health care in improving prisoners’ health literacy, wellbeing-, and continuity of care after release is critical.
All states screen for health problems when detainees are admitted. The new report on prisoner health shows that almost three-quarters of prisoners who were discharged rated their health care in the prison clinic as either excellent or good.
Correctional health services, no matter how good they are or how well-run they may be, cannot overcome systemic issues. The health care provided in prison does not address health literacy, the prevention of health problems, or the continuity of care after release.
Read more: Raising the age of criminal responsibility is only a first step. First Nations kids need cultural solutions.
The health and mental health care service system in Australia is fundamentally flawed.
The state governments are responsible for funding prison health services without the federal funding that all Australians enjoy through the Medicare Benefits Schedule and Pharmaceutical Benefits Schedule.
The funding inequity and the systemic problems contribute to the overall disadvantage of health care in prison.
In some states, prisoner healthcare is the responsibility of the justice department rather than that of the health department.
This leads to a breakdown of integrated service planning and provision, which should include health care for prisoners, health care after release, and continued care in the community.
It is possible to improve health literacy in prisoners. Health literacy is a combination of critical thinking, communication, and problem-solving.
This means giving people the tools they need to take an active role in their health and wellbeing.