Improved access to health services, tackling overcrowding, and better coordinated care for offenders once they leave jail are the keys to addressing high rates of chronic illness, communicable disease and mental illness among Australia's prison population according to St Vincent's Health Australia (SVHA).
Responding to the Australian Institute of Health and Welfare's latest report on prisoner health, SVHA – which provides health services to inmates in both NSW and Victoria – said authorities also needed to prepare themselves for the unique health needs of a rapidly ageing prison population.
"Today's AIHW report on prisoner health confirms much of what we already know about Australia's prison population – the high rates of mental illness, the lack of coordinated care post-release – but it's a valuable reminder of the scale of the problem," said Lisa McDonald, SVHA's General Manager of Mission.
Key findings of the AIHW report include:
- Over half of inmates were unemployed and 1 in 3 homeless before being imprisoned.
- One-third of prison entrants have only completed Year 9
- Almost 1 in 5 (18%) prison entrants had at least one parent or carer who had been in prison during their childhood.
- Almost half of all Indigenous prison entrants have been in prison five or more times before (compared with one-quarter of non-Indigenous entrants)
- More than half expect to be homeless upon leaving prison.
- Around 40% of prison entrants have a mental health condition, including AOD addiction.
- 2 in 3 prison entrants reported using an illicit drug in the previous 12 months.
- 1 in 3 prison entrants has a chronic physical health condition (eg: diabetes, asthma, cancer); 1 in 5 prisoners have Hep C.
Ms McDonald said most offenders entered prison with much poorer and complex health conditions than the general population.
"While it's true the health of most prisoners improves while inside, it’s coming from an extremely low base. And prison conditions, along with the difficulties accessing appropriate care while in custody, can undermine any improvements or worsen existing health problems.
"Today's report details how extensive mental illness is in our nation's prisons: around 40% have a mental illness; 1 in 5 have a history of self-harm before entering jail; and a significant number are in severe psychological distress.
"Overcrowding exacerbates problems in a prison environment already unfavourable to good health. It leads to anxiety and depression; increases the likelihood of aggression and violence; and increases waiting times for support services.
"There are now around 43,000 prisoners in Australia. The national imprisonment rate is increasing at around 3-4 per cent per annum.
“While a number of states are planning large new correctional centres to try and respond to the growth in prisoner numbers, they’re a long way from coming online.
“In the meantime, you have the situation where NSW has re-opened Berrima Jail, which is so old it once accommodated bushrangers like Captain Thunderbolt.
“As prisons attempt to manage overcrowding, double- or triple-bunking existing cells is also commonplace.
"Another major challenge is in the planning and coordination of health and social supports for prisoners prior to their discharge, which we don’t do well.
"As a result, studies show that the mental health of most Australian prisoners deteriorates in the year following their release; men’s homeless shelters are full of ex-offenders.
“Better discharge planning equals reduced risk of re-offending. It's in our society's interest for prisoners to be given a smoother transition into the community in terms of healthcare, housing and employment. Without improvements, the 'revolving door' between prisons and the community will only continue.
"Finally, governments and prison authorities must come to terms with the rapid ageing of Australia's inmate population which brings its own significant health challenges.
"The number of prisoners in Australia’s jails aged 65 years and over has increased by 348% over the past 16 years.
"Ageing brings unique health challenges – chronic illness, lack of mobility, dementia – which our prisons are currently not equipped to manage.
"Some of Australia's prisons were built in the 19th and first half of the 20th centuries and feature narrow doorways and numerous stairs, they're not designed for elderly people with walking frames or in wheelchairs.
"Prison authorities must start planning to cater for the health needs of this growing demographic, including the prospect of establishing new, secure aged care facilities outside the mainstream correctional system.
"In Australia's prison population, we're dealing with a cohort that is notoriously difficult to engage and treat when they are members of the community. So, while they're able to respond to care, we should do everything we can improve their health status – it makes sense for the individuals and for our society as a whole," said Ms McDonald.
