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 disorders among Australia's prison population according to St Vincent's Health Australia (SVHA).
Responding to the Australian Institute of Health and Welfare's new report on prisoner health, SVHA – which is a major provider of health services to Victorian prisoners – said justice 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 and of future challenges," said Jack de Groot, SVHA's Head of Mission.
Key findings of the AIHW report include:
- Just under half (49%) of prisoners have a mental illness (incl. alcohol/drug addiction).
- One-third of prisoners have Hepatitis C.
- Over two-thirds engaged in illicit drug use in the previous 12 months (10% while in prison).
- One-third expect to be homeless upon release.
Mr de Groot said most offenders entered prison with much poorer health and often more complex conditions than the general population.
"While it's true the health of most prisoners improves while inside, the two main risks are a lack of access to services – particularly mental health, and treatment programs for those with alcohol and other drug addictions – and increasing levels of overcrowding.
"Today's AIHW report details how extensive mental illness is in our nation's prisons: almost half have a mental illness; almost one-quarter self-harmed before entering jail; one-third are in severe psychological distress upon entering custody.
"Repeated expert inquiries have identified the need to improve mental health services for prisoners. While some states are responding – Victoria is leading the country with a 75 bed mental health unit it's building in the new Ravenhall Prison – others lag behind.
"As for drug and alcohol, it's hard to overestimate the challenge facing authorities given the level of illicit drug use. There are long waiting lists for access to AOD (alcohol and other drug) programs which are often a pre-requisite for parole.
"Overcrowding exacerbates problems in an 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 34,000 prisoners in Australia, the highest number since 2004. The number grew by 10% over the past 12 months.
"In NSW, prisoner numbers were predicted to reach 12,000 by June 2017; in fact the state reached 12,250 earlier this month.
"When you look across the country, the ratios of healthcare staff to prisoners haven't kept up as prisoner numbers have increased. In fact, in some states, it's gone backwards.
"The other major challenge in prisoner health is in the area we call 'throughcare' – the integration of correctional and post-release community health and social services.
"Across Australia the discharge of prisoners is often poorly planned. Studies show that the mental health of most Australian prisoners deteriorates in the year following their release.
"While there is evidence justice, health and human service authorities are working better together, they need to improve their integration to manage the health of offenders post-release.
"Better throughcare 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 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.
"In NSW, the number of male inmates aged 65 or over has increased 225% over 10 years.
"Australia's prisons are just not equipped to manage such a large number of elderly inmates and it's placing huge demands on an already struggling correctional health system.
"Some of Australia's prisons were built in the 19th and first half of the 20th centuries – narrow doorways, numerous stairs – they're not designed for elderly people 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 Mr de Groot.