Unlocking care: continuing mental health care for prisoners and their families

by David Baker

There were 30,775 prisoners in Australia at the end of June 2013 – an increase of five per cent on the 2012 census conducted by the Australian Bureau of Statistics (ABS). Almost six out of ten (58 per cent) prisoners had previously served a sentence as an adult. The cost of housing a prisoner in 2012-13 was $297 per day. In comparison, annual expenditure on mental health-related services in 2011‑12 was $322 per person – less than a dollar a day. State and territories provided 61 per cent of this funding.

The prison population has higher rates of mental illness than the wider population. While treatment in prison can improve a person’s mental health, it appears that, for some, mental health deteriorates after release. Mental health support is, therefore, an important service for people returning to the community.

If people are re-offending and returning to the prison system in part due to a failure to provide adequate mental health services following release, improvements make sense. The difference in cost for community mental health services and imprisonment provides a budget window for increased spending to improve mental health services. This paper outlines the case for a new model of continued mental health care from prison out into the community.

Among the general population one in ten Australians (11 per cent) registers a high or very high level of psychological distress, suggesting they may have moderate or severe mental health issues. In comparison the Australian Institute of Health and Welfare (AIHW) has reported that almost a third (31 per cent) of prison entrants in 2012 had a high or very high level of psychological distress. Almost one in four (38 per cent) people entering prison in 2012 had previously been told they had a mental health disorder. The rate of referrals to prison mental health services, however, was only 26 per cent in 2012. This referral rate did not differ for men and women, despite women prisoners having a higher rate of mental illness. At the point of leaving prison, twice as many women (31 per cent) as men (16 per cent) had a high or very high level of psychological distress. In 2012 the level of psychological distress among Indigenous prisoners was 22 per cent of prison entrants and 18 per cent prior to release. The data confirms previous research, both in Australia and internationally, that has shown the incidence of mental illness is higher among prisoner populations.

This paper reports that the average level of distress increases after release from prison, reversing evident improvements achieved during imprisonment. More than four in ten people who had been in prison within the previous year had high or very high levels of distress. This rate is higher than that reported by the AIHW for people entering prison and among those preparing to leave. For some people negative mental health outcomes present following release which were not evident in the lead-up to leaving prison. For people suffering a mental illness, the move back into the community can worsen psychiatric symptoms – contributing to greater difficulties adjusting to the change.

The mental wellbeing of those leaving prison is better than that of people entering prison, reflecting the ability of prison health services to deliver targeted, appropriate mental health care. The AIHW data shows that prior to release fewer than two in ten (18 per cent) people are likely to continue to have a moderate or severe mental health issue. A majority (91 per cent) of people being discharged from prison in 2012 reported that their mental health and wellbeing had improved. This positive outcome does not appear to apply to women. A UK study found that while the mental health of men improved in the first three months of imprisonment, there was no real change among women. Improvements achieved in prison, however, may not be maintained after release. Analysis of the Household, Income and Labour Dynamics in Australia (HILDA) Survey provides a third measurement of the psychological distress of people who had been in prison in the past year.

The transition from prison to the community can be a stressful and anxious period for many people. The AIHW has reported that impending release from prison was cited as a reason for psychological distress by almost half (45 per cent) the prisoners assessed as distressed prior to release. Australian research has found that for many people leaving prison there is a continuation of the problems, including mental health issues, faced prior to incarceration. If mental health care provided in prison is not continued after a person’s release, their mental health may worsen, undoing any health benefits that may have been achieved while in prison.

Full report