People in prison are a particularly vulnerable population. They are generally more disadvantaged, with higher health care needs than the wider Australian population. Most people in prison are there for relatively short periods, which means that the health issues of people in prison become health issues for the whole community. These factors suggest that people in prison need a high level of health care and continued health care and support in the community following their release.

Data sources

Data for the National Prisoner Health Data Collection (NPHDC) is collected by the AIHW every 3 years and is the main source of national data about the health of people in prison in Australia. It presents information about the health experiences of people throughout the prison cycle—from entry, to time spent in prison, to discharge, and after release. It includes information on the operation of prison health clinics and the conditions they manage; the medications dispensed; self-reported information from people as they enter and exit the prison system—known as prison entrants and prison dischargees; and summary information, recorded by the prison clinics.

Like any survey, the NPHDC does have limitations. They include:

  • the sample in the NPHDC does not represent the entire prison population. The NPHDC was designed as a census, capturing data on the population of interest at a point in time
  • not all prisoners participated in the survey—this could be due to staffing constraints within a particular prison, uncertain release/transfer dates, limitations (physical or mental) of the potential participants, and prisoners not providing consent to participate
  • the majority of the data collected for the NPHDC were self-reported.

Profile of people in prison

At June 30, 2019:

  • There were about 43,000 prisoners in Australia
  • Just over 9 in 10 (92%) prisoners were male
  • More than 1 in 4 prisoners were Aboriginal and Torres Strait Islander (28%) (ABS 2019a)

The prison population differs from the general population in a number of ways. People in prison are mostly male, and Aboriginal and Torres Strait Islander people are vastly over-represented. People in prison experience higher rates of mental health conditions, chronic physical disease, communicable disease, tobacco smoking, high-risk alcohol consumption, illicit use of drugs, and injecting drug use than the general population (AIHW 2019a).

Prison stays are usually temporary. On 30 June 2019, one-third (33%, or 14,200) of the approximately 43,000 people in prison were on remand while awaiting trial or sentencing. For those who were sentenced, the median time they could expect to serve was 2 years (ABS 2019a). This means that the prison population is fluid, with people continually entering and being released from prison.
 

The number of Australians in prison has increased since 2011; in 2011, there were 29,107 people in prison, and in 2019, there were 43,028 people in prison.

Mental health

Mental health is fundamental to social wellbeing, and affects individuals, families, and the wider community (ABS 2019b). Mental health conditions are chronic conditions such as depression, anxiety disorders, psychotic disorders, and alcohol and other drug use disorders. These conditions can influence thoughts, feelings, behaviour, stress levels, relationships, and decision making.

Of prison entrants surveyed in 2018:

  • 2 in 5 (40%) reported having been told they had a mental health condition at some point during their lives
  • Females were more likely than males to report a history of a mental health condition (65% compared with 35%)
  • Almost 1 in 5 (18%) were referred to mental health services for observation and further assessment (AIHW 2019a)

In the NPHDC, prison entrants and dischargees were asked to rate their mental health as being excellent, very good, good, fair, poor or unknown. Of prisoners surveyed in 2018:

  • almost 7 in 10 prison entrants (69%) and 8 in 10 prison dischargees (79%) reported their mental health to be good, very good or excellent.
  • male prison entrants were more likely than female prison entrants to rate their mental health as good, very good or excellent (73% compared with 50%)
  • Aboriginal and Torres Strait Islander prison entrants (75%) and dischargees (87%) were more likely than non- Aboriginal and Torres Strait Islander prison entrants (67%) and dischargees (77%) to rate their mental health as good, very good or excellent
  • fewer than 1 in 10 prison entrants and 1 in 20 dischargees rated their mental health as poor (8% and 4% respectively).

Physical health

Chronic diseases are long-lasting conditions with persistent effects. Their social and economic consequences can affect people’s quality of life (AIHW 2016a). Some risk factors associated with chronic conditions are considered preventable, including poor diet, physical inactivity, obesity, tobacco smoking, risky alcohol consumption, illicit use of drugs, and unsafe sexual practices (AIHW 2016a).

In the NPHDC, prison entrants were asked whether they had ever been told by a medical professional that they had any of the following chronic physical health conditions: arthritis, asthma, cancer, cardiovascular disease, diabetes. Self-reported data rely on the respondents’ accurate recall and may not represent the true prevalence. Further, some prison entrants might have existing health conditions that have yet to be diagnosed.

Table 1: Prison entrants’ health status, 2018

 

Prison entrants ever diagnosed with a  condition

Prison entrants with a  current condition

Asthma

22%

15%

Arthritis

 7%

7%

Cardiovascular diseases

7%

4%

Diabetes

6%

6%

Cancer

2%

1%

Any condition

30%

26%

Notes

  1. Includes unknowns
  2. Proportions are proportions of prison entrants in this data collection only, and not the entire prison population.
  3. Excludes New South Wales, which did not provide data for the 2018 NPHDC.

Source: AIHW 2019a.

Health risk factors and behaviours

Of prison entrants surveyed in 2018:

  • Three-quarters (75%) were current tobacco smokers
  • Almost two-thirds (65%) had illicitly used drugs in the previous year, with methamphetamine being the most commonly used illicit drug (used by 43% of entrants)
  • About 1 in 3 (34%) were at high risk of alcohol-related harm during the previous 12 months (AIHW 2019a)

Tobacco smoking is one of the largest single preventable causes of death and disease in Australia. It is a major risk factor for many chronic conditions including coronary heart disease, stroke, diabetes, chronic obstructive pulmonary diseases, multiple types of cancers, and asthma (AIHW 2016b).

Prison entrants were asked whether they had ever smoked tobacco and whether they currently smoked.

Of prisoners surveyed upon entry:

  • 3 in 4 (75%) reported that they were current smokers
  • 85% reported smoking at some stage in their lives
  • females were more likely than males to be current smokers (86% compared with 74%)
  • 4 in 5 (80%) Aboriginal and Torres Strait Islander peoples were current smokers compared with almost 3 in 4 (73%) non-Indigenous prison entrants.

Illicit use of drugs can cause death and disability, and is a risk factor for many diseases. It is also associated with risks to users' family and friends, and to the community. Illicit use of drugs includes use of illegal drugs, misuse or non-medical use of pharmaceutical drugs, and inappropriate use of other substances (AIHW 2019b). Illicit use of drugs is a primary motivating factor in many crimes—including non-violent property offences such as burglary and theft—particularly for those who have drug dependence (Kopak & Hoffmann 2014).

Prison entrants were asked about their drug use in the previous 12 months, also referred to as ‘recent’ drug use. Of those prison entrants surveyed:

  • around 2 in 3 (65%) reported illicit use of drugs in the previous 12 months
  • over 2 in 5 had used amphetamines in the previous 12 months (43%)
  • females were more likely than males to have reported illicit use of drugs in the previous 12 months (74% compared with 64%)
  • self-reported recent illicit use of drugs was highest among those aged 18–24 (74%) and lowest among those aged 45 and over (42%).

The consumption of alcohol is widespread in Australia and entwined with many social and cultural activities. However, harmful levels of alcohol consumption are a major health issue associated with increased risk of chronic disease, injury and premature death (AIHW 2019b).

In the 2018 NPHDC, prison entrants were asked questions about their alcohol consumption in the previous 12 months. These were:

  • How often did you have a drink containing alcohol?
  • How many standard drinks would you have on a typical day when you were drinking?
  • How often did you have six or more standard drinks on one occasion?

Of entrants surveyed in 2018, in the previous 12 months:

  • male prison entrants were slightly more likely to drink than female entrants (64% compared with 59%)
  • Aboriginal and Torres Strait Islander entrants were more likely to drink 4 or more times per week than non-Indigenous entrants (18% compared with 14%)
  • just over 1 in 9 prison entrants (12%) were drinking 6 or more standard drinks on a single occasion daily or almost daily (AIHW 2019a).

Where do I go for more information?

For more information on the health of people in prison, see:

Visit Prisoners for more on this topic.

References

ABS (Australian Bureau of Statistics) 2019a. Prisoners in Australia, 2019. ABS cat. no. 4517.0. Canberra: ABS.

ABS 2019b. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2016a. Evidence for chronic disease risk factors. Cat. no. WEB 166. Canberra: AIHW.

AIHW 2016b. Healthy communities: tobacco smoking rates across Australia, 2014–15 (in focus). Cat. no. HPF 1. Canberra: AIHW.

AIHW 2019b. Alcohol, tobacco & other drugs in Australia. Cat. no. PHE 221. Canberra: AIHW.

AIHW 2019a. The health of Australia’s prisoners 2018. Cat. no. PHE 246. Canberra: AIHW.

Kopak AM & Hoffmann NG 2014. Pathways between substance use, dependence, offense type, and offense severity. Criminal Justice Policy Review 25:743–60.