The health and well-being of people in prison are also those of the community. People in contact with the criminal justice system have higher rates of homelessness and unemployment and often come from socioeconomically disadvantaged backgrounds.
People leaving prison are members of society needing employment, housing, health care, and other support services in the community to maintain and improve health and well-being, and reduce the likelihood of returning to prison.
On 30 June 2018, there were about 43,000 people in Australia’s prisons. Most people in prison were either on remand (32%), or serving sentences under 5 years in length (62%), and thousands of people cycle through the prison system each year (ABS 2018a).
People in prison have significant and complex health needs, which are often long-term or chronic in nature. They have higher rates of mental health conditions, chronic disease, communicable disease, acquired brain injury, tobacco smoking, high-risk alcohol consumption, recent illicit drug use, and recent injecting drug use, than the general population (AIHW 2015). Improving the health and well-being of people in prison, and maintaining those improvements after prison, benefits the entire community.
This report presents the results of the 5th National Prisoner Health Data Collection (NPHDC), which was conducted in 2018.
3 in 4 prison entrants had previously been in prison
Most people (73%) entering prison had been in prison before, and almost half (45%) of prison entrants had been in prison within the previous 12 months.
Male prison entrants were more likely to have extensive prison histories than female entrants. More than one-third (35%) of male entrants had been in prison 5 or more times, compared with 15% of female entrants.
Indigenous prison entrants were more likely than non-Indigenous entrants to have an extensive prison history. Almost half (43%) of Indigenous entrants had been in prison at least 5 times before, compared with 25% of non-Indigenous entrants.
2 in 5 prison entrants had been told they had a mental health condition, with almost 1 in 4 currently taking mental health-related medication
About 2 in 5 prison entrants (40%) and prison dischargees (37%) reported a previous diagnosis of a mental health condition, including alcohol and other drug use disorders. Women were more likely than men to report:
- a history of a mental health condition (65% compared with 36%)
- taking medication for a mental health condition (40% compared with 21%).
Non-Indigenous prison entrants (26%) were more likely than Indigenous entrants (19%) to report currently taking medication for a mental health condition.
3 in 4 deaths in prison custody were due to natural causes
Between 2013–14 and 2014–15, 115 people died in prison. Almost 3 in 4 (71%) of these deaths were from natural causes, and 1 in 4 (25%) were due to suicide or self-inflicted causes.
1 in 5 prison entrants reported a history of self-harm
More than 1 in 5 (21%) prison entrants reported a history of self-harm. Women entering prison (31%) were 1.5 times as likely as men (20%) to report a history of self-harm. More than 1 in 4 (26%) younger prison entrants (aged 18–24) reported a history of self-harm, higher than any other age group.
Almost 3 in 10 younger prison entrants had a family history of incarceration
Almost 1 in 5 (18%) prison entrants reported that one or more parents or carers had been in prison when they were a child. This was more likely among Indigenous entrants (31%) than non-Indigenous entrants (11%).
Younger prison entrants (27% of those aged 18–24) were almost 3 times as likely as older entrants (10% of those aged 45 and over) to have had a parent or carer in prison during their childhood.
3 in 4 prison entrants were current smokers
Most (75%) prison entrants said they were current smokers. Indigenous prison entrants (80%) were more likely than non-Indigenous entrants (73%), and women (86%) were more likely than men (73%) to be current smokers. More than 2 in 5 (41%) prison entrants who were current smokers said that they would like to quit.
Almost 2 in 3 prison entrants reported using illicit drugs in the previous year
Almost two-thirds (65%) of prison entrants reported using illicit drugs during the previous 12 months. Female prison entrants (74%) were more likely to report recent illicit drug use than male entrants (64%), and non-Indigenous entrants (66%) were more likely than Indigenous entrants (63%). Methamphetamine was the most common illicit drug used, followed by cannabis.
Almost 1 in 6 (16%) prison dischargees reported using illicit drugs in prison, and 1 in 12 (8%) said they had injected drugs in prison.
About 1 in 3 prison entrants had a high-school education level of Year 9 or under
Prison entrants were asked about the highest level of schooling that they had completed – one-third (33%) said Year 9 or under, and 17% said Year 8 or under. About 1 in 4 (25%) Indigenous prison entrants had completed Year 11 or 12 at school, compared with 41% of non-Indigenous entrants. Indigenous entrants (24%) were more likely than non-Indigenous entrants (10%) to report that their highest level of completed schooling was Year 8 or under.
Almost 1 in 3 (30%) prison entrants had a chronic physical health condition
Almost one-third (30%) of prison entrants said they had a history of at least 1 of the following chronic physical health conditions – arthritis, asthma, cancer, cardiovascular disease, or diabetes. Asthma (22%) was the most common chronic physical health condition reported. Almost half (45%) of female entrants had a history of a chronic condition, compared with almost 3 in 10 (28%) male entrants.
Of the prison entrants tested for blood-borne viruses, 1 in 5 tested positive for hepatitis C
In 2016, more than 1 in 5 (22%) prison entrants tested positive for hepatitis C antibodies – about 1 in 5 (21%) male prison entrants and more than 1 in 4 (28%) female prison entrants (Butler & Simpson 2017). About half (50%) of the prison entrants who had previously injected drugs had positive hepatitis C antibody tests – 52% of males, and 45% of females.
More than 1 in 2 prison dischargees expected they would be homeless on release
Homelessness is far more common among people in contact with the prison system than among people in the general community. About one-third (33%) of prison entrants said they were homeless in the 4 weeks before prison – 28% were in short-term or emergency accommodation, and 5% were in unconventional housing or sleeping rough.
More than half (54%) of prison dischargees expected to be homeless on release from prison, with 44% planning to sleep in short term or emergency accommodation, 2% planning to sleep rough, and 8% did not know where they would sleep.
Part I Overview
- Why is the health of people in prison important?
- How many people are in prison in Australia?
- How are health services delivered?
- What is the National Prisoner Health Data Collection?
- How is the information collected?
- How many prisons and people took part?
- What are the limitations of the data?
- Which ethical and privacy processes were followed?
2. Socioeconomic factors
- Cultural background
- Employment and government support
- Detention history
Part II Mental health and self-harm
3. Mental health
- Mental health before and while in prison
- Mental health history
- Self-assessed mental health status
- Mental health changes
- Recent psychological distress
- Mental health medication
- Prison entrants referred to mental health services
- Self-harm behaviours
- Identification of self-harm or suicide risk
Part III Physical health
5. Communicable diseases
- Sexually transmissible infections
- Blood-borne viruses
6. Chronic conditions
- Entrants with a chronic physical condition
- Cardiovascular disease
7. Activity and health changes
- Self-assessed physical health
- Health changes
- Activity and weight changes
8. Women in prison
- Cancer screenings
Part IV Disability
- Prison entrants with disability
- Comparisons with the general community
Part V Risk behaviours
10. Tobacco smoking
- Smoking status prior to prison
- Smoking in prison
- Quitting smoking
11. Illicit drug use and needle-sharing
- Drug use prior to prison
- Injecting drug use
- Drug use in prison
- Opioid substitution therapy (OST)
- Tattooing and body piercing
12. Alcohol consumption
- Alcohol consumption before prison
- Alcohol treatment in prison
13. Injuries, assaults, and risky sexual behaviours
- Head injury
- Accidents or injuries
- Physical and sexual assault
- At-risk sexual behaviours
Part VI Health services
14. General health services
- Consulting health services in the community and in prison
- Barriers to use of health services
15. Prison clinic
- Use of prison clinics
- Health conditions managed in clinic visits
- Services received during prison clinic visits
- Initiator of clinic visits
- Type of health professional seen
- Satisfaction with health service
16. Prison clinic procedures
- 16.1 Full-time-equivalent staffing
- Health-care referrals
- Indigenous health services
18. Readiness for release
- Health-related discharge planning
- Continuing care
- Medicare card
- Preparedness for release
Part VII Deaths
- Deaths in custody
- Deaths following release from prison
End matter:Acknowledgments; Abbreviations; Glossary; References; List of tables; List of figures; Related publications