Prisoner Health in NSW
"That prison inmates are characterised by manifold disadvantage has clearly and repeatedly been documented, with histories of disrupted family and social backgrounds; abuse, neglect and trauma; poor educational attainment and consequent limited employment opportunities; unstable housing; parental incarceration ; juvenile detention; dysfunctional relationships and domestic violence; and previous episodes of imprisonment...
With such multiple risk factors for poor health, it is hardly surprising that prison inmates are further characterised by physical and mental health far below that enjoyed by the general population."
Poor physical and mental health is frequently experienced by people in prison. The prison environment can often provide an opportunity for people to address some of their physical and mental health needs that may have remained unaddressed in the community. However, people with drug and alcohol issues may also experience a lack of access to appropriate programs while in prison due to constraints related to sentence length and program availability. Prisoners on remand are rarely able to access drug or alcohol programs due to the uncertainty surrounding their length of incarceration. Furthermore prisoners serving sentence of six months or less are rarely able to access drug and alcohol programs as they are categorised as low priority due their short sentence length. Access to drug and alcohol programs may also be limited due to operational constraints such as high demand for program spaces, limited number of correctional centres where programs are run, and the security classification of prisoners. For more information on Prison Programs see About the Criminal Justice System.
Statistics on Prisoner Health in NSW
The arm of NSW Health that addresses the health of prisoners in NSW prisons is Justice Health. Justice Health conducts Inmate Health Surveys to assess the health issues and trends for prisoners in NSW. Most of the following statistics on prisoner health in NSW come from the recently released 2009 Inmate Health Survey. A 2009 Inmate Health Survey: Aboriginal Health Report is at: www.justicehealth.nsw.gov.au/publications.
For Aboriginal specific information see Aboriginal Prisoners in NSW.
Drug and Alcohol Issues1
Drug and alcohol issues are prevalent in the NSW prison population. While most offences were not, strictly speaking, 'drug related' by definition, a large proportion of prisoners were either intoxicated at the time of their offence or had a history of problematic substance use. In the 2009 Inmate Health Survey:
- 64% of men and 50% of women were intoxicated at the time of their offence, with the most common substance used being alcohol (63%) followed by cannabis (19%).
- 86% of men and 78% of women used illicit drugs at some time in their life.
- 42% of men and 54% of women regularly used illicit drugs in the 12 months prior to entering custody.
- 40% of men and 52% of women had injected drugs at some time in their life.
- 62% of men and 38% of women used alcohol in a hazardous or harmful way in the 12 months prior to entering custody.
- 11% of offences committed by prisoners were drug offences, including 20% of women and 9% of men.
- 75% of men and 80% of women were current smokers, markedly higher than the 17% of the general population who reported daily smoking in 20072.
Psychiatric disorders identified in the Australian prison population are substantially higher than in the general community. In 2006, the 12-month prevalence of any psychiatric illness in the last year was 80% in prisoners and 31% in the community.3 While there is no data available to compare mental health issues in the NSW prison system with the general community, the following statistics indicate the general poor mental health of prisoners in NSW.1
- Disorders in the NSW prison population range from serious mental illness to chronic depression with the most common diagnosis for both sexes being depression.
- 48% of men and 54% of women had been treated for a mental health problem.
- 16% of men and 22% of women were currently on psychiatric medication, with anti-depressants being the main type of medication being used.
Sexual and other Abuse
The impact of abuse on mental health is now commonly accepted and prisoners frequently experience some form of abuse during their life time. Child sexual abuse is widely regarded as a cause of mental health problems in adult life6 and violence in domestic relationships has also been associated with ongoing mental health issues7.
- In 2001, 60% women and 37% men in NSW prisons had been emotionally, psychologically and sexually abused before the age of 16 (30% women and 10% men before age 10).4
- In 2009, female prisoners are more likely than male prisoners to report being subjected to at least one form of sexual violence since the age of 16 years (29% vs. 2%).1
- Women were also more likely to report that they had been subjected to such sexual violence on more than one occasion (22% vs. 2%).1
- 66% of women and 28% of men had been in at least one violent relationship.1
People with an intellectual disability are over-represented in the criminal justice system and are more likely to be arrested, questioned and detained for minor public order offences. They are also more likely to receive harsher penalties, have less access to sentencing options, and may experience disadvantage when interviewed by police or when in court because they don't understand what is happening and what is being said. They are often highly vulnerable in prisons because of their disability and have higher rates of reoffending than the general prison population.8
- In 2001, 18% of women and 27% of men in NSW prisons scored below the pass rate on an intellectual disability screening test.4
- Of those further tested, 59% of women in prison and 39% of men in prison were determined to have either an intellectual disability or were functioning in the borderline range.4
"Given the large number of people entering and leaving the corrections system each year, custodial settings pose a serious "incubator" threat to both inmates and custodial staff, and upon inmates' release, to the broader Australian community."
Incarceration in itself is a risk factor in contracting Hepatitis C. While a decline is recognised in Hep C status of NSW prisoners between 2001 and 2009, there is a prevalence of Hep C six times higher in the Australian Prison population than in the community9. The National Hepatitis C strategy 2005-200810 outlines the importance of addressing Hep C prevention for prisoners as the high rate of those cycling through the prison system not only threatens those inside prisons but also the broader community.
- In 2009, 45% of women in prison and 28% of men in prison have tested positive to Hepatitis C antibodies, compared with 64% of women and 40% of men in 2001, a significant decline.4
- 34% of women in prison and 23% of men in prison had Hepatitis B core antibodies, indicating exposure to the virus.4
Illness and Injury1
People in NSW prisons have complex needs in relation to their physical health. In addition to mental health, intellectual disabilities and high instances of Hepatitis C, inmates often suffer from a range of chronic health issues. This is related to lower levels of access to health care, high levels of physical illness and disability, the long term effects from injuries, (eg.head injuries) and high levels of risk taking behaviour.
- Almost half (47%) of inmates in 2009 reported suffering from an illness or disability that bothered them for 6 months or more, compared to 41% in 2001.1 This is still considerably higher than the 36% of Australia's general population who reported a disability or long time restrictive condition in 2008.5
- 22% of women and 12% of men indicated they had two or more illnesses or disabilities that bothered them for six months or more.
- Head injuries resulting in an episode of unconsciousness were common among prisoners (women 35%, men 52%).
- Chronic conditions include poor eyesight, Hepatitis C, back problems, asthma, oral health problems, high blood pressure, arthritis, ulcers, epilepsy, cancers, diabetes, deafness, and liver/kidney disease.4
Access to health care prior to incarceration:
- 17% of men and 4% of women had never accessed health care prior to incarceration.
- 41% of men and 20% of women had never accessed a general practitioner.
- 60% of men and 39% of women had never accessed a medical centre.1
A selection of the references used in No Bars along with other related publications can be found on the Research And Publications page.
- Indig, D. et.al. (2010) 2009 NSW Inmate Health Survey: Key Findings Report. Sydney: Justice Health.
- [AIHW] Australian Institute of Health and Welfare (2008), Indicators for chronic diseases and their determinants, Canberra: AIHW.
- Butler, T. et. Al. (2006) 'Mental disorders in Australian prisoners: a comparison with a community sample', Australian and New Zealand Journal of Psychiatry 2006; 40:272-276.
- Butler, T. & Milner, L. (2003) The 2001 Inmate Health Survey, Sydney: Corrections Health Service.
- Australian Bureau of Statistics (2009) 2007-08 National Health Survey
- Mullen, P. & Fleming, J. (1998) 'Long-term Effects of Child Sexual Abuse', Issues in Child Abuse Prevention, Number 9 Autumn 1998.
- Humphreys, C., & Thiara, R. (2003) 'Mental health and domestic violence: 'I call it symptoms of abuse'', British Journal of Social Work, 33(2), 209-226.
- NSW Ombudsman (2008) Supporting people with an intellectual disability in the criminal justice system:
Progress report, Sydney.
- Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis(MACASHH), Hepatits C Subcommittee, 2008, Hepatitis C Prevention,Treatment and Care: Guidelines for Australian Custodial Settings, MACASHH
- Commonwealth of Australia, 2005, National Hepatitis C Strategy 2005-2008, Commonwealth of Australia.
- Commonwealth of Australia, 1999, National Hepatitis C Strategy 1999-2000 to 2003-2004, Commonwealth Department of Health and Aged Care