People in prison are among the most vulnerable groups in society. They are more likely to experience homelessness and unemployment than people in the general community, and often come from socioeconomically disadvantaged backgrounds (AIHW 2023).
People in contact with the criminal justice system have higher levels of mental health conditions, risky alcohol consumption, tobacco smoking, illicit drug use, chronic disease and communicable disease than the general population (AIHW 2023). This means that people in prison often have complex, long-term health needs. The health of people in prison is so much poorer than that of the general population that people in prison are often considered to be elderly at the age of 45–55 (compared with at 65 years and over in the general community) (Baidawi 2011; Stojkovic 2007; Williams et al. 2014).
In some jurisdictions the state or territory health department provides prison health services, while in others it is the responsibility of the justice or corrections department. Most jurisdictions use a mix of directly provided services, community health services and contracted health services. Providing mental health services and alcohol and other drug services can be particularly complex, both in terms of the services delivered and the method of delivery.
In prisons, nurses usually provide primary health care (or the first level of contact with the health-care system). In the general community, general practitioners provide most of the primary health care. For people who underuse health services in the general community, prison can provide an opportunity to access treatment to improve their health. Many types of health care are accessed less often in the community than in prison for various reasons, including cost, work or family commitments, and alcohol or other drug issues. The stability of the prison environment may provide opportunities for people to reflect on, and seek treatment for, their health concerns.
The Medicare Benefits Schedule (Medicare) gives residents of Australia access to no-cost or subsidised health care, including no-cost or low-cost treatment and accommodation in public hospitals. Medicare is funded by the Australian Government and does not apply to services provided directly by state and territory governments. This means that prison health services are not provided under the Medicare system (Cumming et al. 2018). The Pharmaceutical Benefits Scheme, which provides access to medicines at lower cost for Australian residents, is also funded by the Australian Government. Medications dispensed to people in prison are not covered.
The National Prisoner Health Data Collection (NPHDC) is the main source of national data about the health of prisoners in Australia. It gathers information from prison entrants, dischargees, prisoners visiting the prison health clinic, and prisoners taking prescribed medication.
The NPHDC was designed to monitor the National Prisoner Health Indicators, which comprise more than 100 indicators relating to socioeconomic factors, general health, risk factors, mental health, sexual behaviour, and prison health services. The indicators and data collection were developed by the AIHW, with assistance and advice from the National Prisoner Health Information Committee (NPHIC). They are aligned to the National Health Performance Framework (AIHW 2009) and help ensure that appropriate health services are in place to meet the needs of the prisoner population. The AIHW reports against the indicators in The health of people in Australia’s prisons series.
References
AIHW (2023) The health of people in Australia's prisons 2022, AIHW, Australian Government.
Baidawi S, Turney S, Trotter C, Browning C, Collier P, O’Connor D and Sheehan R (2011) ‘Older prisoners: A challenge for Australian corrections’, Trends and issues in crime and criminal justice, Australian Institute of Criminology, Canberra: 426.
Cumming C, Kinner SA, Preen DB and Larsen AC (2018) ‘In sickness and in prison: the case for removing the Medicare exclusion for Australian prisoners’, Journal of law and medicine, 26:140–58.
Stojkovic S (2007) ‘Elderly prisoners: a growing and forgotten group within correctional systems vulnerable to elder abuse’, Journal of Elder Abuse & Neglect, 19(3–4):97–117, doi:10.1300/J084v19n03_06
Williams BA, Ahalt C and Greifinger RB (2014) ‘The older prisoner and complex chronic medical care’, Prisons and health, World Health Organization, Copenhagen, 165–70.
