Health of prisoners is an Australia's health topic

People in prison are a particularly vulnerable population. They are generally more disadvantaged, with higher health care needs than the wider Australian population. With around 65,000 people cycling through the prison system each year, the health issues of people in prison become health issues for the whole community (ABS 2022).

Data sources

Data for the National Prisoner Health Data Collection (NPHDC) are collected by the AIHW every 3 years and are the main source of national data about the health of people in prison in Australia. The NPHDC 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 30 June 2021:

  • There were about 43,000 prisoners in Australia.
  • Just over 9 in 10 (92%) prisoners were men.
  • Just under 1 in 3 (30%) prisoners were Aboriginal and Torres Strait Islander (ABS 2021).

People in prison are some of the most vulnerable people in society and often come from disadvantaged backgrounds. People who spend time in prison experience higher rates of homelessness, unemployment, mental health disorders, chronic physical disease, communicable disease, tobacco smoking, high-risk alcohol consumption, and illicit use of drugs than the general population (AIHW 2019).

The prison population differs from the general population in several ways. People in prison are mostly male, and Aboriginal and Torres Strait Islander people are over-represented. In 2021, despite Indigenous adults making up only 3% of the total Australian population (ABS 2019a), Indigenous Australian prisoners made up 30% of all prisoners (ABS 2021). Between 2012 and 2021, the age-standardised rate of imprisonment among Indigenous Australians increased from 157 to 222 per 10,000 adults (Figure 1). However, over the same period, the age-standardised rate of imprisonment for non-Indigenous Australians remained relatively stable, increasing only slightly from 13 to 16 per 10,000 adults.

 

The interactive data visualisation shows that the age-standardised rate of imprisonment for Indigenous Australians has increased between 2012 and 2021, from 157 per 10,000 adults to 222 per 10,000 adults. Over the same period, the rate of imprisonment has remained relatively stable for non-Indigenous Australians.

Impact of COVID-19

From March 2020, a range of measures have been introduced in adult prisons to reduce the spread of COVID-19, including vaccinations, social distancing, virtual visits and the use of personal protective equipment such as face masks. COVID-19 outbreaks have been reported in prisons across Australia.

Given the high level of vulnerability of the prison population, COVID-19 poses a serious risk to the physical health of prisoners. Measures introduced to reduce the spread of COVID-19 are also likely to have had an impact on prisoner’s mental, emotional and social wellbeing (Department of Health 2020). However, there is currently limited data available to understand the extent to which COVID-19 has impacted prisoner health. The next NPHDC will take place in 2022 and will include items related to COVID-19. Data are scheduled for release in 2023.

For more information on active COVID-19 cases within prisons in each state and territory, see:

Mental health

Mental health is fundamental to social wellbeing, and affects individuals, families, and the wider community (ABS 2019b). Mental health disorders 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 disorder at some point during their lives.

  • Females (28%) were almost twice as likely as males (15%) to be dispensed mental health-related medication.

  • Almost 1 in 5 (18%) were referred to mental health services for observation and further assessment (AIHW 2019).

In the NPHDC, prison dischargees were asked to rate the change in their mental health since entering prison as being a lot better, a little better, the same, a little worse, a lot worse or unknown.

Of prison dischargees surveyed in 2018:

  • Almost 2 in 5 (39%) reported their mental health improved while in prison.
  • Females were more likely than males to report an improvement in their mental health and wellbeing (46% compared with 38%).
  • 1 in 10 males (10%) and less than 1 in 12 females (8%) reported their mental health had deteriorated during their time in prison.

For information on the mental health of Indigenous Australian prisoners, see The health of Aboriginal and Torres Strait Islander people in prison.

Physical health

Chronic diseases are long-lasting conditions with persistent effects. Their social and economic consequences can affect people’s quality of life. Some risk factors associated with chronic conditions are considered preventable, including poor diet, insufficient physical activity, overweight and obesity, tobacco smoking, risky alcohol consumption and illicit drug use (AIHW 2021).

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, and diabetes. Asthma was the most reported chronic condition amongst prisoners, with 22% reporting that they have been diagnosed with the condition at some point in their lives (Table 1).

Table 1: Prison entrants’ health status, 2018

 

Prison entrants ever diagnosed with a condition (%)

Prison entrants with a current condition (%)

Asthma

21.9

15.4

Arthritis

 7.3

6.7

Cardiovascular diseases

7.3

4.1

Diabetes

6.5

5.9

Cancer

2.1

0.9

Any condition

30.4

26.3

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.

4.      ‘Any chronic condition’ does not represent a sum of the conditions, as one prison entrant might have multiple conditions.

Source: AIHW 2019.

The health of Aboriginal and Torres Strait Islander people in prison

Existing social and health determinants put Indigenous Australians who have spent time in prison at higher risk of poor health due to an increased exposure to behavioural and environmental health risk factors (Shepherd et al. 2020). While most Indigenous Australians entering prison reported good mental health, they were more likely than non-Indigenous Australians to report having some chronic illnesses (AIHW 2019).

Of Indigenous prisoners surveyed in 2018:

  • 3 in 4 (75%) entrants described their mental health as excellent, very good, or good.
  • 1 in 3 (33%) had been told by a health professional that they had a mental health disorder.
  • Less than 1 in 14 (7%) dischargees reported their mental health had deteriorated during their time in prison.

In 2018, asthma was the most reported chronic condition amongst Indigenous prisoners, with 13% reporting that they have been diagnosed with the condition at some point in their lives, followed by diabetes (11%) and cardiovascular disease (8%). Indigenous prisoners were less likely than non-Indigenous prisoners to report currently having asthma (11% compared with 19%) but more likely to report currently having diabetes (9% compared with 4%) and cardiovascular disease (5% compared with 3%).

Strengthening cultural safety for Indigenous Australians’ health care can improve their access to and quality of care (Australian Health Ministers’ Advisory Council 2016). Indigenous prison dischargees were asked whether they received treatment or consultation from an Aboriginal Community Controlled Health Organisation or Service (ACCHO) or Aboriginal Medical Service (AMS) while in prison. They were also asked whether they had received culturally appropriate care in prison.

Of the Indigenous prisoners surveyed upon discharge from prison:

  • 4 in 5 dischargees (80%) reported they always received culturally appropriate health care in prison.
  • Less than 1 in 10 (9%) reported receiving treatment or consultation from an ACCHO and/or AMS service while in prison.
  • Male Indigenous dischargees were more likely to report always receiving culturally appropriate health care (81%) than female Indigenous dischargees (68%).

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) Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2006 to 2031, ABS, Australian Government, accessed 28 March 2022.

ABS (2019b) National Health Survey: first results, 2017–18, ABS, Australian Government, accessed 28 March 2022.

ABS (2021) Prisoners in Australia, 2021, ABS, Australian Government, accessed 28 March 2022.

ABS (2022) Corrective Services, Australia, ABS, Australian Government, accessed 4 April 2022.

Australian Health Ministers’ Advisory Council (2016) Cultural Respect Framework 2016–26 for Aboriginal and Torres Strait Islander health: a national approach to building a culturally respectful health system, Australian Health Ministers' Advisory Council, Australian Government, accessed 28 March 2022.

AIHW (Australian Institute of Health and Welfare) (2019) The health of Australia’s prisoners 2018, AIHW, Australian Government, accessed 17 March 2022,

AIHW (2021) Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018 – Summary report, AIHW, Australian Government, accessed 17 March 2022.

Department of Health (2020) CDNA National Guidelines for COVID-19 Outbreaks in Correctional and Detention Facilities, Department of Health, Australian Government, accessed 23 March 2022.

Shepherd SM, Spivak B, Ashford LJ, Williams I, Trounson J and Paradies Y (2020) ‘Closing the (incarceration) gap: assessing the socio-economic and clinical indicators of Indigenous males by lifetime incarceration status’, BMC Public Health, 20(710):1–14, doi:10.1186/s12889-020-08794-3.