Mental health and self-harm
Mental health is fundamental to emotional, psychological and social wellbeing, and affects individuals, families and the wider community (ABS 2018). 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.
Mental health conditions, particularly severe conditions, are over-represented in the prison population. For example, the prevalence of psychosis in a London prison population was found to be more than 20 times that of the general community, and almost 70% of people in prison had more than one mental health disorder (Bebbington et al. 2017).
Unlike many other chronic conditions, mental health conditions do not increase in prevalence with age (ABS 2022). For some people, interacting with the justice system might be the first time a health professional has assessed their mental health.
An Australian population-based data linkage study of adults in their 20s and 30s found that 1 in 3 (32%) of those with a psychiatric illness had been arrested during a 10-year period, with the first arrest often occurring before their first contact with mental health services (Morgan et al. 2013).
People in prison have a high prevalence of self-reported mental health conditions (AIHW 2019) and, while they are often able to access mental health care during incarceration, their mental health can quickly deteriorate after release (Cutcher et al. 2014).
People in prison with a history of a mental health condition are more likely to experience alcohol and other drug use disorders, crime, and poor health outcomes after their release. A history of substance use, particularly injecting drug use, is linked to mental health conditions, self-harm and suicidal behaviour in people while in prison and after their release (Butler et al. 2018; Cossar et al. 2018; Stewart et al. 2018).
This section analyses the self-reported mental health of prison entrants and prison dischargees, covering:
- mental health condition
- self-assessed mental health status
- recent psychological distress
- reasons for psychological distress
ABS (Australian Bureau of Statistics) (2018) National health survey: first results, ABS website, accessed 14 April 2023.
—— (2022), National study of mental health and wellbeing, ABS website, accessed 5 July 2023.
AIHW (Australian Institute of Health and Welfare) (2019) The health of Australia’s prisoners 2018 [PDF 9.5MB], AIHW website, accessed 17 April 2023.
Bebbington P, Jakobowitz S, McKenzie N, Killaspy H, Iveson R, Duffield G and Kerr M (2017) ‘Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder’, Social Psychiatry and Psychiatric Epidemiology, 52(2):221–229, doi:10.1007/s00127–016–1311–7.
Butler A, Young JT, Kinner SA and Borschmann R (2018) ‘Self-harm and suicidal behaviour among incarcerated adults in the Australian Capital Territory’, Health & Justice, 6(1):13, doi:10.1186/s40352–018–0071–8.
Cossar R, Stoové M, Kinner SA, Dietze P, Aitken C, Curtis M, Kirwan A and Ogloff JRP (2018) ‘The associations of poor psychiatric well-being among incarcerated men with injection drug use histories in Victoria, Australia’, Health & Justice, 6(1):1, doi:10.1186/s40352–018–0059–4.
Cutcher Z, Degenhardt L, Alati R and Kinner SA (2014) ‘Poor health and social outcomes for ex-prisoners with a history of mental disorder: a longitudinal study’, Australia and New Zealand Journal of Public Health, 38:424–429.
Morgan VA, Morgan F, Valuri G, Ferrante A, Castle D and Jablensky A (2013) ‘A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness’, Psychological Medicine, 43:1869–1880.
Stewart AC, Cossar R, Dietze P, Armstrong G, Curtis M, Kinner SA, Ogloff JRP, Kirwan A and Stoové M (2018) ‘Lifetime prevalence and correlates of self-harm and suicide attempts among male prisoners with histories of injecting drug use’, Health & Justice, 6(1):19, doi:10.1186/s40352–018–0077–2.