Criminology Research Council grant ; (19/02-03)
The Western Australian Data Linkage System (WADLS) was used to determine the relative and absolute risk of death or hospital admission or contact with the Mental Health Services (MHS) in approximately 14,000 prisoners released from prison in the period 1995-2001 and followed up for a minimum of two years after first release (mean follow-up of 4.6 years). After adjustment for age, gender and Indigenous status, released prisoners had substantially higher risks of death and hospital admission or contact with MHS after first release than the general population. They also had high rates of hospital admission and contacts with MHS before imprisonment that were strongly predictive of the use of such services after release, and which suggest that many of the health problems of prisoners are of long standing. There were strong similarities between causes of death and hospitalisation. Suicide, drug and alcohol related deaths, accidental poisoning and transport related deaths were the leading causes of death and the principal reasons for hospital admission or contact with MHS before and after release. In general, Indigenous prisoners had worse health outcomes than non-Indigenous prisoners and female prisoners had worse outcomes than male prisoners. Female non-Indigenous prisoners had a particularly high risk of death, as found in studies elsewhere. It is likely that this is related to the use of illicit drugs soon after release. The study has several implications for policy relating to the health of prisoners both before and after release from prison. These include: measures to meet the particular health needs of female and Indigenous prisoners; implementation of programs for the long term management of chronic disease (particularly mental disorders); and improved release planning to ensure continuity of health care.