It is well documented that rates of physical and mental ill health are elevated among people in prison. Some conditions – including chronic disease, substance dependence, and mental illness – are usually brought into the system, whilst others – particularly blood borne viruses – may be acquired within its precincts.
The RACGP estimates, for example, that more than one third of Australian inmates has been exposed to hepatitis C in prison. Meanwhile, rates of depression and anxiety are known to increase significantly behind bars, particularly in institutions with high inmate populations.
However, despite rapidly growing evidence of poor health outcomes after release from prison, health needs during re-entry and post-release have received comparatively little attention – from either correctional health clinicians or policy makers.
The prison system does provide a number of health interventions, including specialist clinics, pharmacotherapies, hepatitis treatment, and mental health services. However, many of the positive health outcomes achieved in custody are lost or reversed when the individual is released back into society.
The result is that people released from prison are at markedly increased risk of death – often due to overdose or suicide – than the general population. Rates of hospitalisation are also elevated after release from prison, potentially indicating decompensation of previously well-managed conditions.
Difficulty accessing a GP
Don McCrae, Chief Executive Officer at JusTas – an advocacy for citizens returning to the community – says one of the key challenges people face upon release from prison is the continuation of primary healthcare support.
“Exiting prison is more challenging than it sounds. Many leave with an ongoing requirement for pharmacotherapy, yet struggle to find a GP who will accept them as a routine patient. This is especially true for those who befit the visual stereotype of an inmate, as they are more prone to discrimination. Often, they are given a single script for Valium, for example, and then sent on their way,” he said.
Without the requisite medical support, some people released from prison turn to self-medication, in the form of illicit drugs and alcohol. This not only perpetuates or worsens existing physical and mental health problems, but potentially re-engages them with criminal connections and behaviour.
This may have a compounding effect, resulting in return to the prison system. Of the 50,000 adults released from prison in Australia in 2016-17, approximately 46.4 percent returned to correctional services in 2018-19. Mr. McCrae believes a large portion of these offences are committed by individuals who wish to re-incarcerate themselves.
“Faced with the challenges of reintegrating into society, a legacy of health problems, and difficulty accessing routine medical support, I have known some ex-prisoners to deliberately re-offend with the sole intention of going back inside prison,” Mr. McCrae said.
“If they are looking for support to maintain integration and equilibrium in community and cannot get it, they often either return to self-medication or other criminal activity.”
Often denied surgery due to homelessness
Homelessness of some degree – including couch surfing, residing in a vehicle, and other forms of temporary accommodation hopping – is common among people released from prison. For those in this position, getting approval for life-altering medical surgery is a challenge.
Don cites one example in which an individual released from prison, living with chronic pain due to liver problems, was denied surgery given his lack of fixed abode. The individual was dishonest about his living circumstances in a bid to gain approval for the surgery, but was repeatedly turned away without proof of address. Eventually, he increased his alcohol consumption as a deliberate act of self-harm.
“Going into supported accommodation after surgery presents a significant health risk, given the threat of adverse reaction or infection. Hence the need to ensure surgery recipients have a safe home to go to after the procedure,” said Mr. McCrae.
“The problem is that homelessness – along with chronic health problems – is rife in the ex-prisoner population, leaving so many people without the medical support they need.”
“As with those who cannot obtain pharmacotherapy, it is not uncommon for people in this position to re-incarcerate themselves in a bid to gain appropriate medical assistance.”
Relapsing into negative health behaviours
Professor Stuart Kinner is an NHMRC Senior Research Fellow, and Head of the Justice Health Unit at The University of Melbourne and Murdoch Children’s Research Institute, Melbourne . He says a further challenge is the tendency for people to relapse into previous patterns of health-damaging behaviour upon release, including tobacco smoking.
“Around 80 percent of people coming into prisons smoke tobacco. They are forced to quit when in custody, but unfortunately almost all of them return to smoking after release from custody. In parallel with this, we often see the recurrence of health problems that were identified and treated in custody,” said Prof. Kinner.
“This is really unfortunate, because we know that many people who go into prison would like to quit smoking permanently. The challenge for them is that, when they return to the community, they often have a lot of stressors – low income, unstable housing, difficulty reintegrating socially, and ongoing medical ailments – which can cause them to relapse into nicotine dependency.”
Prof Kinner is leading a world-first study, looking at how authorities can help people maintain their abstinence from tobacco, upon release from smoke-free facilities. The SQuARe (Staying Quit After Release) trial, funded by the Victorian Health Promotion Foundation (VicHealth), is the first time an intervention of this sort has been evaluated using a randomised design, globally.
Prof. Kinner and Dr Jesse Young from The University of Melbourne will report on their findings at the Correctional Services Healthcare Summit due to take place 25-26 May 2021.
Also due to the present, Don McCrae will share his expert perspective on how authorities can increase access to medical support for people after release from the prison system.
Learn more and register.