Health of people in prison 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 more than 62,000 receptions into and releases out of prison each year, the health of people in prison impacts and contributes to the broader public health (ABS 2023a).

About the data

Data for the National Prisoner Health Data Collection (NPHDC) are collected by the AIHW approximately 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; 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 prison clinics.

Like any survey, the NPHDC has limitations including:

  • 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 people in prison 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 some 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 2022:

  • There were about 40,600 people in Australia’s prisons.
  • Just over 9 in 10 (93%) people in prison were male.
  • About 1 in 3 (32%) people in prison were Aboriginal and Torres Strait Islander (First Nations) people (ABS 2023b).

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 health conditions, communicable disease, tobacco smoking, high-risk alcohol consumption, and illicit drug use than the general population (AIHW 2023).

The prison population differs from the general population in several ways. People in prison are mostly male, and First Nations people are over-represented. In 2022, despite First Nations people making up only 3.8% of the total Australian population, First Nations people made up 32% of all people in prison (ABS 2023b, 2023c).

Between 2012 and 2022, the age-standardised rate of imprisonment among First Nations people increased 37% from 1,574 to 2,151 per 100,000 adults (Figure 1). Over the same period, the age-standardised rate of imprisonment for non-Indigenous Australians increased 16% from 130 to 151 per 100,000 adults (ABS 2023b). Between 2012 and 2022, the ratio of First Nations to non-Indigenous Australian imprisonment rates increased from 12.1 to 14.3.

Figure 1: Age-standardised rates of adult imprisonment by Indigenous status and sex, 2012 to 2022

Interactive chart shows age-standardised rates of imprisonment for First Nations and non-Indigenous Australians have increased between 2012 and 2022.

Mental health

Mental health is fundamental to social wellbeing, and affects individuals, families, and the wider community (ABS 2018). 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 the 371 prison entrants surveyed in the 2022 NPHDC:

  • More than half (51%) reported having been told they had a mental health condition at some point during their lives.
  • Females (28%) were more likely than males (19%) to report taking mental health-related medication.
  • One in 7 (15%) were referred to the prison mental health service after their reception assessment (AIHW 2023).

In the 2022 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 the 431 prison dischargees surveyed in the 2022 NPHDC:

  • 4 in 5 (81%) reported their mental health improved or stayed the same while in prison.
  • Males were more likely than females to report an improvement in their mental health while in prison (47% compared with 39%).
  • Females (44%) were more likely than males (33%) to report their mental health stayed the same while in prison. 

For information on the mental health of First Nations people in prison, see The health of First Nations people in prison. 

Health conditions

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, obesity, tobacco smoking, at-risk alcohol consumption and illicit drug use (AIHW 2022).

In the 2022 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: asthma, arthritis, back problem, cancer, cardiovascular disease, chronic kidney disease, diabetes, osteoporosis, and pulmonary disease. Asthma and back problem were the most reported chronic condition amongst prison entrants, with 27% reporting that they have been diagnosed with either condition at some point in their lives (Table 1). 

Table 1: Prison entrants’ chronic physical health conditions, 2022

 

Prison entrants ever diagnosed with a chronic condition (%)

Prison entrants with a current chronic condition (%)

Arthritis

12

11

Asthma

27

18

Back problem

27

23

Cancer

2.4

0.3

Cardiovascular diseases

13

8

Chronic kidney disease

2.7

1.9

Diabetes

7.5

5.9

Osteoporosis

1.3

1.1

Pulmonary disease

7.8

3.5

Any chronic condition

52

42

Notes 

  1. Proportions are representative of this data collection only, and not the entire prison population.
  2. Excludes Victoria, which did not provide data for the 2022 NPHDC.
  3. ‘Any chronic condition’ does not represent a sum of the conditions, as one prison entrant might have multiple conditions. 

Source: Entrants form, 2022 NPHDC.

The health of First Nations people in prison

Existing social and health determinants put First Nations people 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 First Nations people entering prison reported good mental health, they were more likely than non-Indigenous Australians to report having some chronic illnesses (AIHW 2023). 

Of the 183 First Nations people surveyed upon entering prison and the 200 First Nations people surveyed upon discharge from prison in the 2022 NPHDC:

  • More than 2 in 3 (69%) prison entrants rated their mental health as excellent, very good, or good.
  • Around 2 in 5 (43%) prison entrants had been told by a health professional that they had a mental health condition at some point during their lives. 
  • About 1 in 7 (14%) prison dischargees reported their mental health had worsened during their time in prison.

In the 2022 NPHDC, nearly half (49%) of First Nations prison entrants reported a past diagnosis of a chronic physical condition. Asthma was the most commonly reported chronic condition amongst First Nations prison entrants, with 26% reporting that they have been diagnosed with the condition at some point in their lives, followed by back problem (24%) and cardiovascular disease (15%). First Nations prison entrants were similarly as likely as non-Indigenous prison entrants to report currently having asthma (17% compared with 19%), arthritis (12% compared with 9.8%) and cardiovascular disease (9.8% compared with 6.5%). 

Strengthening cultural safety for First Nations peoples’ health care can improve their access to and quality of care (AHMAC 2016). First Nations prison dischargees were asked whether they received services 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 200 First Nations people surveyed upon discharge from prison:

  • Nearly two-thirds (65%) of prison dischargees reported they received culturally appropriate health care in prison.
  • About 1 in 4 (26%) prison dischargees reported receiving treatment or consultation from an ACCHO and/or AMS service while in prison.
  • Female First Nations prison dischargees were more likely to report receiving culturally appropriate health care (76%) than male First Nations dischargees (63%). 

Impact of COVID-19

From March 2020, a range of measures were 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.

People in prison are known to have a high vulnerability to infectious diseases due to the living conditions within prison (Ndeffo-Mbah et al. 2018) and as such, COVID-19 posed a serious risk to the physical health of this population. Measures introduced to reduce the spread of COVID-19 are also likely to have had an impact on the mental, emotional and social wellbeing of a person in prison (Department of Health and Aged Care 2022). However, there is currently limited data available to understand the extent to which COVID-19 has impacted the health and wellbeing of people in Australia’s prisons.

In the 2022 NPHDC, almost 4 in 5 (79%) prison entrants reported they had received a COVID-19 vaccine. Of these prison entrants:

  • 6.5% had received 1 dose
  • 36% had received 2 doses
  • 47% had received 3 doses
  • 8.8% had received 4 or more doses.

In prison, 84% of dischargees reported being quarantined or isolated due to COVID-19. Males and females were similarly likely to report being quarantined or isolated due to COVID-19 (84% and 83% respectively).

Where do I go for more information?

For more information on the health of people in prison, see:

For more on this topic, see People in prison.