Counting the costs: We need to address the health of people leaving prison
We need to provide much better health services to people leaving prison. Epidemiologist Dr Kathryn Snow (University of Melbourne and the Murdoch Children’s Research Institute) explains why the “good luck system” for prison leavers doesn’t make sense from either a financial or a human rights perspective.
People who spend time in prison often have much poorer health than others in the community. In a recent national survey, 40% of all people in prison had been diagnosed with a mental illness. Many struggle with alcohol and other drug use, which usually started during their early to mid teens. Women in prison are disproportionately affected, with almost twice the rates of mental illness than men, and higher rates of harmful substance use.
We know from studies around the world that the weeks after leaving prison are a very high-risk time for both overdose and suicide. And yet, around Australia, many people leaving prison receive inadequate support to address either their mental health needs or their drug and alcohol problems. The lack of integration between drug and alcohol services and mental health services in Australia is a long-standing issue. For many people leaving prison, these services could be a lifeline, if only they were funded properly and well-integrated with the criminal justice system.
Rates of hospitalisation or ED presentation for injury after release from prison, figure shared with permission from Dr Young
Our study
From 2008 to 2010, we recruited a cohort of people who were leaving prisons across Queensland. Among them, almost a quarter had both a diagnosed mental illness and records of a substance use disorder (for example, living with both bipolar disorder and alcohol dependence).
We found that our participants who had both a mental illness and a substance use disorder were at much higher risk of ending up in emergency departments or hospitals due to physical injuries or poisoning (Young 2018). These presentations and admissions could be due to accidents, violence, self-harm, drug overdoses, or alcohol poisoning.
In a more recent study, we’re looking at the cost of all health service use in our cohort across Medicare, the Pharmaceutical Benefits Scheme, ambulance services, emergency department presentations, and hospital admissions. We’ve found that having a mental illness doubled the cost of health services, and that having both a mental illness and a substance use disorder tripled those costs. Most of these costs are covered by state governments, through hospitals.
On top of the high health service costs in our study, people with both a mental illness and a substance use disorder were almost twice as likely to return to prison within a year of release (compared to those with no mental illness or substance use disorder). Incarcerating one adult for a year in Australia costs about $110,000.
High quality research from around the world shows that people leaving prison need intensive support to access health services and get their lives back on track. It’s not enough to tell people where a GP clinic is. A best practice model would involve supporting community-based health services to work with people in prison before release. This would allow services to develop a relationship with their new clients, and to work together on a plan to help people reintegrate and connect to services when they get out. This should include everything from help finding housing and getting on Centrelink, to working out where they can pick up the medications they need in the first days after release. If you ask some people leaving prison to describe the support they actually do receive in Australia, they’ll call it the “Good Luck system”. Some programs do offer broad support to people leaving prison, but availability is patchy.
There are many reasons we should help to address drug and alcohol problems and mental illness among people leaving prison. People who spend time in prison are a part of our communities, although we sometimes pretend otherwise. They are often some of the most vulnerable among us. Like everybody, they deserve high quality, accessible healthcare. They have partners, children, families and friends who rely on them, and who are impacted when they don’t get the support they need.
But even for the hardest-nosed policymaker, addressing these issues also makes economic sense. Prison is expensive, and so are hospital admissions. As always, prevention is better and cheaper than cure. Investments in mental health and community-based drug and alcohol services would help everybody in our community, especially those trying to reintegrate after prison.