School of Population Health

Improving the health of Indigenous and non-Indigenous ex-prisoners: A multi-jurisdictional mixed-methods study

Further information

Research team

This study will focus on health outcomes and health service utilisation among adult ex-prisoners in two states (WA and QLD). Once complete, this will constitute the most comprehensive cohort study of health outcomes for ex-prisoners ever undertaken, anywhere in the world.

Using an innovative combination of face-to-face surveys and discussions, detailed review of medical records and health information, we will identify the key health needs of this highly marginalised group. Results will identify health areas which need to improve as ex-prisoners transition from prison to the community. Specifically, this study will:

  • Compare the health-related experiences of Indigenous and non-Indigenous ex-prisoners in two Australian States;
  • Identify barriers to, and facilitators of, access to appropriate community-based health care for Indigenous and non-Indigenous ex-prisoners;
  • Explore the health consequences of prisoners’ exclusion from Medicare and the Pharmaceutical Benefits Scheme (PBS);
  • Identify relationships between health care utilisation and physical and mental illness, death and re-offending behaviour among Indigenous and non-Indigenous ex-prisoners;
  • Explore the impact of mental illness on physical health, health service utilisation and offending outcomes among Indigenous and non-Indigenous ex-prisoners.

Full description

More than 50,000 adults pass through Australia’s prisons each year and the ex-prisoner population is estimated at over 385,000. Prisoners experience entrenched social disadvantage and chronically poor health, including rates of mental illness, drug dependence and infectious disease orders of magnitude higher than their community peers. Indigenous people are over-represented among prisoners by a factor of 14.

Health care services in prison are under-resourced to meet this need and the exclusion of prisoners from Medicare and the PBS compounds their disadvantage, and hampers efforts to improve continuity of health care from prison to community. Upon release, many prisoners quickly return to pre-incarceration patterns of behaviour and associated ill health, with a markedly elevated risk of mortality due to drug overdose, suicide and other unnatural causes. Despite this, little is known about the health-related experiences of ex-prisoners; this information is a prerequisite for the development of evidence-based interventions.

The proposed project brings together a highly respected research team and builds on innovative work already funded by NHMRC. It involves the collection of quantitative and qualitative data from a cohort of 2,500 ex-prisoners in two Australia jurisdictions that together hold 44% of Australia’s Indigenous prisoners. Rich baseline data will be collected through face-to-face interview and file audit, using tools already developed for other NHMRC-funded projects. The entire cohort will be followed prospectively through record linkage to identify patterns of (state and federal) health service utilisation post-release; parallel qualitative data from a subset of participants will deepen our understanding of barriers to health care for this highly marginalised group.

Funding

NHMRC Funding APP ID 1002463.Project commenced September 2011.