Improving (mental) health outcomes after incarceration: whose responsibility is it?

Incarceration is both a marker and a driver of poor health outcomes. Rates of preventable morbidity and mortality after incarceration are extraordinarily high, indicating that incarceration is best conceived of as an ‘interruption’ in life trajectories distinguished by chronic health adversity. Among people in prison, complex multi-morbidity (including dual diagnosis) is normative and necessitates coordinated, multi-sectoral care.

Custodial settings provide a rare (albeit regrettable) opportunity to identify unmet health needs and initiate appropriate care. However, achieving sustained improvements in the health of people who experience incarceration requires ongoing, high-quality care after release from custody. Yet investment in throughcare and post-release support is woefully inadequate. Poor health outcomes after incarceration compound health inequity, compromise public health, reduce public safety, and impose an avoidable burden on scarce public resources. Improving health outcomes after incarceration is therefore a whole-of-government responsibility. Forensic mental health services have a critical role to play in providing coordinated, continuous care for people who experience incarceration, but cannot operate effectively in isolation. In this presentation I will summarise the evidence underpinning these statements and argue in support of the World Health Organization (WHO) call for an approach of ‘prison health in all policies’.

Professor Stuart Kinner’s research focusses on health services and health outcomes for people who come into contact with the criminal justice system. Stuart Chairs Australia’s National Youth Justice Health Advisory Group, and convenes the Australasian Justice Health Network. He serves on Australia’s National Prisoner Health Information Committee, the WHO Health in Prisons Programme Steering Group, and the Worldwide Prison Health Research and Engagement Network Steering Committee.

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