Mental health and suicide screening in correctional centres

What's the issue?

Research shows higher rates of mental health concerns, self-harm and suicide in people in correctional centres. Australian research suggests that people in Australian correctional centres were ten times more likely than the general Australian population to report a history of suicide attempts and thoughts of suicide within the previous 12 months.¹ For some population groups, such as women and Aboriginal and Torres Strait Islander peoples, the rate may be even higher.

Although the evidence suggests increased rates of mental health concerns, self-harm and suicide for people in corrections facilities, there is limited research exploring the prevalence upon entry to corrections facilities.

The authors of this study aimed to determine the prevalence of a range of mental health, self-harm and suicide risk indicators for people entering a New South Wales correctional centre, and compare the findings based on gender and Aboriginal and Torres Strait Islander identity.

What was done?

The authors used Justice Health and Forensic Mental Health Network data from the People in NSW Public Prisons: Health Status and Service Utilisation project. The main data source was the Reception Screening Assessment (RSA) - a comprehensive health screen undertaken by a primary care nurse when someone enters a prison and captures physical and mental health status at the time of entry to prison. The RSA records observations by the nurse that suggest the presence of a mental health condition or suicidal thoughts or behaviours. Self-reported history of mental health concerns and suicidal thoughts and behaviours are recorded as part of the assessment. The authors acknowledge that observations made by a nurse and self-reported data may not capture the true state of mental health leading to inaccuracies in data.

The authors used data taken from the RSA from 2 February 2021 to 31 January 2022.

What was found?

In the period of 2 February 2021 to 31 January 2022:

• More than 9,500 (9,568) people entered the correctional centres. Most were men (8,219 or 85.9%), with 14.1% women (1,347).
• Almost one third (32.0%) of people entering a corrections facility identified as Aboriginal and Torres Strait Islander.
• The median age of entrants was 34 years, with ages ranging from 18 to 86 years.
• Most entrants reported having been in corrections facilities before, with only 26% of people being first time entrants.

Mental ill-health and suicidal thoughts and behaviours

Of the people entering the corrections facility during the study period:

• 62.0% reported a history of any mental health condition.
• The most common mental health concerns were a history of depression (47.2%) or anxiety (41.5%).
• 22.9% lived with a serious mental illness.
• 14% reported a history of self-harm
• 6.5% reported a history of self-harm in the past year.
• 12.1% reported a past suicide attempt over their lifetime.
• 5.0% reported a suicide attempt over the past year.
• 7% reported suicidal ideation within the past week.
• 55.4% of people were referred to the mental health team operating at the corrections facility.
• Over 50% of prison entrants were referred to mental health services in prison.
• 10.7% were referred to the risk intervention team.
• Women had a higher prevalence of most mental health concerns, self-harm and suicidal thoughts and behaviours.

Mental ill-health and suicidal thoughts and behaviours of Aboriginal and Torres Strait Islander people entering corrections facility

The authors found that Aboriginal and Torres Strait Islander men had significantly higher prevalence of all self-harm and suicide risk variables compared to non-Aboriginal and Torres Strait Islander men.

Aboriginal and Torres Strait Islander women had higher prevalence of self-harm and suicide risk compared to non-Aboriginal and Torres Strait Islander women and were more likely to be referred to the risk intervention team.

Why are the findings important?

The results of the study highlight the high prevalence of mental health concerns, self-harm and suicidal thoughts and behaviours for people entering corrections facilities. It highlights the need for intervention services that are appropriate for diverse population groups, especially prevention and intervention activities that are culturally responsive and suitable for Aboriginal and Torres Strait Islander people at risk of mental health concerns, self-harm and suicide. Culturally suitable programs that support transition back into community post-corrections can support a reduction of risk of developing mental health concerns or experiencing suicidal thoughts and behaviours in Aboriginal and Torres Strait Islander people.

Mental health staff working in corrections facilities are required to work with complex needs of entrants who often continue to be at a sustained risk of developing mental health concerns, engaging in self-harm, or experiencing suicidal thoughts and behaviours.

Mental health staff would benefit from opportunity to increase their skills to respond to diverse people and risk, particularly for women and Aboriginal and Torres Strait Islander people. Targeted health promotion and suicide prevention activities may support ongoing management of suicide risk whilst in correction facilities.

Public health approaches that consider ways to address systemic factors that can place people at risk of criminal offence (for example, financial hardship, alcohol and other drug use) would be beneficial to prevent them from entering corrections facilities in the first place and experiencing mental health concerns and suicidal thoughts and behaviours.