Contact with Mental Health Services After Acute Care for Self-Harm Among Adults Released from Prison: A Prospective Data Linkage Study.

Abstract

To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm. In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm. Of 217 discharges from acute care following self-harm, 55% (n=119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR)=0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR=0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR=0.98; 95% CI: 0.97-0.99), being female (ARR=1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR=1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR=1.55; 95% CI: 1.08-2.22). Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis.