The mental health of Aboriginal and Torres Strait Islander people in custody

Abstract

Introduction and Aims: Aboriginal and Torres Strait Islander people (Indigenous Australian’s) experience a health burden that is greater than that of non-Indigenous Australians and mental disorder is a significant contributor to this burden. There is a strong link between health inequality and social inequality for Indigenous Australians, including incarceration. Indigenous people are thirteen times more likely to be incarcerated than non-Indigenous Australians and those in custody suffer high rates of health problems including poor mental health. However, very little was known about the type and extent of mental disorder among Indigenous people in custody. This study aimed to estimate for the first time, the prevalence of mental disorder in a representative sample of Indigenous people in Queensland prisons and also identify any relevant mental health correlates.Design and Methods: A survey of the mental health of adults who self-identified as Indigenous (Aboriginal, Torres Strait Islander or both Aboriginal and Torres Strait Islander) in six of the nine major correctional centres across the state of Queensland was undertaken between May and July 2008. The centres housed 75% of all Indigenous males and 90% of all Indigenous females in Queensland custody at the time. The cross-sectional assessment of mental health was done using a questionnaire and a standardised diagnostic interview for mental disorder, the composite international diagnostic instrument (CIDI). This thesis is based on clinical components of the questionnaire and diagnostic information obtained from the CIDI and clinical interviews.The CIDI was used to determine the prevalence of anxiety, depressive and substance use disorders. Psychotic disorders were determined by screening, followed by psychiatrist’s clinical interviews of those who screened positive, supplemented by a diagnostic panel with a cultural advisor. Components of the questionnaire included in this thesis were the demographic, health service use prior to custody, suicide thoughts and acts and self-assessed intoxication at the time of arrest. The method was culturally informed and appropriate for research involving Indigenous Australians. The sample included 25% of all Indigenous males (n=347, aged 18 – 62 years) and 62% of all Indigenous females (n=72, aged 18 – 57 years) in Queensland custody at the time.Results: The 12 month prevalence of mental disorder was 72.8% among men and 86.1% among women. This comprised anxiety disorders (males 20.2%, females 51.7%); depressive disorders (males 11.4%, females 29.2%); psychotic disorders (males 8.1%, females 25.0%) and substance use disorders (males 65.5%, females 69.2%). Alcohol dependence was the most common type of substance use disorder (males 47%, females 55%), followed by cannabis dependence (males 20%, females 26%). Mental illness and lifetime suicide thoughts and attempts were significantly more likely among those with a substance use disorder. The majority of the sample reported intoxication with alcohol (70%) and/or other drugs (51%) at the time of their arrest. Most individuals (87%) had not accessed alcohol and drug services in the 12 months prior to custody.Trauma experience was common and Post-Traumatic Stress Disorder (PTSD) was the most commonly diagnosed mental illness (males 12.1%, females 32.3%). Those with PTSD were more likely to experience other mental disorders, and have experienced suicide thoughts and attempts than those without PTSD. For those with PTSD the most prevalent trauma experience for both men and women was sexual assault either in childhood or early adolescence. Most individuals with PTSD had not accessed any mental health care (58.9%) prior to incarceration.Conclusions: This study was the largest systematic survey of mental disorder among Indigenous Australians in custody. The prevalence of mental disorder in the study sample was very high compared to community estimates. It is likely these findings are generalisable to other Indigenous prisoner populations in Australia given the remarkable similarities in health profiles identified from national prisoner health surveys. There are significant mental health needs for Indigenous people in custody.The mental health needs of Indigenous people are intimately associated with their over representation in custody and poor outcomes in transition back to the community. Mental health care provided to Indigenous people must be culturally informed, trauma informed, integrate drug and alcohol treatment, address social disadvantage and ensure continuity of care into the community. These findings identify opportunities to address the unmet mental health needs of Indigenous Australians in custody.