New South Wales Prisons Research Articles

Substance use among pregnant women in NSW prisons

Introduction and aimsLittle is published about pregnant women in custody. Existing data on the prevalence of substance use among incarcerated pregnant women or their needs are scant. This study sought to determine the prevalence and characteristics of women with substance use histories who present to prison pregnant in New South Wales (NSW), Australia. Design and methodsA retrospective review of prison medical health records was completed for pregnant women entering New South Wales custodial settings between January 2020 and June 2021. ResultsWe identified 158 prison receptions among 141 pregnant women (median age 28 years [IQR 25–33 years]), 42 % identified as Aboriginal or Torres Strait Islander. Eighty four percent of the women (n = 119) reported recent use of one or more than one substance and 36 % had injected drugs. The most commonly used substances were (meth)amphetamine (60 %), cannabis (40 %) and opioids (28 %). We found discrepancies between drug problems self-reported at reception screening on entry to prison and self-reported drug use collected during the subsequent drug and alcohol specialist assessment while incarcerated. Most (88 %) women described their current pregnancy as unplanned and half (52 %) were unaware they were pregnant before incarceration. ConclusionsThese findings highlight the high prevalence of substance use in incarcerated pregnant women and that many women are unaware of their pregnancy prior to incarceration. Findings emphasize the importance of timely and appropriate drug and alcohol assessment and treatment to minimize harm for both the mother and foetus and also underscore the urgent need for enhanced access to contraception for these women.

Reliability of prisoners\u2019 survey responses: comparison of self-reported health and biomedical data from an australian prisoner cohort

ObjectivePrisoner health surveys primarily rely on self-report data. However, it is unclear whether prisoners are reliable health survey respondents. This paper aimed to determine the level of agreement between self-report and biomedical tests for a number of chronic health conditions.MethodThis study was a secondary analysis of existing data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey. The health surveys were cross-sectional in nature and included a stratified random sample of men (n=2,114) from all NSW prisons. Self-reported histories of hepatitis, sexually transmissible infections, and diabetes were compared to objective biomedical measures of these conditions.ResultsOverall, the sensitivity (i.e., the respondents who self-reported having the condition also had markers indicative of the condition using biomedical tests) was high for hepatitis C (96%) and hepatitis B (83%), but low for all other assessed conditions (ranging from 9.1% for syphilis using RPR to 64% for diabetes). However, Kappa scores indicated substantial agreement only for hepatitis C. That is, there were false positives and false negatives which occurred outside of chance leading to poor agreement for all other assessed conditions.ConclusionsPrisoners may have been exposed to serious health conditions while failing to report a history of infection. It may be possible that prisoners do not get tested given the asymptomatic presentation of some conditions, were unaware of their health status, have limited health-service usage preventing the opportunity for detection, or are subject to forgetting or misunderstanding prior test results. These findings demonstrate the importance of the custodial environment in screening for health conditions and referral for treatment should this be needed. Testing on entry, periodically during incarceration, and prior to release is recommended.

Barriers and enablers to health and social services for older prisoners transitioning to community

PurposeWhen properly designed and implemented, prison-to-community transition programs targeting older prisoners could potentially save resources, reduce reoffending rates and contribute to improved public protection and safety. However, older prisoners transitioning to community are often neglected and overlooked, and thus, interventions targeted to address their needs are limited. The purpose of this study was to identify barriers and enablers to health and social services for older prisoners transitioning to community.Design/methodology/approachA qualitative study was conducted using focus group discussions with corrections officers, community corrections officers and parole officers (n = 32) in four correctional centres, two community corrections offices (CCOs) and one parole unit in New South Wales (NSW) in 2019. The authors used thematic analysis to analyse the findings.FindingsThe study identified three main themes relating to barriers and enablers: organisational, social and economic and individual and family and seven sub-themes: planning the transition, communication, assisting prisoners, transition programs, officers’ knowledge and scope of work, social and economic issues and offenders’ conditionsResearch limitations/implicationsThe processes required to ensure effective prison-to-community transition of older prisoners are not well-developed suggesting the need for more systemic and organised mechanisms. Implications of the barriers and enablers for policy, research and practice are discussed.Originality/valueThis study identified a composite of barriers and enablers to health and social services for older prisoners in NSW prisons and CCOs.

Commentary on the harm reduction reference group of justice health and forensic mental health network and corrective services NSW, Australia.

This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW). By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee's success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group's audit were drawn by critically appraising the JHFMHN/CSNSW HRRG's Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature. The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings. Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large. Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives.

First diagnosis of psychosis in the prison: results from a data-linkage study

Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed. Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison. This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006-2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison. Of the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79-2.89), Aboriginality (OR = 1.81, 95% CI 1.49-2.19), older age (OR = 1.70, 95% CI 1.37-2.11 for 25-34 years and OR = 1.63, 95% CI 1.29-2.06 for 35-44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42-5.69). Eight out of ten were diagnosed within 3 months of reception. Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release. None.

Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program

IntroductionThe rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to...

Monitoring a Prison Opioid Treatment Program Over a Period of Change to Clinical Governance Arrangements, 2007–2013

Background and aimsOpioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody. MethodData from the NSW prison OST program were obtained for the calendar years 2007–2013. Outcomes were analyzed quarterly using log binomial segmented regression. Results8577 people were treated with OST in NSW correctional centers, 2007–2013. Over the entire study period, patients were retained in OST until release in 82% of treatment episodes; a prescription for OST was able to be arranged prior to release in 90% of releases; and patients presented to a community clinic within 48 hours of release in 94% of releases with prescriptions. Following the introduction of the changes to clinical governance, there was a significant increasing trend in retention in OST until release, and in provision of an OST prescription at release. There was an initial increase, followed by a decreasing trend, in presentation to a community clinic within 48 hours of release. DiscussionThis large prison-based OST program has high rates of retention in treatment and continuity of care as patients transition from custody to the community. Strengthened clinical governance arrangements were associated with increased retention in treatment until release and increased provision of an OST prescription at release, but did not improve clinic attendance following release from custody.

A robust estimate of the number and characteristics of persons released from prison in Australia

Objective:To estimate the number and characteristics of adults released from prison in Australia. Method:We calculated ratios, stratified by age, sex and Indigenous status, by comparing the number of persons released from prison in New South Wales (NSW), with the number in NSW prisons on 30 June of the corresponding year. These stratified ratios were applied to Australia‐wide prison data to estimate the number and characteristics of persons released annually. Results:We estimated that in 2013, 38,576 persons were released from prison in Australia − 25.3% more than the daily prison population. Young people, Indigenous people and women were over‐represented among those released. We estimated that 3.69 Indigenous women aged 18–24 were released annually for each equivalent person in prison; and 2.75 non‐Indigenous women aged 18–24 were released annually for each equivalent person in prison. Conclusions:The annual ‘flow’ through Australia's prisons is well in excess of the daily number, but information on those moving through prison systems is not yet publicly available. The characteristics of those released from prison differ meaningfully from those of people in prison. Routine, national reporting of prison separations is critical to informing upscaling and targeting of Throughcare services for this profoundly vulnerable population.

Financial sanctions and the justice system: Fine debts among New South Wales prisoners with a history of problematic substance use

Financial sanctions are considered a cost-beneficial alternative to incarceration for lesser offences, but their use has limitations. This study investigates the debt burdens of a group of offenders incarcerated in New South Wales (NSW), Australia, and assesses associations with health and social functioning. Between October 2008 and June 2009, 156 participants of a reintegration programme operating in NSW prisons (the Justice Health Connections Project) completed face-to-face structured interviews concerning the nature, amount and impact of their debts. Copies of participants' NSW State Debt Recovery Office (SRDO) records were also obtained. Ninety-five per cent of participants reported debt to the SDRO. Participants who provided an estimate of their debt reported an average of $12,161 owed to the SDRO, compared to their verifiable average of $8,854. Eighteen per cent of participants with SDRO debt had incurred their earliest outstanding fine when they were younger than 18 years old. Sixty-four per cent perceived their SDRO debt as stressful; and 94 per cent reported that their debt was made worse by drugs (92%) and/or fine enforcement actions (50%). Based on the average Australian pension income and repayments of $15 per week, the average SDRO debt would take an ex-inmate 11 years to repay. Given the many challenges faced by these individuals upon re-entry to the community the additional strain imposed by unmanageable financial penalties should not be ignored. Steps are required to ensure that the criminal justice need for retribution is balanced against the benefit of having ex-prisoners re/join and contribute to a safe and law-abiding society.

Sexual practices and dental dam use among women prisoners - a mixed methods study

Dental dams have been distributed to women prisoners for protection against HIV and other sexually transmissible infections (STIs) in some Canadian and Australian prisons for over a decade. However, we do not know whether they serve any useful public health purpose. To determine how dental dams are used in women's prisons in New South Wales (NSW), Australia. Using quantitative and qualitative methods, we investigated women's sexual practices with a focus on how dental dams are used in NSW prisons. Although 71 of the 199 (36%) women reported having had sex with another inmate, with oral sex involved in most encounters, only eight (4%) had ever used a dental dam. The main sources of STI transmission risk among women prisoners were oral sex, manual sex and sharing dildos. Furthermore, sharing razors could also allow the transmission of blood-borne viruses, which could occur during sex in the presence of cuts or menstrual fluid. The high rates of hepatitis B and C among incarcerated women compound this risk. Dental dams are not widely used by women prisoners and we question their utility in women's prisons. Oral sex is an important risk factor for acquisition of herpes simplex virus type 1, but most women in NSW prisons (89%) are already infected. Condoms and latex gloves may have more use. Condoms could be used as a barrier on shared dildos and sex toys, while latex gloves could be used to protect cut and grazed hands from vaginal and menstrual fluids.

Neurocognitive deficits and psychiatric disorders in a NSW prison population

Approximately 75% of inmates in New South Wales (NSW) have mental health issues (Butler & Alnutt, 2003). Scarce resources force the management of acute psychiatric symptoms only, meaning that co-morbid conditions such as neurocognitive deficits are less likely to be assessed. The objective of this study was to investigate the utility of a computerized battery in the assessment of inmates within the criminal justice system. Thirty male inmates were assessed. Data were compared to matched controls. The custodial sample was characterized by an increase in the prevalence of previous trauma; high levels of depression, anxiety and stress and neurocognitive deficits, including sustained attention, impulsivity and executive dysfunction.

Enhanced chlamydia surveillance in New South Wales (Australia) prisons, 2005-2007.

Chlamydia is currently the most frequently notified infectious disease in New South Wales (NSW). Published articles relating to chlamydia prevalence in Australian prison settings are sparse, but studies from the United Kingdom and the United States indicate relatively high chlamydia prevalence among young incarcerated individuals. This article reports on findings from an enhanced chlamydia surveillance programme in NSW prisons between 2005 and 2007. The authors report a relatively low chlamydia prevalence among the general population of NSW prisoners (compared with figures from the United Kingdom and United States), which by the end of 2007 was 4%. The average crude chlamydia notification rate for the NSW prison population during the review period was about four times that of the general NSW community - 716/100,000 during the review period compared with 175/100,000 in the NSW general community. The average crude chlamydia notification rate for Aboriginal prisoners during the review period was 1262/100,000, compared with 1470/100,000 in the general Australian Aboriginal population. The authors grapple with the dilemma of expanding chlamydia screening and treatment services for the sexual health benefits of prison populations with static prison health budgets on one hand, and limited evidence of cost-effectiveness of such an expensive intervention on the other.

Suicide in New South Wales Prisons, 1995–2005: Towards a Better Understanding

This paper reports on a review of suicides in New South Wales (NSW) prisons from 1 January 1995 to 31 December 2005 in an attempt to gain a better understanding of the nature and quality of the problem of suicide among prisoners. All deaths in NSW prisons for the period were reviewed. Those identified as self-inflicted, with a coronial finding of death by suicide or those awaiting a coronial hearing but reported as possible death by suicide were included. A data set was collected on each case and entered into a database. A total of 92 cases were identified as deaths by suicide in NSW prisons from 1 January 1995 to 31 December 2005, representing 41% of all deaths in custody for the period. The rate of suicide in NSW prisons has been declining over the past 10 years, but remains approximately 10-fold that of the NSW community. Suicide was the leading cause of death among NSW inmates from 1995 to 2005. Suicide is a rare event, making its prediction a difficult task, with the prison environment a further compounding factor. This review highlights a number of factors, which appear to be common in many cases. Increased monitoring during the first week of incarceration may be an effective intervention. It is recommended that consideration be given to the length of time spent on remand and the value of custodial sentences of <or=6 months.

Value for money in drug treatment: economic evaluation of prison methadone

Background Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity of undertaking evaluations in the prison setting. This paper estimates the cost-effectiveness of the New South Wales (NSW) prison methadone program. Methods Information from the NSW prison methadone program was used to construct a model of the costs of the program. The information was combined with data from a randomised controlled trial of provision of prison methadone in NSW. The total program cost was estimated from the perspective of the treatment provider/funder. The cost per heroin free day, compared with no prison methadone, was estimated. Assumptions regarding resource use were tested through sensitivity analysis. Results The annual cost of providing prison methadone in NSW was estimated to be AUD$2.9 million (or $3,234 per inmate per year). The incremental cost effectiveness ratio is AUD $38 per additional heroin free day. Conclusions From a treatment perspective, prison methadone is no more costly than community methadone, and provides benefits in terms of reduced heroin use in prisons, with associated reduction in morbidity and mortality.

Drug Use and Its Correlates in an Australian Prisoner Population

The prevalence of past and present tobacco, alcohol, and illicit drug use is examined in a cross sectional random sample of prisoners. 789 male and female prisoners from 27 correctional centres across New South Wales (NSW) participated in the survey. Information was collected using a face-to-face interview on community and prison drug use, and intoxication while offending. Current tobacco use was reported by 72% of the sample. Use of alcohol by females was more likely than males to be classified as 'safe' according to the Alcohol Use Disorders Identification Test (39 vs. 26%). Overall, 64% of prisoners had used illicit drugs at some time in the past with cannabis and heroin the most common. Forty four percent of prisoners had a history of injecting drug use, with injecting prevalence significantly higher in females than males (64 vs. 40%) with approximately half of both male and female injectors reporting that they had injected while in prison. 'Harmful' or 'hazardous' use of alcohol was associated with imprisonment for violent crimes. Sixty two percent of property offenders had an injecting history. Correctional authorities need to ensure that drug treatment programmes are available to prisoners and consideration should be given to piloting needle and syringe exchange programmes in NSW prisons given the high levels of sharing injecting equipment in prison.

Mantoux positivity among prison inmates -New South Wales, 1996

ObjectivesTo determine the prevalence of Mantoux positivity in a prison population; identify risk factors associated with tuberculosis infection; and assess the risk of tuberculosis transmission in a correctional system. MethodCross sectional random sample (between May and August 1996) of inmates stratified by sex, age and Aboriginality. Participants were 789 adult inmates (657 male and 132 female) from 27 New South Wales (NSW) correctional centres (24 male and 3 female). ResultsOf the 789 inmates (657 male and 132 female) included in the survey, 639 were given a Tuberculin skin test (Mantoux). Eighty-four (13%) were Mantoux positive. A higher proportion of male inmates were Mantoux positive compared with females (14% vs. 8%, p=0.08). Significant independent predictors of Mantoux positivity were: being male, aged over 25 years, Aboriginal, born overseas and resident at a jail where there had been a recent tuberculosis outbreak. ConclusionScreening of inmates in NSW prisons based on the principle of risk stratification is appropriate. ImplicationsWhile the risk of tuberculosis transmission in NSW jails is currently considered low, continued surveillance is recommended.

Methadone maintenance treatment reduces heroin injection in New South Wales prisons

The purpose of this study was to examine whether methadone maintenance treatment reduces injecting risk behaviour (and therefore transmission of blood-borne viral infections) among prisoners in New South Wales (NSW), using comparison of retrospective reports of drug use in prisons for people who received standard drug treatment, time-limited methadone treatment and methadone maintenance treatment. The setting for the study was the NSW prison system. One hundred and eighty-five injecting drug users who had been recently released from NSW prisons were recruited in 1993. Self-reported drug use and injecting risk behaviour were compared in inmates who received standard drug treatment (counselling), time-limited methadone treatment and methadone maintenance treatment. HIV status was determined by serology. Intervention comprised high and low dose methadone treatment and counselling. The groups were similar in terms of most basic demographic characteristics but subjects who had been maintained on methadone reported a significantly lower prevalence of heroin injection, syringe sharing and scored lower on an HIV Risk-taking Behavioural Scale than subjects who received standard drug treatment and time-limited methadone treatment. This study suggests that methadone treatment is associated with reduced injecting risk behaviour in prison with adequate (greater than 60 mg) dose and duration in treatment. These treatment conditions are known to increase effectiveness in community-based methadone programmes. Prospective studies are required to evaluate the effectiveness of methadone programmes in the prevention of HIV and other blood-borne viral infections among IDU prisoners.