South Wales Prisons Research Articles

Alcohol relapse prevention health care after alcohol withdrawal in New South Wales prisons, Australia: A patient file review.

People who enter custody have complex health issues and comorbidities may include alcohol use disorders. We investigated clinical service provision and comorbidities recorded among individuals with a likely alcohol withdrawal syndrome within prison in New South Wales, Australia. For this clinical case series review, electronic medical data were used to identify 50 people entering custody between August and November 2018 who likely had a treated alcohol withdrawal syndrome. We aimed for a 3:2 ratio of men and women, and a 1:1 ratio of Aboriginal and non-Aboriginal individuals. Data were extracted using a purposefully designed tool which included current alcohol withdrawal management, comorbidities and alcohol relapse prevention approaches used or recommended. Thirty-eight men and 12 women, of whom 22 were Aboriginal, were included. Twenty-nine individuals (58%) reported a history of medical comorbidities. Thirty-five (70%) reported using other substances and over half (60%) had a diagnosis of mental health disorders. Fourteen (28%) individuals had a record of receiving brief intervention and five (10%) of motivational interviewing. Twenty-three individuals (46%) were referred to and seen by drug and alcohol clinicians. Only seven (14%) of the sample had pre-release community care plans. Individuals treated for an alcohol withdrawal syndrome in New South Wales prisons have a high prevalence of medical comorbidities and other substance use. Clinical interventions focused on alcohol withdrawal management, and relapse prevention interventions were not recorded for most individuals. Service innovation and expansion are needed to increase the provision of post-withdrawal management.

Health literacy strengths and challenges of people in New South Wales prisons: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

BackgroundHealth literacy is an important factor for enabling people to manage their health and live long fulfilling lives. People in prison are frequently from marginalised communities, often out of reach of conventional community based health organisations, and have poorer health outcomes. It is essential to understanding the health literacy profiles of people in prison, and its contribution to the well-established health inequities and outcomes of this population. This study aimed to use a multi-dimensional health literacy measurement tool to describe the strengths and challenges of adults incarcerated in NSW prisons.MethodsA cross-sectional survey was conducted for people in prison across 14 publicly operated metropolitan prisons. Data were collected from 471 participants using the Health Literacy Questionnaire (HLQ). Participant characteristics and health conditions were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between participant characteristic groups.ResultsParticipants’ median age was 38.0 (range 19 – 91) years. Males comprised 81% of the sample, 21% identified as Aboriginal and/or Torres Strait Islander, and 53% reported a health problem. People in prison had lower scores for all nine HLQ scales when compared to the general Australian population. Small to medium ES were seen for mean differences between most demographic groups. Compared to males, females had lower scores for several of the HLQ scales including ‘having sufficient information to manage health’ (ES 0.30 [95% Confidence Interval (CI) 0.07, 0.53]), ‘ability to actively engage with health care professionals’ (ES 0.30 [95% CI 0.06, 0.53]), ‘navigating the healthcare system’ (ES 0.30 [95% CI 0.06, 0.53]), and, ‘ability to find good health information’ (ES 0.33 [95% CI 0.10, 0.57]). Differing health literacy scale scores with small to medium ES were found when comparing participants by legal status. Mainly small ES were seen when comparing other participant characteristic groups.ConclusionsThis study provides insights into the health literacy strengths and challenges for people in NSW prisons. These findings highlight the important role health literacy could have in addressing health disparities in this vulnerable population and can inform prison health services.

A service evaluation on the impact of brain injury linkworker (BIL) interventions on the anxiety and depression of men in prison and on probation

It is well established that the prevalence of Traumatic Brain Injury (TBI) is higher in offender populations than the general population. Men in prison and probation services also have many of the risk factors that place them at higher risk of developing neuropsychiatric complications following a TBI (e.g., low socioeconomic backgrounds, previous history of substance misuse). The BIL service, developed in 2013 by Brainkind (formally The Disabilities Trust) delivers brain injury rehabilitation to men engaged with South Wales (United Kingdom) Prison and Probation Services. As part of a wider service evaluation, we reviewed the levels of anxiety (Generalised Anxiety Disorder assessment, GAD-7) and depression (Patient Health Questionnaire, PHQ-9) of 50 men in prison or on probation pre- and post-BIL intervention. Results showed a significant decrease in the scores reported on the GAD-7 between the start (Mean—M = 15.38, Standard Deviation—SD = 4.64) and end (M = 11.84, SD = 5.15) of the intervention (t (49) = 2.01, p = 0.00000733). Additionally, there was a significant decrease in self-reported depression symptoms as observed by the scores on the PHQ-9 between the start (M = 17.08, SD = 5.55) and end (M = 12.42, SD = 6.55) of the intervention (t (49) = 2.01, p = 0.0000125). These results indicate that overall there was an improvement in the men’s levels of anxiety and depression following the BIL intervention. This service evaluation provides a clear rationale for the development of a more rigorous research protocol to explore the relationship between brain injury interventions and the impact on mental health in this population.

The prevalence of self-reported mental illness among those imprisoned in New South Wales across three health surveys, from 2001 to 2015.

The prevalence of mental illness among those in prison is much higher than in the community; however, very few studies have examined whether rates have changed over time, in line with increasing self-reported rates in the community. This study compares the prevalence of self-reported mental illness, self-harm and suicidal thoughts/behaviours, and drug and alcohol use across three waves (2001, 2009 and 2015) of health surveys involving men and women in New South Wales prisons and compared these rates with published community-level findings. The prevalence of those reporting any mental health diagnosis increased significantly across the three surveys, even after adjustment for socio-demographic and criminal justice variables that also changed over time. Individuals surveyed in 2015 were more likely to report a mental health diagnosis than those surveyed in 2001 (adjusted odds ratio = 2.66, 95% confidence interval = [2.16, 3.27]). The prevalence of self-harm and suicidal thoughts and behaviours remained stable across the three surveys, while self-reported regular drug use decreased over the period. Women experienced a far greater burden of mental illness than men across all three surveys and experienced more growth in the prevalence of most psychiatric disorders. These findings have important implications for public and prison health systems given the poor social, health and criminal justice outcomes of those imprisoned with mental illness, both in custody and post-release.

Pandemics in New South Wales prisons: the more things change….

The current COVID-19 pandemic is not the first time New South Wales prisons have faced contagion. This paper examines the current responses in New South Wales prisons to the threat of COVID-19 to prisoner health, by contrasting contemporary activities with actions and policy developed during two historical epidemics: the influenza epidemic of 1860 and pandemic of 1919. Epidemiological information relating to cases of disease in NSW prisons during the 1860 and 1919 influenza epidemics was obtained from the Comptroller-General's reports for the specific outbreak years and for the preceding and succeeding five-year periods. Additional archival sources such as digitised newspaper reports and articles available through the National Library of Australia were analysed for closer detail. The management of these outbreaks was compared to current strategies to mitigate against risk from the COVID-19 pandemic in the NSW prison system. Interesting similarities were discovered in relation to the management of the historic influenza outbreaks in NSW prisons and in the management of the current COVID-19 pandemic. An outbreak of influenza in mid-1860 impacted seven penal institutions in Sydney and Parramatta. Infection rates at these institutions were between 3.1% and 100%; the mean rate was 41.8%. The public health measures employed at the time included allowing 'air circulation freely night and day', and treatments that were 'tonical and stimulatory'. While the past 100 or more years have brought huge progress in scientific knowledge, public health approaches remain the mainstay of outbreak management in prisons; and, as in 1919, the opportunity for Australia to observe the rest of the world and plan for action has not been wasted. Prisons pose a potential risk for pandemic spread but they also present a unique opportunity for reducing disease risk by ironic virtue of the 'separate system' that was recognised even 100 years ago as characteristic of these institutions.

A randomized controlled trial of a Group psychological intervention to increase locus of control for alcohol consumption among Alcohol‐Misusing Short‐term (male) Prisoners (GASP)

Reducing alcohol misuse by male prisoners is an important global issue. Control of drinking behaviour could be a useful target for intervention in this population, and locus of control could be a causal factor in this. We aimed to assess the effect of a clinical psychologist-facilitated group intervention on male prisoners' locus of control of drinking behaviour. A two-arm, single-site, open, randomized controlled trial. A category B local training prison in South Wales, housing about 770 mainly sentenced men. Prisoners serving less than 2years who met inclusion criteria for pre-imprisonment alcohol misuse, alone or with drug misuse. A total of 119 were allocated to the intervention arm and 119 to the control arm; 104 and 87, respectively, completed the post-randomization baseline interview and 68 and 60 completed a second interview approximately 4weeks later, respectively, after intervention or treatment as usual (TAU) alone. Nine clinical psychologist-facilitated groups in the prison over 3weeks. Range of participants per session was one to seven, with three to five most usual. The primary outcome was locus of control of behaviour (LCB); secondary outcomes included mental state generally (comprehensive psychiatric rating scale/CPRS) and specifically (Beck Depression Inventory/BDI). An integral process evaluation was conducted. LCB scores decreased during the study, but without significant intervention effect [-1.7, 95% confidence interval (CI)=-5.1 to 1.6, P=0.329]. Change among completers in the control group was from a mean score of 37.4 [standard deviation (SD)=10.0] to 33.7[SD=11.7] and in the intervention group from 37.4 (SD=11.6) to 31.9 (SD=11.8). Secondary outcomes, including change in mental state, did not differ between arms, but 686 (64%) sessions were lost, most because of 'prison issues'. A clinical psychologist-facilitated group intervention did not have a statistically significant effect on sense of control of drinking behaviour among men with pre-imprisonment alcohol misuse serving less than 2years in a South Wales prison. The study proved coterminous, however, with 40% prison staff cuts which seem likely to have contributed to the high loss of group sessions and possibly overwhelmed any treatment effect. Intervention completion failures, previously cited as harmful, had no effect here, so the trial should be repeated when the prison climate improves.

Combined treatment and prevention strategies for hepatitis C virus elimination in the prisons in New South Wales: a modelling study.

Australia is currently on track to meet the World Health Organization (WHO) global hepatitis C virus (HCV) elimination goals by 2030, reflecting universal subsidized access to testing and direct-acting antiviral (DAA) treatment. In New South Wales, DAA treatment in prisons has scaled-up substantially, with 1000 prisoners treated in 2017. However, HCV prevalence and incidence in this setting is high, which could undermine elimination efforts. This study aimed to test the preventative effects of DAA treatment scale-up, opiate substitution treatment (OST) and needle and syringe programme (NSP) strategies for prisons. Modelling study using an individual-based mathematical model of a typical prison setting. The model was calibrated against Australian epidemiological data sets and executed in-prison events for each individual daily, including movements between prisons, changes in risk behaviour and uptake of prevention measures such as OST and NSP, as well as DAA treatment. Scenarios were projected from 2018 to 2030. New South Wales prisons. New South Wales prisoners. Variables including prison populations, prevalence and incidence rate were calculated. Prisoners were described by demographic characteristics, HCV infection history, risk behaviours and accessing treatment and prevention measures in varied security settings. Increasing the number of prisoners treated for HCV to 2000 annually was projected to reduce the HCV incidence rate to 8.69 [95% confidence interval (CI) = 8.17, 9.20] per 100 person-years (100 p.y.). Combined treatment and prevention strategies were necessary to reduce the projected incidence rate to 5.22 (95% CI = 5.13, 5.52) per 100 p.y. Considering the expected reductions in the prevalence of chronic HCV in the Australian community, incidence rate was predicted to drop to 0.93 (95% CI = 0.92, 0.98) per 100 p.y. by 2030. This model, which simulates prison scenarios to inform Australia's national hepatitis C virus elimination efforts, suggests that continued direct-acting antiviral (coverage in the community combined with a moderate increase of direct-acting antiviral treatments in prisons, and introduction of improved harm reduction via opiate substitution treatment and/or needle and syringe programmes, makes hepatitis C virus elimination feasible in Australian prisons.

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.

An examination of chronic ill-health and lifestyle factors among inmates: searching for the healthy immigrant effect in New South Wales Prisons

PurposeThe purpose of this paper is to compare the rates of chronic health conditions and lifestyle factors between Australian-born and overseas-born inmates and to uncover predictive relationships between lifestyle factors and health outcomes for both groups.Design/methodology/approachData are presented from a cross-sectional study based on a sample of inmates from correctional sites in New South Wales (NSW). The inclusion of results here was guided by the literature relating to the healthy immigrant effect.FindingsResults indicate that a higher proportion of Australian-born inmates consumed alcohol at higher levels and were more likely to smoke on a daily or almost daily basis than overseas-born inmates. Australian-born inmates were also more likely than overseas-born inmates to have been diagnosed with cancer, epilepsy or hepatitis C. Physical activity predicted the number of diagnoses for Australian-born inmates while physical activity and smoking frequency predicted the number of diagnoses for overseas-born inmates.Practical implicationsOverseas-born inmates make up a considerable portion of the prison population in NSW. A better understanding of those health and lifestyle factors that distinguish them from Australian-born inmates provides important insight regarding health promotion and the planning of service provision for those providing health care in this space.Originality/valueComparison of the health of immigrant and native-born prison inmates has not been undertaken before and promises to provide important information regarding those factors that distinguish a sizeable minority in the prison population.

Ageing in corrective services: from the perspective of prison chaplains

The number of older inmates in New South Wales prisons has increased over the past ten years but it is unclear whether corrective services can cater for the increase. The current study reports the results of a qualitative study about ageing in prison. Eight prison chaplains from four corrective facilities in NSW were interviewed using a semi-structured interview schedule. The results of a thematic analysis revealed four main themes: the system, the services, the environment and the inmate. The themes reveal a system that is not designed to cope with an ageing population. Inmates become resentful of what has happened to them rather than for the damage they have done to somebody else. The system lacks processes and programmes to enable proper rehabilitation. The issues raised by the chaplains in terms of services, the environment and the inmates decrease the possibility that an older inmate will adapt to the environment and successfully age in place.

Supporting continuity of care between prison and the community for women in prison: a medical record review.

Objectives The aim of the present study was to examine health information transfer and continuity of care arrangements between prison and community health care providers (HCPs) for women in prison. Methods Medical records of women released from New South Wales prisons in 2013-14 were reviewed. Variables included health status, health care in prison and documented continuity of care arrangements, including information transfer between prison and community. Associations were measured by adjusted odds ratios (AORs) using a logistic regression model. Text from the records was collected as qualitative data and analysed to provide explanatory detail. Results In all, 212 medical records were systematically sampled and reviewed. On prison entry, information was requested from community HCPs in 53% of cases, mainly from general practitioners (GPs, 39%), and was more likely to have occurred for those on medication (AOR 7.08; 95% confidence interval (CI) 3.71, 13.50) or with schizophrenia or other psychotic disorders (AOR 4.20; 95% CI 1.46, 12.11). At release, continuity of care arrangements and health information transfer to GPs were usually linked to formal pre-release healthcare linkage programs. Outside these programs, only 20% of records had evidence of such continuity of care at release, with the odds higher for those on medication (AOR 8.28; 95% CI 1.85, 37.04) and lower for women with problematic substance misuse (AOR 0.32; 95% CI 0.14, 0.72). Few requests for information were received after individuals had been released from custody (5/212; two from GPs). Conclusion Increased health information transfer to community HCPs is needed to improve continuity of care between prison and community. What is known about the topic? Many women in prison have high health needs. Health and well being are at further risk at the time of transition between prison and community. What does this paper add? This study provides evidence that outside formal programs, which are currently available only for a minority of women, continuity of care arrangements and transfer of health information do not usually occur when women leave prison. Pragmatic choices about continuity of care at the interface between prison and community may have been made, particularly focusing on medication continuity. Barriers to continuity of care and ways forward are suggested. What are the implications for practitioners? Siloing of health care delivered within prison health services through lack of continuity of care at release is wasteful, both in terms of healthcare costs and lost opportunities to achieve health outcomes in a vulnerable population with high health needs. There is need for an increased focus on continuity of care between prison and community health services, HCP support and training and expansion of pre-release planning and healthcare linkage programs to assist larger numbers of women in prison.

Treatment outcomes for Indigenous and non‐Indigenous inmates with hepatitis C in New South Wales prisons

Treatment outcomes for Indigenous and non‐Indigenous inmates with hepatitis C in New South Wales prisons

A cross‐sectional study of susceptibility to vaccine‐preventable diseases among prison entrants in New South Wales

To determine the prevalence of susceptibility to measles, mumps, rubella, varicella and hepatitis B virus (HBV) among New South Wales prison entrants and to compare results for prison entrants with those of a community sample. Between 11 October 2010 and 24 October 2010, new entrants at seven adult correctional centres completed a cross-sectional survey and provided a venous blood sample. All adults entering the correctional centres were eligible to participate, with 211 completing the survey (response rate 68%). Serological evidence of immunity to measles, mumps, rubella, varicella and HBV. Prison data were compared with community data obtained from the 2007 Australian National Serosurveillance Program. Over half of the participants (106/204, 52%) were susceptible to HBV, followed by susceptibility to mumps (82/198, 41%), rubella (33/209, 16%), measles (27/203, 13%) and varicella (19/198, 10%). Having no history of drug injection was a significant predictor of susceptibility to measles, mumps and HBV. Prison entrants were significantly less likely than people in the community to be susceptible to varicella (10% versus 18%; risk ratio [RR], 1.9; 95% CI, 1.1-3.2) and HBV (52% versus 65%; RR, 1.3; 95% CI, 1.1-1.5). Prison entrants are susceptible to a number of vaccine-preventable diseases. We recommend a cost-benefit analysis of implementing routine vaccination for measles, mumps, rubella and varicella and an exploration of options for improving uptake of HBV vaccination.

Sexual coercion prior to imprisonment: prevalence, demographic and behavioural correlates

Little is known about experiences of sexual coercion among prisoners prior to incarceration. Prisoner populations are routinely excluded from national surveys of sexual health which also tend to under-represent marginalized groups. We surveyed 2351 randomly selected men and women, aged 18-64 years, in New South Wales and Queensland prisons who participated in a computer-assisted telephone interview. Around 60% of women and 14% of men self-reported having been sexually coerced prior to incarceration, with 60% of these experiences occurring before the age of 16 years. Factors independently associated with a self-reported history of sexual coercion were: homosexual and bisexual identity, being unable to work, separated marital status, higher level of education (among women), having been paid for sex, a past sexually transmissible infection (among men), drug use (among women) and a history of mental health problems. Prior sexual coercion was associated with unwanted sexual contact and physical assault while in prison. The high prevalence of sexual coercion reported by prisoners and its association with a range of factors indicates a need for a greater acknowledgement of the potential consequences of this within the criminal justice system. This could entail providing counselling and support services within the correctional setting.

Blood-Borne Viruses in New South Wales Prisons: Results from a Multi-Centre Study in Australia: Category: Clinical lesson

Blood-Borne Viruses in New South Wales Prisons: Results from a Multi-Centre Study in Australia: Category: Clinical lesson

Knowledge of sexually transmissible infections: a comparison of prisoners and the general population

The World Health Organization (WHO) has identified a failure to provide education for vulnerable populations such as prisoners as a contributing factor to the epidemic of sexually transmissible infections (STIs). Despite this recognition, little is known about prisoners' level of knowledge of STIs compared with the general population. Using computer-assisted telephone interviews, we compared a representative sample of 2289 Australian prisoners, aged 18-59 years from New South Wales and Queensland prisons with a representative community sample of 3536 participants from these two states. Prisoners had significantly better knowledge than the general community of chlamydia-related questions, while knowledge of herpes (genital and oral) was slightly better in the community sample. Prisoners who were aged over 25 years, not married, female, self-identified as either homosexual or bisexual and reported a history of STIs tended to have better STI knowledge levels. Despite their more disadvantaged backgrounds, prisoners demonstrated relatively good health literacy in relation to STIs. Ongoing education about the transmission risks of STIs for prisoners and the general community is needed.

Self-reported impulsivity in male offenders with low cognitive ability in New South Wales prisons

The study of impulsivity in offenders with low cognitive ability has received relatively little empirical investigation. A sample of 108 male offenders with IQ scores below 75 points answered an adaptation of the Barratt Impulsiveness Scale version 11 (BIS-11). The adapted version had high reliability, and results showed the instrument is useful in discriminating sex offenders from both violent offenders, and non-sex offenders with low cognitive ability. Sex offenders with low cognitive ability achieve better planning scores, while other offenders with low cognitive ability show increased impulsiveness in terms of scores indicating quicker decision making, and a reduced amount of concern for the consequences of their actions. The study highlights the stability of impulsivity according to historical offences. Overall results indicate that the combination of acting without thinking, and lack of concern for consequences, differentiates offenders with low cognitive ability from many other offenders. Neither age nor IQ scores are significantly related to impulsivity in this group.

Value for Money? Neo‐Liberalism in New South Wales Prisons

The NSW prison sector has undergone considerable reform over the last ten years. The NSW government now oversees the operation of publicly managed prisons, one privately managed prison and a number of new public prisons operating under the new ‘Way Forward’ management model. In order to establish which approach to prison management offered the best value for money, the NSW government undertook a ‘value for money’ assessment in 2005. In this article, we argue the cost accounting information is privileged in the assessment process. However, we contend that this information was limited and partial, and provided a poor basis on which to form policy. Even so, the NSW government has proceeded on this basis. In order to explain this, we position the report within the wider neo‐liberal turn in policymaking and the workplace reforms that have accompanied it.

Antecedents of chronic kidney disease in Aboriginal offenders in New South Wales prisons

Antecedents of chronic kidney disease in Aboriginal offenders in New South Wales prisons

Moving and Thinking Behind Bars: The Effectiveness of an Exercise and Health Education Program on Psychological Distress of Incarcerated People with, or at Risk of Developing, a Chronic Illness

Rates of chronic illness within the New South Wales, Australia, prison population are alarmingly high. Population approaches to health care and community development pose some unique challenges in the context of prisons. These challenges are discussed in the context of the report on the results of a small pilot randomised control trial conducted within one New South Wales prison that investigated the effect of a 12-week exercise and health education program on male inmates? psychological distress. The exercise program targeted individuals with a chronic illness, those who had two or more risk factors for developing a chronic illness and/or inmates over 40 years of age. The psychological distress of the inmate participants was measured weekly using a modified Kessler 10 tool. No statistically significant differences were found between the groups pre- or post- the exercise program. There was also no significant correlation between total psychological distress and participating or not participating in the exercise. A further study, with a larger sample size and different tool, is recommended.