2009 NSW Inmate Health Survey: Key Findings Report

Executive Summary

Given the service model described above, the health issues identified in this report cannot be solved or improved by Justice Health alone. Justice Health’s primary focus remains on screening, assessment and referral and release planning.

Partnerships with the criminal justice system and health services in the community will be critical to improving the health status of the inmate population in NSW.

Methodology

The 2009 NSW Inmate Health Survey was conducted using a stratified random sample of all inmates from 30 adult correctional centres (26 male centres and 4 female centres).

Of the 1,166 inmates randomly selected and invited to participate, 996 agreed, equating to a response rate of 85.4%. Women and Aboriginal people were over-represented in the sample to ensure better estimates of health issues for these populations. The sample was also stratified by age groups (18-24 years, 25-44 years and 45 years or more) to ensure adequate representation of older and younger inmates. Participants were provided with a comprehensive health check (including any referrals for further healthcare) and were reimbursed with $10 for their involvement.

The methodology for the 2009 NSW Inmate Health Survey was different from the 1996 and 2001 Surveys which were conducted using face-to-face interviews. The questionnaire component of the IHS was conducted via Computer Assisted Telephone Interviewing technology at Hunter New England Population Health with each of the scripted interview questions displayed on computer monitors and data collected from the inmates by the telephone interviewers entered directly into a database. A key concept supporting the use of this technology was the provision of continuous real-time data for immediate surveillance capacity.

Telephone interviews took an average of 73 minutes (median of 70 minutes, range 21 to 198 minutes) to conduct.

Key Findings

Social Determinants

• Over half (52%) of men and just under half (45%) of women did not finish year 10 of schooling.

• Just over one in ten (11%) participants were living in unsettled accommodation or had no fixed abode prior to their current incarceration, a slight increase since 1996 (8%).

• Half (50%) of men and two-thirds (67%) of women were unemployed in the 6 months before their incarceration.

Much of this unemployment was long-term with 30% of men and 44% of women being unemployed for five years or longer.

• An increased proportion (30%) of 2009 participants had a history of being placed in care before the age of 16 years compared to 2001 (21%).

• Just under one in five (18% of men, 17% of women) had a history of parental incarceration during their childhood.

Offending behaviour

• Twice as many men (42%) as women (22%) had a history of juvenile detention.

• The proportion of men who had previously been incarcerated remained stable from 1996 to 2009 at just under two-thirds.

Among women, the proportion steadily decreased from 63% in 1996 to 55% in 2001 to 46% in 2009.

• Men were less likely to have their own cell in 2009 (35%) compared with 1996 (60%), a finding which also held for women where 56% had their own cell in 2009 compared to 77% in 1996.

Physical health

• Over half (56%) of participants were overweight or obese in 2009, representing a small increase from 1996 and 2001 (both 49%). The largest increase in overweight and obesity was found among women who increased from 42% in 1996 to 44% in 2001 to 58% in 2009.

• High blood pressure decreased among men from 24% in 1996 to 22% in 2001 to 15% in 2009. High blood pressure increased slightly for women from 7% in 2001 to 12% in 2009.

• Despite the average age of the sample being 35 years, a high proportion (20%) had been told by a doctor that they had a heart problem such as chest or angina pain, heart murmur or palpitations. This steadily increased from 16% in 1996 to 20% in 2009, with a higher proportion of women (24%) reporting heart problems than men (19%).

• Over half (54%) of women and just under half (46%) of men reported a disability or illness that had impacted on their health for six months or more, which represented a steady increase from 1996 (34%) to 2001 (41%) to 2009 (47%) for all participants.

• Half (52%) of men and 35% of women had a history of a head injury resulting in unconsciousness. The prevalence of head injuries has decreased among women from 39% in 2001 to 35% in 2009, but increased among men from 45% in 2001 to 52% in 2009. Most of these head injuries (47%) occurred over ten years previously and involved only a short period of unconsciousness (51% less than ten minutes)

Access to healthcare

Infectious diseases

• There were substantial drops between 2001 and 2009 in the proportion of participants who were hepatitis C antibody positive, from 64% to 45% among women, and 40% to 28% among men.

• Just over a third (38%) of inmates demonstrated vaccine conferred immunity to Hepatitis B infection, which was a slight increase from 2001 (35%).

Smoking, alcohol and other drugs

• Over three quarters of participants (75% of men and 80% of women) were current tobacco smokers (compared to 17% of the general population in Australia). This rate of smoking has not changed much from 1996 to 2009, in contrast to steady decreases in the community.

• However, a high proportion (85%) of current smokers indicated they would like to quit smoking. Desire to quit was higher among men (89%) than among women (74%) in 2009.

• Risky alcohol consumption in the year before incarceration was much higher than the community average, with 63% of men and 40% of women drinking alcohol at hazardous/harmful levels in the year before prison. In particular, a high proportion (35% of men, 16% of women) were drinking at levels suggestive of alcohol dependence.

• The majority (84%) of participants had used illicit drugs, compared to just over a third (38%) in the general community. The proportion of women who had used illicit drugs decreased slightly between 1996 and 2009 (from 82% to 78%), while use of drugs increased among men from 69% in 1996 to 86% in 2009.

• Cannabis was the most common drug ever used (81%), followed by amphetamines (57%), cocaine (45%) and ecstasy (44%). The use of heroin decreased from 2001 to 2009 (from 49% to 41%), while the use of crystalline methamphetamine (ice) increased over this same time period from 11% to 42%, which reflect changes in illicit drug markets during this time.

• There was a decrease in the proportion of participants indicating daily/near daily use of drugs in the year before prison between 2001 (68%) and 2009 (44%) which may reflect the decreased use of heroin noted above. Similarly, there was a decrease in ever using drugs in prison from 48% in 2001 to 43% in 2009.

• A striking finding from the Survey was the substantial drop in the proportion of participants who had ever injected drugs from 2001 (57%) to 2009 (43%). This decline was evident among both men (53% to 40%) and women (74% to 52%). There was a major decrease in heroin injection from 47% in 2001 to 32% in 2009, and an increase in crystalline methamphetamine injection from 4% in 2001 to 23% in 2009, again reflecting changes in Australia’s drug markets.

Mental health

• The proportion of participants who had ever been assessed or treated by a doctor or psychiatrist for a mental health problem increased steadily from 39% in 1996 to 43% in 2001 to 49% in 2009. This increase was mostly due to an increasing proportion of men being treated for mental health problems (from 35% in 1996 to 41% in 2001 to 47%), as the proportion of women remained steady at around 54%. The three most common mental health conditions were depression, anxiety and drug dependence.

• Similarly, an increasing proportion of participants reported ever having been admitted to a psychiatric unit from 13% in 1996 to 14% in 2001 to 16% in 2009. A higher proportion of women (20%) than men (15%) reported this in 2009.

• There was a steady decline in participants who had ever thought about committing suicide (from 42% in 1996 to 36% in 2001 to 33% in 2009). This drop was most notable among women, decreasing from 60% in 1996 to 38% in 2009.

• There was also a small decrease in the proportion of participants who had ever attempted suicide (from 24% in 1996 to 22% in 2001 to 21% in 2009), with a higher proportion of women (27%) than men (19%) reporting having attempted suicide in 2009.

• The rates of self-harm remained relatively stable from 1996 to 2009, at around 15% for all participants. However, a steady decline was observed among women, from 23% in 1996 to 21% in 2001 to 17% in 2009.