Who are the patients?

Patients not prisoners...

The current prison population of Australia is at an all-time high with over 36,000 adults incarcerated –and another 1,000 young people in some form of detention. There are strong indications given current policy direction that these numbers will continue to climb.

In the 230 years since the penal colony of NSW was established, the state has overseen, and for most of this time operated, the prison system. Throughout the period, the people incarcerated have overwhelmingly been drawn from the most disadvantaged in our society and have had some of the highest health needs.

Aboriginal and Torres Strait Islander people are grossly over-represented in Australia’s prisons, accounting for just over one-quarter of all adult prisoners in 2015 despite representing just 2% of the population.

Established indicators of health implications of disadvantage include chronic disease, poor mental health, unemployment, low levels of literacy and substance abuse. These feature heavily in the demographics of newly sentenced prisoners.

On entry to prison: iThree-quarters are smokers iTwo-thirds have not finished secondary school iThose sentenced are more likely to have been recently unemployed or homeless compared to the general population iIn 2014, one-third had a long-term health condition or disability which limited daily activities, or restricted participation in education or employment iIn 2014, two-thirds had used illicit drugs in the 12 moths before their imprisonment

When one considers an overall population perspective, it is not surprising that many prisoners report improvements in their health once they enter the prison system. As many prisoners tend to be ‘non-help seekers’ or those who find accessing the health system difficult, the prison environment may be the first place where they are able to access health care services.

Historically, this picture has not changed much since colonisation. Then, as now, more people were imprisoned, and indeed transported, from economically strained backgrounds than the wealthy. While the crimes that were the ostensible reason for their imprisonment may have changed, the underlying issues of poverty and disadvantage remain.