SCOTT BEVAN: When a person goes to prison, they're often taking with them a host of health problems.
A new report indicates Australian prisoners have much higher rates of mental and physical health issues than among the general population.
The study released by the Australian Institute of Health and Welfare also shows that more than a quarter of those coming out of prison felt that their mental health had actually become much better while they were inside.
So once prisoners are discharged, what happens to their health?
Associate professor Stuart Kinner, from the University of Melbourne's School of Population and Global Health says that's an area that needs a lot more attention, for the former inmates' sake, and the community's.
I spoke with Professor Kinner a short time ago.
STUART KINNER: Look we know for a fact that the health of people in prison is markedly worse than the health of people in the community who aren't in prison. The latest in this series report by the Australian Institute of Health and Welfare really clearly documents that.
We know that people coming into prison, despite being relatively young, have a range of complex and chronic health problems. We know they have a range of chronic health conditions that require considerable medical care.
We know that the prevalence of mental illness is extremely high in this population. We know that the prevalence of substance dependence is extremely high.
We know that infectious diseases are prevalent in this population. So what we're looking at is a group of young people, typically in their early 30s, characterised by a number of complex health problems at much higher rates than you see in the general community.
SCOTT BEVAN: In regard to the report and the responses gained, 27 per cent of prison dischargees reported that their mental health had become a lot better while in jail. What does that say about the methods of picking up and indeed treating mental illness before these people even end up in prison?
STUART KINNER: Look, that's, there's a couple of things I'd like to touch on there. First is that we do often see people reporting that their health improves in prison. Look, we can always do better with prison health services but by and large, we're doing a pretty decent job.
We do provide a very low threshold access to usually pretty good quality health service in prison settings. So people's mental health will often improve, or at least stabilise. We often do a really good job of initiating care for chronic conditions.
The problem is it all tends to fall apart when people return to the community, when we're not providing that same level of high intensity, low threshold care. So of course it's stopping people coming into prison in the first place is an even better result. Both for those individuals and for society, from an economic and a health point of view. And addressing people's mental health needs is one part of that.
SCOTT BEVAN: What sort of flow on effects are there for dischargees in their behaviour in the short term, after their release?
STUART KINNER: There are really only two things that we know with great certainty about people being released from prison in Australia. One is that the majority return to custody at some point. And in fact around two in five return to custody within two years. So we can certainly do better in terms of trying to prevent reoffending.
The other thing that we unfortunately know with certainty is that people recently released from prison are at a very considerably increased risk of death. And we're talking about preventable deaths, most often from drug overdose and suicide which of course are related to substance-related problems and mental illness.
SCOTT BEVAN: If there is such a high rate of recidivism and of deaths soon after and given all the effort put in while these people are inside, why isn't there a greater follow up regime to prevent this?
STUART KINNER: Look that's a really good question and I think the answer is not one that I've got at my fingertips. I think a couple of the key ingredients that we're currently missing. One is the evidence. We do need to do more research so that we have a more full understanding of what the needs of people are after they're returned to the community.
The other thing that we need to do is get beyond doing research and doing some doing. And that's about providing coordinated transitional care for people returning from prison to the community.
We do some transitional care in all Australian jurisdictions. We could do a lot more in all Australian jurisdictions. And to get that up and running, I think what we, the other ingredient that we really need is some national leadership on this issue. Because effectively what we're talking about here is the health outcomes of a very vulnerable segment of the community, which is what these folks are once they return from prison.
SCOTT BEVAN: What do you mean by national leadership? And what form should that take?
STUART KINNER: Look, I think there's certainly a place for some national strategies around this, about getting correctional authorities around the country, around the table, to agree on a set of minimum standards around transitional care. And that includes acknowledging the scale at which that transitional care has to be provided. Not providing it to a very at-risk subset but providing it to all of those who are in need of that transitional care in the same way as we would transitioning people out of, for example, hospitals.
SCOTT BEVAN: What do you think the general population's attitude would be to the thought of ongoing treatment?
STUART KINNER: Look, that's a really pivotal question. I think one of the greatest challenges in providing health care to people in prison and when they get out of prison is this idea that while they deserve it, they're offenders and they're criminals and you know they're getting what they deserve.
Look, I think that's sometimes easy to say until you see the reality or until you know somebody's who's experienced incarceration or know somebody who's experienced serious mental illness and substance use and some of the related behavioural problems.
We do nationally have a recognition that incarceration is the punishment. We don't incarcerate people and then punish them. What that means is, as soon as people are incarcerated, we're either seizing an opportunity to address their unmet health needs or we're missing that opportunity.
SCOTT BEVAN: That's associate professor Stuart Kinner from the University of Melbourne's School of Population and Global Health.