Imprisoned in body and mind

An insight into the mental health of those behind bars

While the COVID-19 pandemic has seen many Australians experience separation and isolation over the past year, it has added an extra layer of despair to the lives of those behind bars, who have had little or no face-to-face contact with loved ones.

About 30,000 people move through the New South Wales custodial system each year, many with similar profiles of fractured lives.

Their statistics – collated in a ground-breaking 2017 report based on a survey among the incarcerated in 2015 by the Justice Health and Forensic Mental Health Network (the Network) – make for grim reading.

The Network Patient Health Survey found nearly 70 per cent of adolescent offenders had experienced childhood abuse or neglect, more than 20 per cent had been placed in care before they were 16 years old and 54 per cent had one or both parents who had spent time spent time in jail.

Of the adults in custody, 18 per cent had attempted suicide before incarceration and one-fifth had one or both parents sent to jail during their childhood. Sixty-five per cent reportedly experienced or witnessed at least one traumatic experience in their lifetime.

Complex psychological disorders in both cohorts were common.

However, one of the positives about their incarceration was that comprehensive healthcare was often more accessible than at any other time in their lives, according to the Network’s Executive Director of Performance and Planning, Janelle Buncombe.

The Network provides health services to patients in adult correctional centres and police cells as well as juvenile detainees and patients in Long Bay Hospital.

Key services include primary care, population health, women’s health, oral health, drug and alcohol services, adolescent health, mental health, aged care and Aboriginal health.

“The model is similar to a large general practitioner’s surgery,” Ms Buncombe says.

“Everybody’s health needs are assessed when they enter custody and that includes a mental health screen. Those services are available throughout their time in custody,” she adds.

Specialist care is also available on referral during their stay.

Ms Buncombe began her career in occupational therapy before progressing into senior leadership roles and completing further post-graduate study at UOW’s Sydney Business School. Keen for a new challenge, she moved into the justice health system six years ago.

“One of the challenges in this area of health is that many people in the wider community question whether our patients deserve the healthcare they receive,” she says.

“Our patients lose their right to liberty but their needs don’t get a lot of airplay in the community … the public are mainly interested in reading about waiting lists in the healthcare system and a lot feel that when people are in custody they don’t have the right to care over and above the general community.

“That attitude makes it difficult to advocate for people in the court and custody system – it’s very sad actually,” Ms Buncombe says.

In addition to the adults and adolescents in custody, the Network also provides services for forensic patients who under the Mental Health (Forensic Provisions) Act 1990 are deemed not responsible for their offences because of serious mental health conditions.

The top primary diagnosis among this category is schizophrenia which affects 88 per cent of patients. The break up is 88 per cent male to 12 per cent female. Nearly half have a history of suicide attempts.

Ms Buncombe believes the Patient Health Survey is valuable evidence-based research that is crucial to design future services that result in better outcomes for patients.

As an example, she points to one of the key findings among the overall prison population that says most of the participants reported having awareness of their mental illness and the role that illness played in relation to their unlawful act.

“This is significant in terms of ensuring a patient accesses care in their regular community environment. We do have services in some courts who identify people with mental illness and try to get them treated, as opposed to pushing them through the court and the custodial system.”

As well, the findings could be used to reduce high incarceration rates among the Aboriginal community who make up about 3 per cent of the Australian population, but more than a quarter of the prison population.

Ms Buncombe says the study also places a question mark over our healthcare delivery in the wider community.

“It’s not always about what we are doing in here,” she says. “It’s what as a community we could be doing to look after people in need before they go down the wrong path.”

The Network Patient Health Survey is expected to be repeated about every five years.

Five of the ten key findings in the 2015 survey:

  • 83 per cent of participants reported having been seen by a psychiatrist, psychologist or other clinician prior coming into custody/hospital, and 65 per cent had been previously admitted to a psychiatric unit or hospital.
  • 47 per cent were diagnosed with a mental health condition before the age of 20.
  • Almost two-thirds of all participants (63 per cent) reported having experienced at least one traumatic event in their lifetime. Forensic patients (72 per cent) reported this more frequently than other patients.
  • More than two-thirds of all participants reported a history of suicidal thoughts.
  • Just over one half (53 per cent) of participants reported a history of at least one head injury resulting in unconsciousness.

Janelle Buncombe

Master of Management, 2009
Master of Business Administration, 2012