Population ageing, incarceration and the growing digital divide: Understanding the effects of digital literacy inequity experienced by older people leaving prison.

BACKGROUND: Digital inequity refers to the inequality and exclusion experienced by those who lack the same opportunities or circumstances to support the development of digital skills as the rest of modern society. One rapidly growing and highly vulnerable group to digital inequity is older people attempting to reintegrate into society after release from prison, where technology access is limited. Inadequate support for digital skills in this population entails widespread consequences for public health, human rights, social welfare and recidivism. This qualitative study is the first to: examine digital inequity experienced by older people who have been incarcerated, understand the effects of this on reintegration to society, and begin informing appropriate solutions. METHOD: Semi-structured interviews were conducted with N = 15 older people (mean age = 57) who had been released from an Australian prison in the last two years, regarding their experiences of digital literacy since leaving prison. Reflexive thematic analysis was conducted under a critical realist lens. RESULTS: The analysis resulted in six themes that illustrated the extent of digital inequity experienced by this population, and key challenges for improving digital literacy: 'surviving in a digital world', 'stranger in a foreign world', 'questioning the digital divide', 'overcoming your "old" self', 'don't like what you don't know', and 'seeking versus finding help'. CONCLUSIONS: The digital inequity that older people experience during and after incarceration creates additional challenges for a growing group who are already medically and socially marginalised. Prioritisation of this group for digital literacy initiatives both during incarceration and in the community will have benefits for their health, social and financial reintegration. Their unique life experiences should be considered in designing and delivering these programs. Simultaneously, prisons should be cognizant of the potential detrimental effects of technology restriction on reintegration and criminogenic outcomes.

Multi-sector stakeholder consensus on tackling the complex health and social needs of the growing population of people leaving prison in older age.

BACKGROUND: As populations age globally, cooperation across multi-sector stakeholders is increasingly important to service older persons, particularly those with high and complex health and social needs. One such population is older people entering society after a period of incarceration in prison. The 'ageing epidemic' in prisons worldwide has caught the attention of researchers, governments and community organisations, who identify challenges in servicing this group as they re-enter the community. Challenges lie across multiple sectors, with inadequate support leading to dire consequences for public health, social welfare and recidivism. This is the first study to bring together multi-sector stakeholders from Australia to form recommendations for improving health and social outcomes for older people re-entering community after imprisonment. RESULTS: A modified nominal group technique was used to produce recommendations from N = 15 key stakeholders across prison health, corrections, research, advocacy, aged care, community services, via online workshops. The importance and priority of these recommendations was validated by a broader sample of N = 44 stakeholders, using an online survey. Thirty-six recommendations for improving outcomes for this population were strongly supported. The key issues underlying the recommendations included: improved multi-stakeholder systems and services, targeted release preparation and practices that ensure continuity of care, advocacy-focused initiatives in the community, and extended funding for effective programs. CONCLUSIONS: There is consensus across stakeholders on ways forward, with intervention and policy updates required at the individual, systems and community levels. These recommendations entail two important findings about this population: (1) They are a high-needs, unique, and underserved group at risk of significant health and social inequity in the community, (2) Multi-sector stakeholder cooperation will be crucial to service this growing group.

Challenges and facilitators in repeated bio-behavioural surveys for blood-borne virus infections in Australian prisons.

BACKGROUND: Prison-based blood-borne virus (BBV) surveillance is essential for evaluation of prevention and treatment programs for high-risk populations, such as people who inject drugs who are over-represented amongst those incarcerated. Regular triennial surveillance has been in place in Australian prisons for almost two decades, but has been focused to date only on new prison entrants. Recently, the Australian Hepatitis and risk survey in prisons (AusHep study) was established to provide improved surveillance via an expanded bio-behavioural survey representative of all people in prison, including those sentenced and those on remand. This paper aims to identify the challenges and facilitators in conducting bio-behavioural surveys for BBV infections in prison settings. METHODS: Randomly selected individuals in 23 prisons, representative of prisons and people in prison (male/female, security classification, rural location, Aboriginal or Torres Strait Islander), were offered point-of-care testing for HIV and hepatitis C (HCV) antibodies, hepatitis B virus surface (HBs) antigen, and HCV RNA (if HCV antibody positive). Data regarding risk behaviours, harm reduction measures, and prior BBV testing and treatment were collected by interview. Data was also collected on the challenges and facilitators encountered during planning and implementation at each participating prison. RESULTS: In the first round, AusHep recruited 1599 participants (98 % participation, 89 % male, median age 35 years, 49 % ever injected drugs). Major implementation challenges included: slow and complex ethics and governance requirements in each jurisdiction, and challenging logistical arrangements and participant access constraints in the prisons. Major facilitators included use of point-of-care testing allowing immediate feedback of results, strong support from jurisdictional stakeholders in correction and public health sectors, flexibility in the timing and detailed planning for each site, and computer tablet-based data collection. CONCLUSION: The high participation and informative findings indicated clear feasibility of this improved surveillance system. Strong stakeholder engagement and flexibility in logistics facilitated successful implementation of multi-jurisdictional prison-based surveillance.

Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study.

BACKGROUND: Mental health services are available for young people involved with the criminal justice system. However, they have unmet mental health needs after the expiration of criminal justice supervision. OBJECTIVE: To determine the incidence rate and identify predictors of psychiatric hospitalisations within 24 months after the expiration of criminal justice supervision among young people involved with the New South Wales (NSW) criminal justice system. METHODS: Retrospective data from 1556 individuals aged 14-22 years who participated in four surveys of justice-involved young people in NSW were harmonised and linked to four NSW data collections. We calculated the incidence rates of psychiatric hospitalisations within 24 months postsupervision and identified predictors of these hospitalisations using a competing risks regression analysis. RESULTS: Within 24 months postsupervision, 11.4% had a psychiatric hospitalisation compared with 3.5% during supervision. 20.7% of those admitted had a known history of mental illness and engaged with community-based and outpatient mental health services postsupervision. Predictors of psychiatric hospitalisations were: female sex (adjusted subdistribution HR (asHR) 1.84, 95% CI 1.24 to 2.73); previous incarceration (highest asHR for ≥4 episodes 1.67, 95% CI 1.01 to 2.78); head injury (asHR 1.63, 95% CI 1.20 to 2.21); personality disorder (asHR 3.66, 95% CI 2.06 to 6.48) and alcohol and substance use disorder (asHR 1.89, 95% CI 1.29 to 2.77). CONCLUSION: Justice-involved youth have higher rates of psychiatric admissions after criminal justice supervision. Engagement with mental health services postsupervision is important in addressing emerging or persisting mental health needs.

Who gets diverted into treatment? a study of defendants with psychosis.

The current study aimed to advance our understanding of the factors that influence mental health diversion in Local Courts in New South Wales, Australia. Logistic regression was used to systematically identify the factors that are correlated with diversion in a cohort of individuals (N = 7283) diagnosed with psychosis. Those with a substance-induced psychotic disorder were less likely to be diverted than those with an affective psychosis or schizophrenia, after adjusting for age, gender, Indigenous status, offence seriousness, violence and criminal history. Unexpectedly, those with psychotic disorders committing violent or serious offences were more likely to be diverted than those committing non-violent, less serious offences. Legal representation should be provided to all individuals with serious mental illnesses facing criminal charges. The State-wide Community and Court Liaison Service should be expanded to more Local Courts. Further research is required into why Aboriginal defendants with a psychotic illness are less likely to be diverted.

An analysis of published study designs in PubMed prisoner health abstracts from 1963 to 2023: a text mining study.

BACKGROUND: The challenging nature of studies with incarcerated populations and other offender groups can impede the conduct of research, particularly that involving complex study designs such as randomised control trials and clinical interventions. Providing an overview of study designs employed in this area can offer insights into this issue and how research quality may impact on health and justice outcomes. METHODS: We used a rule-based approach to extract study designs from a sample of 34,481 PubMed abstracts related to epidemiological criminology published between 1963 and 2023. The results were compared against an accepted hierarchy of scientific evidence. RESULTS: We evaluated our method in a random sample of 100 PubMed abstracts. An F1-Score of 92.2% was returned. Of 34,481 study abstracts, almost 40.0% (13,671) had an extracted study design. The most common study design was observational (37.3%; 5101) while experimental research in the form of trials (randomised, non-randomised) was present in 16.9% (2319). Mapped against the current hierarchy of scientific evidence, 13.7% (1874) of extracted study designs could not be categorised. Among the remaining studies, most were observational (17.2%; 2343) followed by systematic reviews (10.5%; 1432) with randomised controlled trials accounting for 8.7% (1196) of studies and meta-analysis for 1.4% (190) of studies. CONCLUSIONS: It is possible to extract epidemiological study designs from a large-scale PubMed sample computationally. However, the number of trials, systematic reviews, and meta-analysis is relatively small - just 1 in 5 articles. Despite an increase over time in the total number of articles, study design details in the abstracts were missing. Epidemiological criminology still lacks the experimental evidence needed to address the health needs of the marginalized and isolated population that is prisoners and offenders.

Learnings from a prison-based drug treatment program on planning for release: A qualitative study.

INTRODUCTION: Prison-based drug and alcohol group treatment programs operate in all Australian jurisdictions. With more than two-thirds of people in prison having a history of substance use prior to incarceration, such programs are needed. There have been few published papers on the impact of attending group treatment programs in Australian prisons, and the research published to date has been predominately quantitative. We aim to report the experiences of males in prison who completed and those who did not complete a group-based drug and alcohol program, to gain insight into their strategies for reducing harm from drug and alcohol post-release. METHODS: Qualitative thematic analysis of in-depth interviews with 12 males who completed or were about to complete and 10 males who discontinued a prison-based group drug and alcohol treatment program. RESULTS: Program completers were more likely to have well-developed plans to reduce drug and alcohol harms and maintain abstinence upon return to the community, which included creating healthier social networks. They also showed stronger insights into the factors that led to offending. Those who did not complete the drug and alcohol program appeared to rely on self-will as the main way to reduce drug and alcohol harms, with less awareness of options for support services to reduce or stop drug and alcohol use. DISCUSSION AND CONCLUSIONS: Prison-based drug and alcohol program engagement imparted useful information for program completers. Controlled trials are needed to examine whether such differences equate to improved outcomes after release.

Physical health status of individuals convicted of sexual offences: Results from an Australian prisoner cohort.

Although the poor health of prisoners poses a serious public health problem, very little is known about the health of specific offender groups. Three waves of an Australian Inmate Health Survey were used to describe the self-reported and objectively tested health of men incarcerated for sexual offences against children only (ISOC), adults only (ISOA), and against both (age-polymorphous; ISOP) compared to men incarcerated without sexual offences. ISOC and ISOP were found to have the poorest self-reported health of all groups, with higher rates of eyesight and cardiovascular problems; however, lower rates of Hepatitis B and Hepatitis C as objectively measured. There are important implications for the correctional and public health systems for addressing the health needs of specific offenders.

Predicting attrition of men with a history of violence from randomised clinical trials.

Preventing dropout (attrition) from clinical trials is vital for improving study validity. Dropout is particularly important in justice-involved populations as they can be very challenging to engage and recruit in the first instance. This study identifies factors associated with dropout in a double-blind, placebo-controlled randomised control trial of a selective serotonin reuptake inhibitor (SSRI) aimed at reducing reoffending in highly impulsive men with histories of violent offending. Age, education, social support, psychiatric history, and length of previous incarceration were identified as factors that predict attrition. These findings are consistent with previous research examining variables associated with attrition in clinical trials for community and offender populations. We also explored referral source and treatment allocation as attrition predictors. Although neither significantly predicted attrition, we identified that there are discernible differences in the median time to attrition among the referral source subgroups. Understanding factors that predict treatment completion and attrition will allow researchers to identify participants for whom additional provisions may optimise retention and inform development of targeted interventions.

Self-reported traumatic brain injury in a sample of impulsive violent offenders: neuropsychiatric correlates and possible "dose effects".

Background: Traumatic brain injury (TBI) is a major public health problem that may be associated with numerous behavioral problems, including impulsivity, aggression and violence. Rates of self-reported TBI are high within offender populations, but the extent to which TBI is causally implicated in causing illegal behavior is unclear. This study examined the psychological and functional correlates of histories of traumatic brain injury in a sample of impulsive violent offenders. Methods: Study participants, all men, had been recruited to participate in a randomized controlled trial of sertraline to reduce recidivism. Study entry criteria were an age of at least 18 years, a documented history of two or more violent offenses and a score of 70 or above on the Barratt Impulsiveness Scale. An extensive list of standardized questionnaires was administered to obtain information on previous TBI and other neuropsychiatric conditions or symptoms. Results: In the sample of 693 men, 66% were aged between 18 and 35 years old, and 55% gave a history of TBI ("TBI+"). Overall, 55% of study participants reported at least one TBI. High levels of neuropsychiatric symptomatology were reported. In 75% of TBI+ individuals, their most severe TBI (by self-report) was associated with loss of consciousness (LOC) < 30 min. Compared to TBI- (those without history of TBI) participants, TBI+ individuals were more impulsive (Eysenck Impulsivity), irritable, angry, and reported higher levels of assaultive behavior, depressive symptomology, alcohol use disorder, suicidal ideation, suicide attempts, and lower quality of life. Potential "dose effects" of TBI severity and frequency in terms of neuropsychiatric symptomatology were identified. Conclusion: Like other studies of offender populations, single and multiple TBIs were very common. The associations of TBI, TBI severity, and TBI frequency (i.e., TBI "burden") with adverse neuropsychiatric phenomena suggest TBI contributes importantly to offender morbidity but the select nature of the sample and cross-sectional study design constrain the interpretation of these findings.

Neuropsychiatric correlates of olfactory identification and traumatic brain injury in a sample of impulsive violent offenders.

Background: Olfactory deficits have a diverse etiology and can be detected with simple olfactory tests. Key olfactory pathways are located within the frontal and temporal lobes where they are vulnerable to damage due to head trauma. Orbitofrontal cortex (OFC) integrity is important for olfaction and aspects of behavioral regulation. We measured olfactory identification ability in a sample of impulsive violent offenders to determine its associations with history of traumatic brain injury (TBI) and a range of neuropsychiatric indices, including proxies for cognitive ability, impulsivity and social connectedness. Methods: Male participants were drawn from the ReINVEST study, a randomized controlled trial of sertraline to reduce recidivism in violent impulsive offenders. Criteria for participation in the study included a minimum age of 18 years, a documented history of two or more violent offenses, and a score of 70 or above on the Barratt Impulsiveness Scale (BIS-11). The 16-item "Sniffin sticks" (SS) odor identification test (OI) was administered as were standardized questionnaires regarding previous TBI, additional measures to screen cognition [word reading test of the Wechsler Individuals Achievement Test (WIAT), social connectedness (the Duke Social Support Scale), and a range of other neuropsychiatric conditions or symptoms]. The sample SS scores were compared against published age-specific norms. Univariate and multivariate analyses were performed with SS score (linear regression, within those without hyposmia) or hyposmia (logistic regression) as the outcome. Results: The mean OI scores were lower than population norms and 16% of participants were classified as hyposmic. Univariate analyses showed associations of SS score with age, WIAT score, impulsivity, TBI and TBI severity, social connectedness, childhood sexual abuse, suicidality and current use of heroin. In multivariate analyses, age, TBI severity and WIAT remained as significant independent predictors of SS score (within the normosmic range) or hyposmia (logistic regression). Conclusion: Olfactory performance was associated with multiple behavioral phenomena in a pattern that would be consistent with this serving as a proxy for orbitofrontal functioning. As such, OI testing may have utility in further studies of offenders. In future, we will examine whether olfactory score predicts recidivism or response to the administration of sertraline, in terms of reducing recidivism.

A comparison of older and younger offenders with delusional jealousy.

We sought to determine whether or not there were differences in medical, criminological and legal factors between older and younger offenders with diagnoses of delusional jealousy by undertaking a retrospective case-file search of Australian legal databases. Our results demonstrate that older offenders were more likely to have comorbid dementia whereas younger offenders were more likely to have comorbid substance use and chronic psychotic conditions. A history of domestic violence frequently predated the index offence but we were unable to determine if this was due to psychosis or a pre-existing tendency for violence. Despite a common diagnosis, the older offenders were more likely to be made forensic patients rather than sentenced prisoners when compared with the younger offenders. Consequently, different factors might mediate the pathway to violence in older and younger people suffering from delusional jealousy and could be additional targets for clinical intervention.

Automatic Extraction of Research Themes in Epidemiological Criminology From PubMed Abstracts From 1946 to 2020: Text Mining Study.

BACKGROUND: The emerging field of epidemiological criminology studies the intersection between public health and justice systems. To increase the value of and reduce waste in research activities in this area, it is important to perform transparent research priority setting considering the needs of research beneficiaries and end users along with a systematic assessment of the existing research activities to address gaps and harness opportunities. OBJECTIVE: In this study, we aimed to examine published research outputs in epidemiological criminology to assess gaps between published outputs and current research priorities identified by prison stakeholders. METHODS: A rule-based method was applied to 23,904 PubMed epidemiological criminology abstracts to extract the study determinants and outcomes (ie, "themes"). These were mapped against the research priorities identified by Australian prison stakeholders to assess the differences from research outputs. The income level of the affiliation country of the first authors was also identified to compare the ranking of research priorities in countries categorized by income levels. RESULTS: On an evaluation set of 100 abstracts, the identification of themes returned an F1-score of 90%, indicating reliable performance. More than 53.3% (11,927/22,361) of the articles had at least 1 extracted theme; the most common was substance use (1533/11,814, 12.97%), followed by HIV (1493/11,814, 12.64%). The infectious disease category (2949/11,814, 24.96%) was the most common research priority category, followed by mental health (2840/11,814, 24.04%) and alcohol and other drug use (2433/11,814, 20.59%). A comparison between the extracted themes and the stakeholder priorities showed an alignment for mental health, infectious diseases, and alcohol and other drug use. Although behavior- and juvenile-related themes were common, they did not feature as prison priorities. Most studies were conducted in high-income countries (10,083/11,814, 85.35%), while countries with the lowest income status focused half of their research on infectious diseases (47/91, 52%). CONCLUSIONS: The identification of research themes from PubMed epidemiological criminology research abstracts is possible through the application of a rule-based text mining method. The frequency of the investigated themes may reflect historical developments concerning disease prevalence, treatment advances, and the social understanding of illness and incarcerated populations. The differences between income status groups are likely to be explained by local health priorities and immediate health risks. Notable gaps between stakeholder research priorities and research outputs concerned themes that were more focused on social factors and systems and may reflect publication bias or self-publication selection, highlighting the need for further research on prison health services and the social determinants of health. Different jurisdictions, countries, and regions should undertake similar systematic and transparent research priority-setting processes.

Sexually transmissible infections (STI) and HIV testing and diagnosis among Aboriginal and non-Aboriginal adolescents in contact with the Australian justice system: a cross-sectional study.

BACKGROUND: It is unclear what factors are associated with sexually transmissible infections (STI) and HIV testing and diagnosis among justice-involved adolescents, and if these differ for Aboriginal or Torres Strait Islander peoples. METHODS: A cross-sectional survey of 465 justice-involved adolescents (aged 14-17years) from Australia was conducted between 2016 and 2018. Participants were asked about sexual behaviours, STI/HIV knowledge, and prior STI diagnoses and testing. RESULTS: Approximately 38% (n =130) of those sexually active had ever been screened for STI/HIV and 17.8% (n =23) had been diagnosed with an STI. No participant reported living with HIV. For Aboriginal participants, being male (aOR 3.6, 95% CI 1.3-10.1) and having under three sexual partners in the past 12months (aOR 3.1, 95% CI 1.2-8.0) was associated with never having had an STI/HIV test. For non-Aboriginal participants, being male (aOR 2.7, 95%CI 1.2-5.7), single (aOR 2.4, 95% CI 1.2-4.9), attending school (aOR 2.4, 95% CI 1.1-5.1), not having sought sexual health information (aOR 2.8, 95% CI 1.4-5.8), and having a lower STI/HIV knowledge score (aOR 2.3, 95% CI 1.1-5.0) were associated with never having had an STI/HIV test. Factors associated with STI diagnosis were non-heterosexual sexual orientation (aOR 5.6, 95% CI 1.1-28.2), transactional sex (aOR 11.2, 95% CI 3.0-41.3), and having sought sexual health information (aOR 3.5, 95% CI 1.0-12.5). CONCLUSIONS: Males, particularly Aboriginal male adolescents, should be engaged with sexual health promotion and testing services as soon as they come into contact with the justice system. Approaches should consider different cultural, gender and sexual orientations.

Rethinking standards on prison cell size in a (post)pandemic world: a scoping review.

OBJECTIVE: To describe the current international, regional and national standards on prison cell spatial density and the evidence for the association between COVID-19 transmission and prison crowding measures to provide recommendations on prison cell spatial density standards for a (post) pandemic world. DESIGN: Scoping review. DATA SOURCES: PubMed, ProQuest, Informit, Criminal Justice Abstracts, Cochrane, Web of Science, Scopus, EMBASE, Google Scholar and Google were searched up to November 2021. ELIGIBILITY CRITERIA: Guidelines were included provided they described standards of prison accommodation with respect to prison cells. Studies were included provided they examined an association between COVID-19 cases and a crowding measure. DATA EXTRACTION AND SYNTHESIS: Data were extracted by one reviewer and cross-checked by another. Quantitative and qualitative data on prison cell standards and characteristics of studies examining an association between COVID-19 and prison crowding were collected.Findings were synthesised qualitatively. RESULTS: Seventeen reports and six studies met eligibility criteria. International and regional standards on cell spatial density were mostly qualitative, with two quantifiable international standards located (3.4 m2 and 3.5 m2 per person for multiple occupancy cells), and two quantifiable regional standards located (4 m2 per person (Europe) and 5.75 m2 or 4 m2 per person (Australia and New Zealand)). Country-based standards varied substantially, ranging from 1.25 m2 per person (Pakistan) to 10 m2 per person (Netherlands). Consideration of airborne transmission of disease in prisons were mostly overlooked or absent to rationalise standards. There was consistent evidence that prison crowding measures were associated with COVID-19 transmission/cases. CONCLUSION: Considering the physics of respiratory emissions, we recommend prison cell spatial density standards be updated to reflect graded levels of risk that consider other factors that combine to inform airborne transmission risk. Decarceration strategies should be considered and become vital if standards are not met.

Is use of opioid agonist treatment associated with broader primary healthcare use among men with recent injecting drug use histories following release from prison? A prospective cohort study.

BACKGROUND: A precipitous decline in health status among people recently released from prison is common. In Victoria, Australia, opioid agonist treatment (OAT) in the community involves frequent contact with primary care, potentially facilitating broader use of primary healthcare services. Among a cohort of men who injected drugs regularly pre-imprisonment, we estimated differences in rates of primary healthcare use and medication dispensation between people who did and did not receive OAT post-release. METHODS: Data came from the Prison and Transition Health Cohort Study. Three-month post-release follow-up interviews were linked with primary care and medication dispensation records. Generalised linear models were fit with one exposure (OAT: none/partial/complete) for 13 outcomes relating to primary healthcare use, pathology testing, and medication dispensation, adjusted for other covariates. Coefficients were reported as adjusted incidence rate ratios (AIRR). RESULTS: Analyses included 255 participants. Compared to no OAT use, both partial and complete OAT use were associated with increased rates of standard (AIRR: 3.02, 95%CI: 1.88-4.86; AIRR: 3.66, 95%CI: 2.57-5.23), extended (AIRR: 2.56, 95%CI: 1.41-4.67; AIRR: 2.55, 95%CI: 1.60-4.07) and mental health-related (AIRR: 2.71, 95%CI: 1.42-5.20; AIRR: 2.27, 95%CI: 1.33-3.87) general practitioner (GP) consultations, total medication (AIRR: 1.88, 95%CI: 1.19-2.98; AIRR: 2.40, 95%CI: 1.71-3.37), benzodiazepine (AIRR: 4.99, 95%CI: 2.81-8.85; AIRR: 8.30, 95%CI: 5.28-13.04) and gabapentinoid (AIRR: 6.78, 95%CI: 3.34-13.77; AIRR: 4.34, 95%CI: 2.37-7.94) dispensations, respectively. Partial OAT use was also associated with increased after-hours GP consultations (AIRR: 4.61, 95%CI: 2.24-9.48) and complete OAT use? with increased pathology utilisation (e.g. haematological, chemical, microbiological or immunological tissue/sample testing; AIRR: 2.30, 95%CI: 1.52-3.48). CONCLUSION: We observed higher rates of primary healthcare use and medication dispensation among people who reported partial and complete OAT use post-release. Findings suggest that access to OAT post-release may have a collateral benefit in supporting broader health service utilisation, underscoring the importance of retention in OAT after release from prison.

Prospective study of retention in opioid agonist treatment and contact with emergency healthcare following release from prisons in Victoria, Australia.

BACKGROUND: People recently released from prison engage with emergency healthcare at greater rates than the general population. While retention in opioid agonist treatment (OAT) is associated with substantial reductions in the risk of opioid-related mortality postrelease, it is unknown how OAT affects contact with emergency healthcare. In a cohort of men who injected drugs regularly prior to imprisonment, we described rates of contact with ambulance services and EDs, and their associations with use of OAT, in the 3 months after release from prison. METHODS: Self-report data from a prospective observational cohort of men who regularly injected drugs before a period of sentenced imprisonment, recruited between September 2014 and May 2016, were linked to state-wide ambulance and ED records over a 3-month postrelease period in Victoria, Australia. We used generalised linear models to estimate associations between OAT use (none/interrupted/retained) and contact with ambulance and EDs postrelease, adjusted for other covariates. RESULTS: Among 265 participants, we observed 77 ambulance contacts and 123 ED contacts over a median of 98 days of observation (IQR 87-125 days). Participants who were retained in OAT between prison release and scheduled 3-month postrelease follow-up interviews had lower rates of contact with ambulance (adjusted incidence rate ratio (AIRR) 0.33, 95% CI 0.14 to 0.76) and ED (AIRR 0.43, 95% CI 0.22 to 0.83), compared with participants with no OAT use postrelease. Participants with interrupted OAT use did not differ from those with no OAT use in rates of contact with ambulance or ED. CONCLUSION: We found lower rates of contact with emergency healthcare after release among people retained in OAT, but not among people reporting interrupted OAT use, underscoring the benefits of postrelease OAT retention. Strategies to improve accessibility and support OAT retention after leaving prison are important for men who inject drugs.

Discontinuation of opioid agonist treatment following release from prison in a cohort of men who injected drugs prior to imprisonment in Victoria, Australia: A discrete-time survival analysis.

BACKGROUND: Retention in opioid agonist treatment (OAT) following release from prison is associated with improved outcomes, however factors associated with post-release OAT discontinuation in Australia are poorly understood. We examined post-release OAT discontinuation in a cohort of men who engaged in approximately monthly injecting drug use (IDU) prior to imprisonment in Victoria, Australia. METHODS: Longitudinal data were used to calculate incidence of first-event post-release OAT discontinuation among men released from prison receiving OAT, and single-event discrete-time survival methods were used to estimate associations with post-release OAT discontinuation. RESULTS: Among 110 participants, 55 OAT discontinuations were observed in the two years post-release, an overall crude incidence rate (IR) of 46 per 100 person-years (PY) (95 % confidence interval [95 %CI]: 36-60 per 100PY). Incidence was greatest between release from prison and first follow-up (IR: 84 per 100PY, 95 %CI: 62-116 per 100PY). Initiating OAT during index imprisonment (versus transitioning from community OAT; adjusted hazard rate [AHR]: 2.17, 95 %CI: 1.14-4.13) and identifying as Aboriginal and/or Torres Strait Islander (AHR: 4.95, 95 %CI: 2.00-12.25) were associated with an increased hazard of OAT discontinuation. CONCLUSION: In a cohort of men with recent histories of IDU released from prison receiving OAT, half reported OAT discontinuation within two years of release from prison, with incidence of discontinuation greatest soon after prison-release. Targeted support for men who initiate OAT during episodes of imprisonment and Aboriginal and/or Torres Strait Islander peoples is necessary to reduce incidence of OAT discontinuation among people at greatest risk of discontinuation.

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.