Predictors of post‐sentence mental health service use in a population cohort of first‐time adult offenders in Western Australia

Abstract

Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders.

Pre- and post-sentence mental health service use by a population cohort of older offenders (≥45 years) in Western Australia

“…Of those who did, offenders with psychotic disorders were more likely to use MHSs than those with other disorders. This differential MHS use is similar to observations in the Australian community (49,50) and offenders younger than 45 years (19), and may indicate greater treatment-seeking behaviour, for those with more serious underlying psychopathology (49). It raises concerns regarding the adequacy of current throughcare and/or transitional care practices which link offenders with appropriate community based services (51).…”

“…Exclusively in older offenders without a MHS contact, pre-sentence hospitalisation for physical illness was a strong predictor of post-sentence MHS contact, similar to findings in adult offenders younger than 45 years (19). General population studies have identified higher prevalence of mental disorders (28.0% vs. 17.6%) (52) and a greater likelihood of using MHSs in people with chronic physical illnesses than in those without (53,54).…”

“…Pre-sentence history MHS contacts in the 1-year and 5-year pre-sentence periods were identified through psychiatric diagnoses (ICD-9-CM codes 290-319) during each period, and the latest psychiatric diagnosis established (18,(27)(28)(29). For 1-year pre-sentence MHS use, seven diagnostic categories were created in order of severity (16,18,29,30 (19,29). Both 1-year and 5-year history of attempted self-harm was identified from the hospital external cause of injury codes (E950.0-E959.9, E980.0-E980.6).…”

“…However, although pre-sentence MHS contact prevalence differed by custodial setting, it was not a determinant of postsentence MHS contact in multivariable analyses. This is surprising given that non-custodial offenders would likely have greater post-sentence MHS contacts relative to ex-prisoners due to greater morbidity at sentence commencement, better familiarity, access and absence of incarceration related stigma (19,41). Further, reviews have recognized short-comings in MHS provision by Australian prison health services (42,43).…”

“…To date, only a few whole-population studies have reported offenders to have a greater likelihood of using MHSs before sentencing compared with the wider non-offending community (14)(15)(16)(17)(18). Only two other studies have identified the predictors of MHS use in exoffenders (19,20): one focussing on adult offenders younger than 45 years (19) and the other on substance abuse service use (20). However, no study has targeted older offenders although in 2012 people over 45 years constituted 11% of prison entrants Australia-wide, of whom over two-fifths reported a diagnosed mental illness and almost one-third used psychiatric medicines (21).…”