DEATHS of recently released prisoners outnumber annual deaths in custody, highlighting the need for enhanced support for ex-prisoners, according to new research in the MJA.

The study estimated that among the approximately 50 000 people released from prison in the 2007-08 financial year, between 449 and 472 died within their first year of release. (1)

Up to one-third of these deaths occurred within the first month of release.

The figures were calculated by applying crude mortality rates, derived from two state-based record-linkage studies, to a national estimate of prison releases.

Dr Stuart Kinner, head of justice health research at Melbourne’s Burnet Institute and a coauthor of the study, said evidence suggested that the two most common causes of death among recently released prisoners were drugs and suicide. The research found between 30% and 45% of the deaths in the first year of release were drug-related.

“We need to increase access to mental health services for people who are in prison and also for those who are transitioning into the community”, Dr Kinner told MJA InSight.

He said decreased drug tolerance among ex-prisoners was a major reason for their high mortality rates. However, he said the study showed there was more to the reasons why ex-prisoners were dying as more than 50% of deaths were not drug-related and at least two-thirds of deaths in the first year occurred after the first month.

“These findings underscore the importance of moving beyond simplistic messages about reduced drug tolerance and overdose risk in the first few weeks of release, to build a more sophisticated, evidence-based approach to reducing mortality”, the researchers wrote.

Dr Kinner said the services currently provided to recently released prisoners were patchy and inconsistent across states, and there was substantial room for improvement.There was also a need for enhanced evaluation of the services provided to ex-prisoners to determine the efficacy of various interventions, he said.

One strategy Dr Kinner said could be effective in reducing fatal drug overdoses among ex-prisoners was improving access to naloxone for peer administration, to reverse the effects of heroin overdose.

“That is something that is happening in other parts of the world”, he said.

Dr Kinner emphasised that the figures in the study were imprecise given the “concerning” lack of data on prisoners and ex-prisoners.

He said there was no routine monitoring of the health and mortality outcomes of ex-prisoners. Data on the number of people serving time in prison each year were not collected either, apart from a snapshot of prisoners at 30 June each year.

The researchers said that although considerable attention had been directed to monitoring deaths in custody since the 1991 Royal Commission into Aboriginal Deaths in Custody, little was known about deaths among ex-prisoners. (2)

“There is an urgent need to establish a national system for routine monitoring of ex-prisoner mortality and to continue the duty of care beyond the prison walls for this vulnerable population”, the researchers wrote.

– Sophie McNamara

1. MJA 2011; 195: 64-68
2. Royal Commission into Aboriginal Deaths in Custody 1991

Posted 18 July 2011

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