At June 2009, there were 29,317 prisoners in Australia, 93% of which were men . Indigenous prisoners made up 25% of the total prisoner population (Table 1). Indigenous people were 14 times more likely than non-Indigenous people to be imprisoned.
|Sex||Indigenous status||All people|
|Source: ABS, 2009 |
Different states and territories had different rates of imprisonment, ranging from 471 prisoners per 100,000 population for Tas to 3,329 per 100,000 for WA (Table 2) .
|Indigenous status||Rate ratio||Total population|
|Source: ABS, 2009 |
Between 2008 and 2009, the total number of prisoners increased by 6%, and the number of Indigenous prisoners increased by 10% . The offender population is even larger if those in the wider criminal justice system are counted (including people under arrest and held in lock-ups; appearing before the courts; periodic detainees; juvenile offenders not in detention; and those serving community orders). For example, in 2008-09 an average of 56,972 offenders per day were serving community corrections orders .
Before the arrival of the First Fleet in 1788, Indigenous people had their own laws and customs. After the arrival, Indigenous people became part of the British Empire and subject to the control of a foreign legal system that was not well understood and was different than their traditional laws . As European settlement spread across the country, Indigenous people were affected by the legal system in many ways including:
Indigenous people have continued to be over-represented in prisons. For example, in WA in 1949, Indigenous people made up 9% of the male and 12% of the female prisoner populations . In 2007, Indigenous people made up 43% of the prison population but made up only 4% of the general population in Australia .
In the 1970s and 1980s, when public drunkenness became decriminalised (it was no longer a criminal offence) , the rate of imprisonment was reduced. As recommended by the Royal Commission into Aboriginal Deaths in Custody (RCIADC), sobering-up centres were established across Australia and the number of people imprisoned for public drunkenness declined.
The factors contributing to the poor health of Indigenous people should be seen within the broader context of the 'social determinants of health' . The social determinants of health is a term used to talk about factors that affect people's lives, and that also affect people's health. These determinants include: income, education, employment, stress, social networks and support, social exclusion, working and living conditions, and gender. Related to these are cultural factors, including: traditions, attitudes, beliefs, and customs. Together, these social and cultural factors have a major influence on a person's behaviour.
Determinants that have been shown to impact on Indigenous offending behaviour include:
There is debate about whether racism plays a role in the number of Indigenous people sentenced to prison instead of diverted into other options, like drug and alcohol treatment programs. The most recent evidence indicates that there is no difference between the sentences given to Indigenous and non-Indigenous people, but that high imprisonment rates for Indigenous people are due to high rates of violent offences and re-offending . There has been some evidence, however, that Indigenous young offenders may be less likely to receive diversionary (non-court related) outcomes than non-Indigenous young offenders . Since being in prison as a young person is strongly related to being in prison as an adult, it is important to consider the impact that this might have on later overrepresentation of Indigenous adults in the correctional system .
Many Australian prisons are full or over-full, and overcrowding makes it harder to maintain a safe and healthy environment for prisoners . One result of overcrowding is the frequent movement of prisoners between facilities, making it hard to maintain consistent physical and mental health interventions. In many cases this also makes it very difficult for family members to visit prisoners. In overcrowded prisons, there is a greater risk of transmission of airborne and respiratory infections, which can be a danger to pregnant women and people who are HIV positive .
The RCIADC was established in October 1987 as a result of growing public concern about a large number of Indigenous people who died in custody during the 1980s . The RCIADIC investigated each death individually and also investigated the 'larger social and economic factors which might help explain Aboriginal deaths in custody' (, p.2). The RCIADC's final report, completed in April 1991, contained 339 recommendations . Positive outcomes from the inquiry include:
The RCIADC found that the rate of deaths in custody for Indigenous people was no higher than for non-Indigenous people. Indigenous Australians were not more likely to die in custody than non-Indigenous Australians, but Indigenous people were significantly overrepresented in custody. The problem was 'too many Aboriginal people are in custody too often' (, p.1).
Of the 74 deaths that occurred in custody in 2007 (45 in prison custody, 29 in police custody and custody-related operations), nine (12%) were Indigenous (five in prison custody, and four in police custody and custody-related operations). In the 27 year period from 1980 to 2007 there were 1,206 deaths in prison, 745 in police custody and custody-related operations, and 17 deaths in juvenile detention centres. Indigenous people accounted for almost one-fifth (19%) of these deaths. Since the RCIADC, Indigenous people have continued to be overrepresented in custody in all Australian states and territories .
The health of offenders is worse than that of the general population. Two recent health surveys give a good picture of the health of Indigenous prisoners. The 2009 NSW inmate health survey, in which 966 inmates were asked to answer questions about their health, reported:
The best national picture of offender heath is The health of Australia's prisoners 2009 . The data in this report is mostly from the National prisoner health census which collected information from 549 prison entrants, over 3,700 prisoners in custody who visited a clinic, and over 4,900 prisoners who were taking prescribed medication . Of the prison entrants, 141 (26%) were Indigenous. This report showed :
These two major studies collected information on the general prison population not specifically the Indigenous prison population, however, a recent study of prisoners in NSW found there were not many differences between Indigenous and non-Indigenous prisoners in self-reported chronic health conditions .
Mental health is one of the most important issues in offender health. People with mental illness are often incarcerated rather than treated, mostly because of the lack of appropriate mental health and other services . Prisoners have much higher rates of mental health conditions than the general population, with some conditions five times as common among prisoners . This difference is often greater for female prisoners than for male prisoners. The difference between prisoners and the general population is greatest in the area of substance use disorders . The following general facts are known about the mental health of offenders:
There is very little information known specifically about the mental health of Indigenous prisoners. The largest survey was carried out in NSW prisons and included 277 Indigenous prisoners as part of a total sample of 1,470 prisoners . This study found no difference in the mental health of Indigenous and non-Indigenous male prisoners, except for depression which was higher among non-Indigenous than among Indigenous male prisoners. Indigenous female prisoners, however, had higher levels of psychosis and psychological distress than non-Indigenous female prisoners.
Mental health issues often occur with, and because of, substance use issues. This is a problem for Indigenous offenders. Substance use and mental illness have been linked to the high level of Indigenous offending, particularly violent offending . This contributes to high levels of imprisonment for Indigenous offenders, with violent offenders often not eligible for diversion programs. There needs to be further development of Indigenous specific programs which provide both treatment for substance use and treatment for mental illness.
Substance use is a large issue in offender health. It has been reported that people who have been in prison are more than five times as likely to have a substance use disorder as people who had never been in prison . Evidence exists that substance misuse is responsible for a large proportion of offending behaviour, with some studies estimating that over half of prisoners have had a substance use disorder . Drug use monitoring in Australia: 2007 annual report on drug use among police detainees reported that more than two-thirds (68%) of Indigenous adults who were tested while detained by the police had positive results for a range of drugs . Almost two-thirds (64%) of people arrested across Australia said they had consumed alcohol in the 48 hours prior to their arrest. Australia-wide, women prisoners were more likely than men to test positive to any drug. There is a large overlap of harmful drinking and testing positive to illicit drugs; two-thirds (65%) of people who self-reported that they drink at a harmful level also tested positive to one or more other drug. In this survey the authors concluded that drinking played a bigger role in the offending behaviour of Indigenous people than non-Indigenous people.
The 2007 national prison entrants bloodborne virus survey reported that of the 749 entrants surveyed :
There is a well-established link between alcohol and offending behaviour. The prisoner population is often characterised by high rates of risky drinking . The health of Australia's prisoners 2009 found that two-thirds (65%) of Indigenous entrants and almost half (47%) of non-Indigenous entrants reported drinking alcohol at harmful levels in the previous 12 months. Tobacco smoking was also very common among offenders, with around seven-out-of-ten Indigenous entrants (72%) and non-Indigenous (74%) entrants being daily smokers.
High-risk behaviours for blood-borne virus (BBV) transmission, such as injecting drug use, tattooing, physical violence, body piercing and unprotected sex, are more common in prisons than in the wider community . Estimates suggest that between 7,500 and 10,000 prisoners in 2005 had hepatitis C (HCV) .
The 2007 national prison entrants' bloodborne virus survey included all jurisdictions (except the NT) and covered 18 reception centres across Australia . This survey reported that:
The national rates of both hepatitis B and HCV for the total population is less than 1% . Transmission of HCV in prison has been documented but few prisoners receive treatment for this virus . Allowing HCV-positive prisoners access to treatment is necessary to reduce the risk of infection for other inmates, and for the wider community after their release .
There are a number of key issues relating to the sexual health of prisoners, including :
Prisoners are a high-risk group for sexual ill-health . Offenders often engage in a range of risk-taking behaviours for STIs before and after entering prison, including substance abuse, alcohol consumption, tobacco smoking, and being involved in acts of violence . Prisoners generally come from the most disadvantaged groups in the community, which are recognised as having poor sexual health . Prisoners have been shown to have very low rates of contraception use prior to entering prison . High rates of STIs (such as syphilis, HIV, hepatitis B, and herpes simplex virus type-2) have been reported in the prisoner population . Often testing procedures are not properly put in place within prisons and the true level of STIs and BBVs are not known. Thorough assessment and referral for treatment on admission to a prison is an important strategy for improving health care for all offenders.
Sexual assault is common among prisoners and has negative short and long term effects, including increasing mental illness and drug misuse. The most comprehensive source of information on sexual assault is the 2006-2007 NSW prisoner telephone sex survey. Inmates were asked whether they were afraid of or had experienced sexual violence while in prison . The inmates reported :
According to the June 2009 prison census, there were 2,125 female prisoners in Australia (Table 1) . The imprisonment rate for females was much less than the rate for males: 25 female prisoners per 100,000 female adults, compared with 329 prisoners per 100,000 male adults. But imprisonment rates in the last decade have increased more for women than for men: between 1999 and 2009 the imprisonment rate for females increased by 57% compared with an increase of 35% for males. The following general facts are known about Indigenous females in prison:
Female prison entrants differed from male prison entrants in the following health areas in The health of Australia's prisoners 2009 :
Only about 5% of young Australians are Indigenous, but 54% of young people in juvenile detention are Indigenous . During 2007-08, WA had the highest Indigenous youth detention rate in Australia at 880 per 100,000 persons aged 10-17 years, followed by NSW (585 per 100,000), and SA (442 per 100,000). On an average day in 2007-08, 40% of juveniles under supervision (for example, on a community supervision order) were Indigenous, as were over one-half of those in detention and 60% of those who were in remand yet to be sentenced . Indigenous offenders are more likely than non-Indigenous offenders to begin regularly committing serious offences at younger ages and this makes them more likely to have a history of juvenile detention and further incarceration as an adult .
Indigenous juvenile offenders have been shown to:
Being in prison separates a person from their home and community and often breaks the bonds between that person and wider society. Offenders re-entering the community need on-going care and support to help them readjust to being part of wider society, especially in areas such as employment and housing. Often the programs offered to offenders do not provide the through-care needed to help them make this transition which can lead to negative health outcomes, with factors such as homelessness and ongoing drug misuse being strongly associated with re-offending and returning to prison .
A study of the risk of death after release from prisons in WA found Indigenous prisoners have a significantly higher rate of death than did non-Indigenous prisoners . In this study:
Contact with the criminal justice system presents an opportunity to identify and treat the physical and mental health problems of a group that is economically and socially disadvantaged. But prison health services still largely operate without a rehabilitative focus, and the rehabilitation that is offered is often under-funded and poorly designed . The health services offered often fail to account for the specific needs of Indigenous offenders, despite the large proportion of Indigenous offenders within the criminal justice system. There is a clear need to embrace more diversionary measures when dealing with Indigenous offenders. Diversion for young offenders into programs that help build their skills and resilience, and prevent them entering a cycle of re-offending, is the best way to reduce the hugely over-representative Indigenous incarceration rate in Australia.