Identifying predictors and patterns of illness in the period after release from prison

Informing pre-release planning and intervention

Indigenous people make up three per cent of Australia’s population and yet 28 per cent of prisoners are Indigenous.

Prisoners experience entrenched social disadvantage and chronical poor health, including mental illness, drug dependence and infectious disease at higher rates than their community peers.

Healthcare services in prison are under-resourced to assist with these issues and the exclusion of prisoners from Medicare and the Pharmaceutical Benefits Scheme (PBS) compounds this disadvantage.

Upon release, many prisoners quickly return to pre-incarceration patterns of behaviour and associated ill health, with an increased risk of drug overdose, suicide and other unnatural causes of death.

Despite this, little is known about the health-related experiences of ex-prisoners, and yet this information is needed to develop evidence-based interventions.

We aim to change this by using a combination of face-to-face surveys and discussions, and a detailed review of medical records and health information, to identify the key health needs of this highly marginalised group.

We are collaborating with the University of Melbourne and the University of Queensland to carry out this research.

The study involves the collection of cross-sectional survey and longitudinal administrative data from 2700 ex-prisoners in Western Australia and Queensland which hold 44 per cent of Australia’s Indigenous prisoners.

Our results will identify the health areas that need to be improved as ex-prisoners transition from prison to the community.

Once complete, it will be the most comprehensive cohort study of health outcomes for ex-prisoners ever undertaken, anywhere in the world. More than 50,000 adults pass through Australia’s prisons each year with the ex-prisoner population estimated at over 385,000.

In 2011, we received nearly $1.5 million in funding from the National Health and Medical Research Council to conduct this project.

Project goals

This study will:

  • compare the health-related experiences of Indigenous and non-Indigenous ex-prisoners in WA and QLD
  • identify barriers to, and facilitators of, access to appropriate community-based health care for Indigenous and non-Indigenous ex-prisoners
  • explore the health consequences of prisoner exclusion from Medicare and the PBS
  • identify relationships between healthcare use and physical and mental illness, death and re-offending behaviour among Indigenous and non-Indigenous ex-prisoners
  • explore the impact of mental illness on physical health, health service use and offending outcomes among Indigenous and non-Indigenous ex-prisoners

Project team leader: Research Fellow Craig Cumming

PhD opportunities

Successful PhD applicants will have access to a broad range of baseline survey and longitudinal administrative health and justice data.

Data relating to socio-economic, physical and mental health circumstances of participants has been collected and will be used to measure pre-existing health and socio-economic conditions.

The administrative data record of prospective health and justice outcomes occurring after release from prison will also be examined.

A number of validated measures are incorporated into the baseline survey, so PhD students will have the opportunity to investigate the validity of these measures in a prison setting, as well as patterns of illness after release from prison.

PhD eligibility criteria specific to this project:

  • Quantitative research skills with a sound understanding of biostatistics is essential
  • Sound knowledge of epidemiology and epidemiological study designs is essential
  • Experience working with administrative linked data is an advantage



Prospective PhD students are invited to read the below to access background research and knowledge on this project:

  • Kinner SA, Lennox N, Williams GM, Carroll M, Quinn B, Boyle FM, et al. Randomised controlled trial of a service brokerage intervention for ex-prisoners in Australia. Contemporary Clinical Trials. 2013;36(1):198-206.
  • Kinner SA, Jenkinson R, Gouillou M, Milloy MJ. High-risk drug-use practices among a large sample of Australian prisoners. Drug and Alcohol Dependence. 2012;126(1):156-60.
  • Dias S, Ware RS, Kinner SA, Lennox NG. Co-occurring mental disorder and intellectual disability in a large sample of Australian prisoners. Australian and New Zealand Journal of Psychiatry. 2013;47(10):938-44.
  • Thomas EG, Spittal MJ, Taxman FS, Kinner SA. Health-related factors predict return to custody in a large cohort of ex-prisoners: new approaches to predicting re-incarceration. Health & Justice. 2015;3(1):1-13.
  • Young JT, Arnold-Reed D, Preen D, Bulsara M, Lennox N, Kinner SA. Early Primary Care Physician Contact and Health Service Utilisation in a Large Sample of Recently Released Ex-prisoners in Australia: Prospective Cohort Study. BMJ Open. 2015;5(6).

Contact Research Fellow Craig Cumming