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Pre-sentence mental health service use predicts post-sentence mortality in a population cohort of first-time adult offenders

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Abstract

Purpose

With the high risk of death associated with mental disorders and their increased prevalence in offenders, it is judicious to investigate the risk of post-sentence mortality with respect to offenders’ psychiatric treatment history.

Methods

Using linked administrative data for a whole-population retrospective cohort of first-time adult offenders (n = 25,537) sentenced to either prison or non-custodial orders in Western Australia, we determined the risk and baseline predictors of post-sentence mortality.

Results

Of 192 deaths within 2 years of sentence completion, deaths from injury/poisoning (55.6 %), cancer (13.3 %) and cardiovascular disorders (9.7 %) were the most common. Pre-sentence history of mental health service (MHS) contact doubled the risk of post-sentence all-cause and injury/poisoning-related mortality. Physical comorbidity was the strongest predictor of mortality irrespective of pre-sentence MHS contact. Baseline history of attempted self-harm and being an Indigenous male were associated with an elevated risk of death in offenders with a pre-sentence MHS contact. In offenders without a pre-sentence MHS contact, socio-economic disadvantage and incarceration almost doubled the risk of dying from any cause and injury/poisoning.

Conclusions

Mortality risk in the 2 years following sentence completion is associated with pre-sentence health service use and a range of socio-demographic factors for both incarcerated and non-custodial offenders. The opportunity afforded by imprisonment could be exploited by provision of funding to identify and treat mental illness, impart preventive health education addressing modifiable risk factors and provide transitional care to community-based services, all of which may help reduce preventable post-sentence deaths. Diversion to non-custodial sentences is also a plausible option.

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Acknowledgments

This study was supported by a NHMRC grant (No. 403909) and the first author was supported by the UWA-SIRF scholarship. We thank the Data Linkage Branch for linkage and client support services aspects of data provision. We also thank the WA Department of Corrective Services, the custodians of the Inpatient and Mental Health Data Collections of the WA Department of Health and the WA Registry of Births, Deaths and Marriages for the provision of service data.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Centre for Health Services Research, School of Population Health, The University of Western Australia (M431), 35 Stirling Highway, Crawley, WA, 6009, Australia

    Nita Sodhi-Berry & David B. Preen

  2. School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia

    Matthew Knuiman

  3. Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia

    Janine Alan

  4. Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia

    Vera A. Morgan

Authors
  1. Nita Sodhi-Berry
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  2. Matthew Knuiman
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  3. Janine Alan
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  4. Vera A. Morgan
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  5. David B. Preen
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Corresponding author

Correspondence to Nita Sodhi-Berry.

Additional information

The results and discussions of this study are not an expression of the views or policies of the Department of Corrective Services, the Department of Health or the Department of the Attorney General.

Appendix

Appendix

See Table 5.

Table 5 Multifactorial analysis of all potential predictors of post-sentence mortality in all adult offenders (18–64 years) (Hazard Ratios)
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Sodhi-Berry, N., Knuiman, M., Alan, J. et al. Pre-sentence mental health service use predicts post-sentence mortality in a population cohort of first-time adult offenders. Soc Psychiatry Psychiatr Epidemiol 50, 109–124 (2015). https://doi.org/10.1007/s00127-014-0919-8

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