Healthcare is a major issue for people in custody in Australia. People in prison have substantially more complex physical and mental health care needs than the general population, and have significantly higher rates of both diagnosed and undiagnosed conditions. Despite their higher health needs, people in prison have significantly less access to healthcare in custody compared to the general Australian population. There are no national standards for healthcare in Australian prisons. Prisoners in all jurisdictions, however, are prevented from accessing the Medicare universal health care system or the Pharmaceutical Benefits Scheme (PBS), which contributes to the lack of healthcare in custody as many prisons are unable to afford certain services and medications without Medicare or PBS rebates. Other issues inhibiting healthcare provision in custody include limited access to the National Disability Insurance Scheme, no access to needle and syringe programs, being reliant on prison officers to make medical appointments, and issues with record keeping.
Health services There are no national standards for healthcare in Australian prisons. There are eight prison systems in Australia, one for each internal state and territory. No jurisdiction provides access to the Medicare universal health care system. In the absence of Medicare, each jurisdiction in Australia provides healthcare in custody differently through a variety of models, including services being provided by the public sector, outsourced to private providers, or through public-private partnerships. While prisoners do receive free healthcare, the range of services and medications are significantly lower than those available to the general community. Growth in prison populations around Australia are not matched with an equivalent growth in prison health resources or budgets. Medical issues in prisons were the most common category of complaint made to the Ombudsmen in New South Wales (NSW) during 2022–2023. Similarly, in Victoria in 2021–2022, the Ombudsmen received more complaints about Corrections Victoria than any other government department, with health services being the most frequent issue complained about within prisons.
Physical health Prisoners on average are less healthy and have higher rates of chronic illnesses, infectious diseases, acquired brain injuries and drug use than the general community. People entering prison typically come from extremely disadvantaged backgrounds, and may have under-utilised health care prior to entering custody, as health was viewed as a lower priority than issues including housing, employment, caring obligations or drug addiction. For example, 43% of people entering prison were homeless, making prison entrants about 100 times more likely to be homeless than other Australians.
Despite their higher health needs, there is a lower level of health care available in prison than in the general community. However, for people in prison who underuse health services prior to their incarceration, prison can provide an opportunity to obtain treatment and improve health; 26% of people released from prison report being diagnosed with a previously unknown health condition while in custody. Among people being released from prison, approximately 53% reported their health improved in custody, 22% said it stayed the same and 25% said it deteriorated. While many surveyed people in prison rate the health care they receive as better than what they received in the community, these raw statistics do not take into consideration the lack of healthcare access many people had before entering prison. Most chronic health conditions are more prevalent in prison entrants than the general community, though some conditions more associated with older people, such as arthritis and osteoporosis, are much less common in custody. This is attributed to the average age in prison being much lower than the general population. Communicable diseases are more prevalent, partly due to the higher levels of at-risk behaviours associated with people entering the prison system, such as drug use and unsafe sex. While only 18% of Australians have a disability, 39% of prisoners have one. Hearing loss affects approximately 90% of Indigenous Australians in custody. Nine out of ten people incarcerated in Australia require dental treatment. Furthermore, 6% of the general Australian community between the age of 15 and 64 required dental extraction, whereas 28% of prison inmates between the age of 15 and 64 required an extraction. Some prisons do not offer dental services at all. While prisoners report positive interactions with some health professionals in prison, such as optometrists, reports about dental professionals are often negative, with complaints that dentists focus on extracting teeth, rather than doing fillings, and do not provide preventative services. Prisoners report that access to dental services is a significant concern, and that the typical treatments for toothache in prison, which is being given ibuprofen or paracetamol by nurses, are ineffective. After their release, people wth poor health outcomes from their imprisonment place significant strain on themselves, the public health system, and the general community. Accordingly, improving the health of people in prison benefits the entire population.
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