Understanding healthcare utilisation for aboriginal people in New South Wales prisons with histories of self-harm and suicidal behaviour: a retrospective cohort study.

backgroundPeople in prison are at increased risk of suicide. Aboriginal people are overrepresented in Australian prisons, and their self-harm/suicide risk may be complicated by experiences of trauma, colonisation, loss of land and culture, and social injustices. This study aims to investigate mental health morbidities and in-prison service utilisation of Aboriginal people with histories of self-harm and/or suicidality.

methodsHistorical cohort study utilising Justice Health and Forensic Mental Health Network routinely collected data, including records of Aboriginal people entering NSW public prisons from 2015 to mid-2024. Records included Reception Screening Assessments (RSA), Patient Administration System appointments and alerts, and patient transfers to external hospitals. Descriptive statistics were produced for people's characteristics, appointments, type of professional/clinician seen, alerts, and hospital transfers. Multivariable logistic regression was used to investigate the association between self-harm and/or suicidal behaviour (SHSB) reported at reception and mental health appointments.

resultsThe study includes 42,161 RSAs for 15,583 Aboriginal people. A history of SHSB was reported in 10,253 RSAs. Of the study population, 2152 people reported having ever attempted self-harm/suicide at one reception without disclosing this information in a later reception. Depression and anxiety were the most prevalent mental health conditions reported by people with a history of SHSB. Of all appointments booked within four weeks of reception for people reporting SHSB, only 447 appointments (0.3%) were with an Aboriginal Health Worker. People who reported SHSB were 37% more likely to have a mental health appointment booked within four weeks of reception compared to people who did not report SHSB. Of mental health appointments booked within four weeks, 51.2% involved individuals under Risk Intervention Team management, with 59.0% following RSAs where SHSB was reported. There were 452 hospital transfers due to self-harm or suspected suicide attempts, with 20.1% occurring within four weeks of reception.

conclusionSelf-reporting self-harm/suicide at reception, on its own, is an unreliable predictor of future risk. Better identification of people with SHSB histories could support delivery of safer care for Aboriginal people. Establishing a therapeutic environment and offering comprehensive, culturally sensitive healthcare can help lower the risk of self-harm and suicide among people in prison.