School of Population Health

Mental health tops the list of priorities for people in prison

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New research published in Lancet Public Health outlines the health research priorities of people in prison according to people in prison themselves, with mental health ranked the most pressing. 

Other top priorities identified were access to healthcare services, alcohol and other drug use, education and infectious diseases and infections. 

Authors from UNSW School of Population Health conducted the study due to a lack of consultation with people in prison regarding research about them, despite community consultation being routine practice in designing and conducting health and medical research in the general population. 

Lead author, Dr Paul Simpson from UNSW School of Population Health, says that if efforts towards research priority setting are to address inequalities in health, then such efforts must incorporate the views of those most impacted, including people in prison. 

“Our study begins to address the substantial gap in involving people in prison in decisions about research to instill a sense of citizenship in a place where citizenship is denied,” says Dr Simpson.

“This is the first study to conduct citizens’ juries in the prison setting to garner the views of incarcerated people, showing that it is feasible to allow the voices of people in prison to be heard regarding research,” he said. 

A citizens' jury approach requires a group of participants to act as citizens on behalf of a community, not as individuals concerned only for themselves, and assumes that the group of people can collectively evaluate, discuss, and arrive at their own conclusions and priorities that represent a wider community. The approach has been used on a range of policy issues in health care, public health, the environment, and research priority setting.

All six citizens’ juries from six prisons in the study ranked mental health as the most important research priority, which according to the authors is likely due to a combination of factors - the poor mental health of people entering prison and under-resourced mental health care services in prison. 

“Incarcerated populations are more socially disadvantaged and have higher rates of mental health problems and alcohol and other drug use than other populations, and access to and staffing of prison mental health services in Australia are far from community equivalent,” says Dr Simpson. 

“More investment in mental health research and prison-based mental health care is urgently required and compared to other disease areas, is relatively underfunded,” he says. 

“More broadly, there is a critical lack of evidence globally on how prison health services are structured or funded, or the methods and processes by which they are held accountable.”  

To-date there has been little consideration in academic and policy fields on whether established health research priorities, including those determined for incarcerated populations, are just and relevant.

According to co-author of the study, Professor Tony Butler and lead of the Justice Health Research Program at UNSW School of Population Health, the study illustrates the feasibility of engaging incarcerated people in research priority setting and should be used to guide studies undertaken by researchers to advance just and relevant priority setting. 

“Whilst it was not easy to get clearance to run this study, it was a thoroughly worthwhile undertaking that we hope can lead to future studies that address the issues the target group see as being of most importance to them,” says Professor Butler.

The researchers are now assessing the current research landscape against the research priorities identified by citizens in prison so these can be advocated for and investment in these health areas by funders and governments can be justified.

In a commentary about the new research published in Lancet Public Health, the authors reinforce the critical role of community engagement in research, in particular the citizens' jury approach used by Simpson and colleagues, to address systematic marginalisation of vulnerable populations such as people in prison.

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UNSW School of Population Health