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Goal: This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada. Methods: Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes. Results: Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning

Background and Aims: Poor substance use‐related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post‐release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance‐related hospitalisation post‐release is unestablished. We measured whether screening for moderate/high‐risk substance use on the ASSIST was associated with increased risk of substance‐related hospitalisation. Design: A prospective cohort study. Setting: Prisons in Queensland and Western Australia. Participants: Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. Measurements: Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high‐risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance‐related hospitalisations during follow‐up. We compared rates of substance‐related hospitalisation between those classified as low/no‐risk and moderate/high‐risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. Findings During follow‐up, 158 (6%) participants had cannabis‐related, 178 (7%) had opioid‐related and 266 (10%) had methamphetamine‐related hospitalisation. The hazard rates of substance‐related hospitalisation after prison were significantly higher among those who screened moderate/high‐risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). Conclusions: Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high‐risk substance use appear to have a significantly higher risk of post‐release substance‐related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison. [ABSTRACT FROM AUTHOR]

Little is known outside of the United States about the risk of violence-related death among young people who have had contact with the youth justice system (justice-involved young people). We examined violence-related deaths among justice-involved young people in Queensland, Australia. In this study, youth justice records for 48,647 young people (10–18 years at baseline) who were charged, or experienced a community-based order or youth detention in Queensland, Australia (1993–2014) were probabilistically linked with death, coroner, and adult correctional records (1993–2016). We calculated violence-related crude mortality rates (CMRs) and age- and sex-standardized mortality ratios (SMRs). We constructed a cause-specific Cox regression model to identify predictors of violence-related deaths. Of 1,328 deaths in the cohort, 57 (4%) were from violence. The violence-related CMR was 9.5 per 100,000 person-years (95% confidence interval [95% CI] [7.4, 12.4]) and the SMR was 6.8 [5.3, 8.9]. Young Indigenous people had a greater risk of violence-related death than non-Indigenous people (cause-specific hazard ratio [csHR] 2.5; [1.5, 4.4]). Young people who experienced detention had more than twice the risk of violence-related death than those who were charged only (csHR 2.5; [1.2, 5.3]). We found that justice-involved young people have a risk of dying from violence that far exceeds that of the general population. The rate of violence-related death found in this study is lower than that in U.S.-based studies, which most likely reflects lower population level firearm violence in Australia. In Australia, young Indigenous people and those released from detention appear key groups to target for violence prevention efforts. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods: We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results: In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion: Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission. What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police. [ABSTRACT FROM AUTHOR]

Issues: Despite long‐standing recommendations to integrate mental health care and alcohol and other drug (AOD) treatment, no prior study has synthesised evidence on the impact of physically co‐locating these specialist services on health outcomes. Approach: We searched Medline, PsycINFO, Embase, Web of Science and CINAHL for studies examining health outcomes associated with co‐located outpatient mental health care and AOD specialist treatment for adults with a dual diagnosis of substance use disorder and mental illness. Due to diversity in study designs, patient populations and outcome measures among the included studies, we conducted a narrative synthesis. Risk of bias was assessed using the MASTER scale. Key Findings: Twenty‐eight studies met our inclusion criteria. We found provisional evidence that integrated care that includes co‐located mental health care and AOD specialist treatment is associated with reductions in substance use and related harms and mental health symptom severity, improved quality of life, decreased emergency department presentations/hospital admissions and reduced health system expenditure. Many studies had a relatively high risk of bias and it was not possible to disaggregate the independent effect of physical co‐location from other common aspects of integrated care models such as care coordination and the integration of service processes. Implications: There are few high‐quality, peer‐reviewed studies establishing the impact of co‐located mental health care and AOD specialist treatment on health outcomes. Further research is required to inform policy, guide implementation and optimise practice. Conclusion: Integrated care that includes the co‐location of mental health care and AOD specialist treatment may yield health and economic benefits. [ABSTRACT FROM AUTHOR]

Background and aims: Illicit substance use is common among people entering prisons, as is returning to substance use after release from prison. We aimed to assess the predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for returning to substance use after release from prison. Design: A longitudinal design with baseline survey conducted between 2008 and 2010 in the 6 weeks before expected prison release and up to three follow‐up surveys in the 6 months after release. Setting: Prisons in Queensland, Australia. Participants: A total of 1054 adults within 6 weeks of expected release from prison. Measurements The ASSIST was used to assess problematic use of cannabis, methamphetamine, heroin and other non‐prescribed opioids in the 3 months before incarceration. Post‐incarceration substance use was measured at 1, 3 and 6 months after release. We calculated the area under the receiver operating characteristic curve (AUROC) and the optimal ASSIST cut‐off score for each substance, using Youden's index (J). Findings Forty‐one per cent (n = 434) of the cohort reported any substance use during follow‐up: 33% (n = 344) used cannabis, 20% (n = 209) methamphetamine, 10% (n = 109) heroin and 9% (n = 97) illicit other opioids. The optimal ASSIST cut‐off score was ≥ 4 for heroin, methamphetamine and cannabis and ≥ 1 for other opioids. Using these cut‐offs, the AUROC was highest for heroin in predicting both any use (AUROC = 0.82) and weekly use (AUROC = 0.88) in the past 4 weeks. AUROCs for other drugs ranged from 0.73 to 0.79. Conclusions: The ASSIST shows promise as an accurate and potentially scalable tool that may be useful for predicting a return to substance use after release from prison and could inform service delivery. The substantial rates of returning to substance use after release from prison suggest that prison serves to interrupt rather than cease substance use. [ABSTRACT FROM AUTHOR]

Objectives: Guided by minority stress theory, we explored the association between sexual identity, justice system involvement, self-harm and suicide attempts, among a cohort of incarcerated adults in Australia. Methods: A sample of 2698 adults incarcerated in Queensland and Western Australia were surveyed between 1 August 2008 and 12 August 2016 about their current psychological distress, mental health diagnoses, contact with mental health services, and lifetime and recent self-harm and suicide attempts. We used multivariable logistic regression to explore the relationship between sexual orientation, prior criminal justice system involvement, mental health and demographic factors. Results: Five percent of the sample identified as gay, lesbian or bisexual, with 37% of lesbian, gay, bisexual and other same-sex attracted individuals reporting that they had self-harmed (vs 14% of heterosexual peers; χ2 = 52.4; p < 0.001) and 49% reporting a history of at least one suicide attempt (vs 23%; χ2 = 49.2; p < 0.001). Lesbian, gay, bisexual and other same-sex attracted people were 2.1 times (95% confidence interval: [1.4, 3.3]) and 1.8 times (95% confidence interval: [1.2, 2.8]) more likely to report a history of self-harm and suicide attempt, respectively, than non–lesbian, gay, bisexual and other same-sex attracted respondents. Conclusion: Intersectionality theory suggests that people who are navigating two or more marginalised identities often experience a compounding of internal and external stressors. Consistent with that theory, lesbian, gay, bisexual and other same-sex attracted people who experience incarceration may be at particularly high risk of self-harm and suicidal behaviour. Custodial settings should both improve cultural competency for frontline staff working with lesbian, gay, bisexual and other same-sex attracted individuals and improve access to mental health services during incarceration. [ABSTRACT FROM AUTHOR]

A disproportionate number of mental health presentations to emergency services are made by frequent presenters. No current consensus definition of a frequent presenter exists. Using a statewide population-based ambulance database, this study (i) applied previous statistical methods to determine thresholds for frequent presenters, (ii) explored characteristics of the identified frequent presenter groups compared to non-frequent presenters and (iii) assessed the reliability of these methods in predicting continued frequent presenter status over time.Statistical methods utilised in previous studies to identify frequent presenters were applied to all ambulance attendances for mental health symptoms, self-harm and alcohol and other drug issues between 1 January 2017 and 31 December 2020 in Victoria, Australia. Differences in characteristics between identified frequent and non-frequent presenter groups were determined by logistic regression analysis. The consistency of agreement of frequent presenter status over time was assessed using intraclass correlation coefficients.Thresholds for frequent presenters ranged from a mean of 5 to 39 attendances per calendar year, with groups differing in size, service use and characteristics. Compared to non-frequent presenters, frequent presenters had greater odds of being female, presenting with self-harm, experiencing social disadvantage or housing issues, involving police co-attendance and being transported to hospital. All frequent presenter definitions had poor reliability in predicting ongoing frequent presentations over time.A range of methods can define frequent presenters according to thresholds of yearly service use. Reasons for identifying frequent presenters may influence the method chosen. Future studies should explore definitions that capture the dynamic nature of presentations by this group. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses. Methods: Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive sample of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content. Results: Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care; consumer-focused service; knowledge improvement; early assessment; the development of models, systems and processes; and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified. Conclusions: Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What is known about the topic?: There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses; however, the evidence for appropriate model of care approaches and systems processes is limited. What does this paper add?: For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What are the implications for practitioners?: Planning changes to services for mental health clients with acute problems needs to incorporate clinicians, health service planners, architects and a range of emergency services personnel. [ABSTRACT FROM AUTHOR]

Introduction: Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms. Methods: We used cross-sectional data on 13,697 males aged 18–55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms. Results: Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p < 0.001), suicidal ideation (21.8% vs 9.4%, p < 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p < 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination. Conclusion: Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Introduction: People released from prison have an increased risk of morbidity, including from nonfatal violence. We examined the incidence and predictors of violence‐related morbidity after release from prison and investigated whether there are differences according to sex and Indigenous status. Methods: Baseline data were collected from 1325 people within 6 weeks of release from prisons in Queensland, Australia, between 1 August 2008 and 31 July 2010. Data were linked to state‐wide health (ambulance, emergency department and hospital) and prison records, and national death records until 31 July 2012. Predictors were identified using a multivariable Andersen‐Gill model. Differences according to sex and Indigenous status were investigated using effect modification. Results: A total of 225 (18.2%) people experienced 410 violence‐related events that were recorded in health records. The incidence was 12.8 per 100 person‐years [95% confidence interval (CI) 11.7, 14.1]. Risk factors for violence‐related morbidity included diagnosed mental illness [hazard ratio (HR) = 2.0, 95% CI 1.1, 3.8], substance use disorder (HR = 1.6, 95% CI 1.1, 2.3) or dual diagnosis (HR = 3.2, 95% CI 2.2, 4.8); high‐risk alcohol use (HR = 2.1, 95% CI 1.5, 2.8); being Indigenous (HR = 1.7, 95% CI 1.2, 2.5); and two or more prison releases (HR = 1.7, 95% CI 1.2, 2.6). Indigenous status modified the risk of violence‐related morbidity, with Indigenous men having twice the risk of non‐Indigenous men (HR = 1.9, 95% CI 1.3, 2.8). Discussion and Conclusions: Approximately one in five people released from prisons in Queensland experienced violence‐related morbidity. Coordinated and continuous mental health and substance use treatment from prison to the community may reduce the risk of violence‐related morbidity in this population. [ABSTRACT FROM AUTHOR]

Aims To demonstrate a novel method for presenting and exploring data in systematic reviews of the alcohol literature. Methods Harvest plots are a graphical method for displaying data on the overall pattern of evidence from a systematic review. They can display the direction of effects and risk of bias within studies for multiple outcomes in a single graphical chart. Using data from our previous meta-analysis on the association between personality disorder and alcohol treatment outcome, we extended the application of harvest plots by developing an interactive online harvest plot application. Results Studies included in the review were heterogeneous in design. There were many different primary outcomes, and similar outcomes were often defined differently across studies. The interactive harvest plot allows readers to explore trends in the data across multiple outcomes, including the impact of within-study bias and year of publication. In contrast, meta-analysis on the same data was hampered by a lack of consistency in the way outcomes were measured, and incomplete reporting of effect sizes and their variance. This meant many studies included in the systematic review could not be meta-analysed. Conclusions Interactive harvest plots are a novel graphical method to present data from systematic reviews. They can supplement or even replace meta-analysis when the studies included in a systematic review use heterogeneous designs and measures, as is often the case in the alcohol literature. [ABSTRACT FROM AUTHOR]

Aims: To estimate the treated prevalence of mental illness, substance use disorder (SUD) and dual diagnosis and the association between dual diagnosis and fatal and non‐fatal overdose among residents of British Columbia (BC), Canada. Design A retrospective cohort study using linked health, income assistance, corrections and death records. Setting: British Columbia (BC), Canada. Participants: A total of 921 346 BC residents (455 549 males and 465 797 females) aged 10 years and older. Measurements Hospital and primary‐care administrative data were used to identify a history of mental illness only, SUD only, dual diagnosis or no history of SUD or mental illness (2010–14) and overdoses resulting in medical care (2015–17). We calculated crude incidence rates of non‐fatal and fatal overdose by dual diagnosis history. Andersen–Gill and competing risks regression were used to examine the association between dual diagnosis and non‐fatal and fatal overdose, respectively, adjusting for age, sex, comorbidities, incarceration history, social assistance, history of prescription opioid and benzodiazepine dispensing and region of residence. Findings Of the 921 346 people in the cohort, 176 780 (19.2%), 6147 (0.7%) and 15 269 (1.7%) had a history of mental illness only, SUD only and dual diagnosis, respectively; 4696 (0.5%) people experienced 688 fatal and 6938 non‐fatal overdoses. In multivariable analyses, mental illness only, SUD only and dual diagnosis were associated with increased rate of non‐fatal [hazard ratio (HR) = 1.8, 95% confidence interval (CI) = 1.6–2.1; HR = 9.0, 95% CI = 7.0–11.5, HR = 8.7, 95% CI = 6.9–10.9, respectively] and fatal overdose (HR = 1.6, 95% CI = 1.3–2.0, HR = 4.3, 95% CI = 2.8–6.5, HR = 4.1, 95% CI = 2.8–6.0, respectively) compared with no history. Conclusions: In a large sample of residents of British Columbia (Canada), approximately one in five people had sought care for a substance use disorder or mental illness in the past 5 years. The rate of overdose was elevated in people with a mental illness alone, higher again in people with a substance use disorder alone and highest in people with a dual diagnosis. The adjusted hazard rates were similar for people with substance use disorder only and people with a dual diagnosis. [ABSTRACT FROM AUTHOR]

An editorial is presented on the complex effect COVID-19 pandemic on stimulated innovation in the justice sector globally. It expresses the view that Imprisonment damages family, and economic and social bonds; harms the mental health of children and adolescents; and leads to long-run increases in both crime and morbidity.

Objective: The relationship between psychosis and contact with the criminal justice system for Indigenous people living in rural and remote areas is not well understood. In this study, the authors examine patterns of incarceration among Indigenous people living with psychosis in Cape York and the Torres Strait over two decades. Methods: Data were collated from a clinical database of complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients with a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Corrections Service database. Descriptive statistics were calculated to compare characteristics between those incarcerated and those not incarcerated during the study period and to quantify patterns of incarceration including types of offences, time spent in custody and frequency of incarceration. Multivariate Cox regression analysis was used to assess associations between reported variables and 'first incarceration'. Results: Forty-five percent of Aboriginal patients (n = 116) were incarcerated compared with 31% of Torres Strait Islanders (n = 41) (p = 0.008), and the proportion of males incarcerated (51%, n = 141) was approximately twice that of females (24%, n = 35; p = 0.001). A cluster of first incarcerations were observed in close time proximity to diagnosis of psychosis. Individuals who had a history of both alcohol and cannabis use had approximately two times higher risk of being incarcerated following positive diagnosis compared to those without a history of substance use (hazard ratio = 1.85; 95% confidence interval: [1.08, 3.17]; p = 0.028). Males accounted for approximately 85% (n = 328) of sentences. The most common most serious offence was causing physical harm to others (assault – n = 122, 31%). Conclusion: Our study found that for Aboriginal and Torres Strait Islander people with a psychotic disorder in North Queensland, criminal justice responses with resultant incarceration occurs frequently. Access to appropriate mental health services and diversion options for Indigenous Australians with psychosis should be a key public health and justice priority. [ABSTRACT FROM AUTHOR]

Objective: To determine the care pathway and rate and predictors of mental health care contact within seven days of discharge from acute care following self-harm.Method: In a representative cohort of adults released from prisons in Queensland, Australia, we probabilistically linked person-level, statewide ambulance, emergency department, and hospital records, both prospectively and retrospectively, and community mental health service and Medicare records prospectively, to baseline survey data. We fit multivariate modified log-linked Poisson regression models to examine the association between sociodemographic, health, and criminal justice factors and mental health care contact after self-harm.Results: Of 217 discharges from acute care following self-harm, 55% (n = 119) received mental health care within seven days of discharge. Mental health care contact was associated with substance use disorder (adjusted relative risk (ARR) = 0.48; 95% CI: 0.27-0.85), dual diagnosis (ARR = 0.58; 95% CI: 0.41-0.82), physical health-related functioning (ARR = 0.98; 95% CI: 0.97-0.99), being female (ARR = 1.39; 95% CI: 1.02-1.90), being identified as at risk of self-harm by correctional authorities (ARR = 1.50; 95% CI: 1.07-2.09), and prior engagement with state-funded mental health care (ARR = 1.55; 95% CI: 1.08-2.22).Conclusion: Our findings highlight the need to improve the integration of community mental health care for people who present to acute care following self-harm with a recent history of incarceration, particularly for men and those with substance use disorder or dual diagnosis. [ABSTRACT FROM AUTHOR]

Objective: We aimed to examine whether suicidal thoughts and behaviour were independently associated with a wide range of health and social risk behaviours. Methods: We conducted cross-sectional analyses of data collected from 13,763 adult males who participated in The Australian Longitudinal Study on Male Health. We fit generalised linear models to estimate the relative risk of engaging in a range of health and social risk behaviours across several domains by suicidal thoughts and behaviour status. Results: Men with recent suicidal ideation (relative risk range, 1.10–5.25) and lifetime suicide attempts (relative risk range, 1.10–7.65) had a higher risk of engaging in a broad range of health and social risk behaviours. The associations between suicidal thoughts and behaviour and health and social risk behaviours were typically independent of socio-demographics and in many cases were also independent of depressive symptoms. Conclusion: Suicidal thoughts and behaviour overlaps with increased risk of engagement in a wide range of health and social risk behaviours, indicating the need for an alignment of broader public health interventions within clinical and community-based suicide prevention activities. The experience of suicidality may be an important catalyst for a broader psychosocial conversation and assessment of health and social risk behaviours, some of which may be modifiable. These behaviours may not carry an imminent risk of premature death, such as from suicide, but they carry profound health and social consequences if left unaddressed. [ABSTRACT FROM AUTHOR]

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services. Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries. Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level. [ABSTRACT FROM AUTHOR]