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Objective: People released from prison who experience mental health and substance use problems are at high risk of reincarceration. This study aimed to examine the association between contact with mental health and substance use treatment services, and reincarceration, among adults released from prison., Methods: Pre-release survey data from 1,115 adults released from prisons in Queensland, Australia were linked with administrative health and correctional records covering a median of 787 days post-release. We constructed marginal structural Cox proportional hazards models, adjusting for pre-release variables and time-varying indicators of emergent mental health and substance use problems, to examine the association between contact with mental health and substance use treatment services, and reincarceration., Results: The adjusted hazard ratio (AHR) for reincarceration associated with mental health service contact was 1.76 (95%CI 1.23,2.51). Among those not on parole following release, the AHR for reincarceration associated with substance use treatment service contact was 3.16 (95%CI 2.09,4.77); we found no evidence for an association among those who were released on parole (AHR = 1.07; 95%CI 0.80,1.43)., Conclusions: Although we cannot eliminate the possibility of residual confounding, our findings suggest that infrequent or unsustained contact with community-based mental health and substance use treatment services is not protective against reincarceration, and may even be iatrogenic. Increased investment in high-quality and timely behavioural health services for people released from prison may simultaneously improve health outcomes, and reduce reincarceration., Competing Interests: The authors have declared that no competing interests exist.

Objective: This paper identifies publicly available data about the use of involuntary treatment orders within Australia and considers whether this reporting is sufficient given the gravity of the intervention., Method: A search of mental health tribunal, health department and justice department annual reports was conducted to determine the use of involuntary treatment orders in Australia., Results: Reporting of involuntary treatment orders varied significantly across jurisdictions; for example, South Australia reported 11,570 distinct orders made during a 12-month period while the Australian Capital Territory reported 627 for the same period., Conclusion: The publicly available data for involuntary treatment orders in Australia is inadequate for jurisdictional comparisons. This concern should be addressed to enable transparent public reporting and facilitate benchmarking.

Background: Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community., Method: The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage., Results: We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours., Conclusions: For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.

Objective: To (a) characterise medication use and knowledge, according to Indigenous status, and (b) identify independent correlates of medication knowledge in a sample of adult prisoners., Methods: Cross-sectional survey of 1,231 adult prisoners in Queensland, interviewed within six weeks of release. Measures included self-reported demographic and health-related characteristics, self-reported use of medications, the Hayes Ability Screening Index (HASI) and the Short-Form Health Survey (SF-36). Objective medication data were abstracted from prison medical records. A medication knowledge score was calculated to reflect the agreement between self-reported and objective medication use., Results: 46% of participants were taking at least one medication. The most common class of medication was Central Nervous System (30% of participants). Medication knowledge was generally poor, with one quarter of prisoners unable to accurately identify any of their medications. Independent correlates of poor medication knowledge included not taking Central Nervous System medications, identifying as Indigenous and age >54., Conclusions and Implications: Around half prisoners are taking medications in prison, but most have poor knowledge of what these medications are. Medication knowledge is associated with better adherence and may contribute to improved health outcomes post-release. Changes to prescribing and dispensing practices in prison may improve medication knowledge and health outcomes in this profoundly marginalised group., (© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.)

Introduction and Aims: The Indigenous Risk Impact Screen (IRIS) is a validated culturally appropriate and widely used tool in the community for assessing substance use and mental disorder. This research aimed to assess the utility of this tool in an Indigenous prison population., Design and Methods: The study used data collected from a cross-sectional study of mental health among Indigenous inmates in Queensland custodial centres (n = 395, 84% male). Participants were administered a modified version of the IRIS and International Classification of Diseases-10 diagnoses of substance use, depressive and anxiety disorders obtained using the Composite International Diagnostic Interview (CIDI). The concurrent validity of the modified IRIS was assessed against those of the CIDI., Results: Three hundred and twelve people screened as high risk for a substance use disorder and 179 were high risk for mental problems. There were 73% of males and 88% of females diagnosed with a mental disorder. The IRIS was an effective screener for substance use disorders, with high sensitivity of 94% and low specificity of 33%. The screener was less effective in identifying depression (sensitivity 82%, specificity 59%) and anxiety (sensitivity 68%, specificity 60%)., Discussion: The IRIS is the first culturally appropriate screening instrument to be validated for the risk of drug and alcohol and mental disorder among Indigenous adults in custody., Conclusions: This study demonstrated that the IRIS is a valid tool for screening of alcohol and drug use risk among an incarcerated Indigenous population. The IRIS could offer an opportunity to improve the identification, treatment and health outcomes for incarcerated Indigenous adults., (© 2013 Australasian Professional Society on Alcohol and other Drugs.)

Objective: To estimate the prevalence of mental disorder in a representative sample of Aboriginal and Torres Strait Islander people in Queensland prisons., Design, Setting and Participants: Cross-sectional assessment of mental health using the Composite International Diagnostic Interview (CIDI) and clinical interviews, conducted by Indigenous mental health clinicians who undertook specific training for this purpose, with support from forensic psychiatrists when indicated. We assessed adults who self-identified as Indigenous and were incarcerated in six of the nine major correctional centres across Queensland (housing 75% of all Indigenous men and 90% of all Indigenous women in Queensland prisons) between May and June 2008., Main Outcome Measures: Diagnoses of anxiety, depressive and substance misuse disorders using the CIDI; diagnosis of psychotic illness determined through psychiatrist interviews supplemented by a diagnostic panel., Results: We interviewed 25% of all Indigenous men (347/1381; mean age, 31.5 years) and 62% of all Indigenous women (72/116; mean age, 29.2 years) incarcerated at the time of our study. The recruitment fraction was 71% for men and 81% for women. Among the 396 individuals who completed both the interview and the CIDI, the 12-month prevalence of mental disorder was 73% among men and 86% among women. This comprised anxiety disorders (men, 20%; women, 51%); depressive disorders (men, 11%; women, 29%); psychotic disorders (men, 8%; women, 23%) and substance misuse disorders (men, 66%; women, 69%)., Conclusions: The prevalence of mental disorder among Indigenous adults in Queensland custody is very high compared with community estimates. There remains an urgent need to develop and resource culturally capable mental health services for Indigenous Australians in custody.

Objectives: To determine the 12-month prevalence of substance-use disorders and psychological morbidity in an Australian arrestee population., Design: Cross-sectional descriptive study., Participants and Setting: 288 police arrestees at the Brisbane City Police Watch House in February and March 2001., Outcome Measures: Prevalence of drug and alcohol disorders; psychological "caseness" according to the 28-item General Health Questionnaire; demographics and index offences., Results: 86% of the arrestees had at least one substance-use disorder; most had multiple disorders. More than 80% were substance dependent. The predominant substances used were amphetamines, marijuana, opioids and alcohol. 82% of the men and 94% of the women were suffering significant psychological distress., Conclusions: Development of services for detoxification and treatment of this population is a pressing need. The findings provide crucial information for the planning and implementation of drug courts and court diversion systems.

The results of haemorrhoidectomy alone and anal dilatation alone for the treatment of 20 patients with second or third degree haemorrhoids were assessed prospectively over a 12-month period. After haemorrhoidectomy the symptoms of bleeding, lump, pruritus and discharge disappeared, and anal continence was maintained. Proctoscopy showed the occasional development of secondary piles high in the anal canal. Of those patients having an anal dilation alone, nearly half had symptoms and one had a mucus leak. Anal continence was unalttered in the remainder. Proctoscopy indicated the loss of anal venous engorgement.