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.

National Health and Medical Research Council.

Objective: Prisoners are at increased risk for both self-harm and suicide compared with the general population and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for, and characterise emergency department presentations resulting from self-harm in adults after release from prison. Method: Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from selfharm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations. Results: During 3192 person-years of follow-up (median 2.6 years per participant) there were 3755 emergency department presentations. Eighty-three (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% CI 41.2-58.7) and 60.5 (95% CI 44.9-81.6) per 1000 person-years respectively. Presenting due to self-harm was associated with being Indigenous (IRR 2.01; 95% CI 1.11, 3.62), having a lifetime history of a mental disorder (IRR 2.13; 95% CI 1.19-3.82), having previously been hospitalised for psychiatric treatment (IRR 2.68; 95% CI 1.40-5.14) and having previously presented due to self-harm (IRR 3.91; 95% CI 1.85-8.30). Conclusions: Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm. Declarations of interest: None.

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.

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