Emergency health service contact and reincarceration after release from prison: A prospective cohort study

Abstract

Background Adults released from prison often have complex health needs. They are at high risk of poor health outcomes and reincarceration, with health service use unlikely to be planned. Aims/hypotheses To determine the incidence of emergency health service (EHS) use, ambulance attendance and/or emergency department presentation, among 1,181 adults released from Australian prisons. We hypothesised that EHS contact would be associated with increased reincarceration risk. Methods Baseline surveys were conducted within 6 weeks before release. Postrelease EHS contacts and reincarceration were identified through prospective data linkage. For each participant, EHS contacts within a 24‐hour period were combined to make an episode. We used Cox proportional hazards regression to examine the relationship between EHS episodes and reincarceration, controlling for covariates. Results More than half (53.3%) of participants had at least one EHS contact over a median of 25.6‐month follow‐up. In adjusted analyses, compared to those with no EHS contacts, the hazard of reincarceration was greater for participants who had one to three EHS episodes (hazard ratio [HR] = 1.84; 95% confidence interval [CI] [1.48, 2.29]) or four or more (HR = 2.35; 95% CI [1.67, 3.29]). Conclusions/implications for practice Emergency department attendance by people with a history of imprisonment may be indicative of wider decompensation. Improved management of such patients may improve health outcomes and have collateral benefits for reducing reincarceration.

Associations Between Supported Accommodation and Health and Re-offending Outcomes: a Retrospective Data Linkage Study

“…quality of life and self-efficacy) [ 19 ]. More frequent emergency health service contact is associated with increased likelihood of reincarceration [ 24 ], and use of these services following release from prison is commonly related to alcohol, other drugs or mental health [ 22 , 23 , 34 ]. The relationship between these health issues and (re)incarceration has previously been demonstrated [ 35 – 38 ], and this increase may be an indication of poor personal well-being or quality of life.…”

“…Linked administrative data enables a low-resource means of measuring the impact of attending supported accommodation on criminal justice and health outcomes included in the co-designed model of care and program logic. Emergency department (ED) presentation after release from prison is commonly due to health problems that are also associated with reincarceration, primarily alcohol and other drug use or mental health issues [ 21 – 23 ], and frequent contact with emergency health services (ED and ambulance attendance) is itself associated with increased likelihood of reincarceration [ 24 ]. Although self-efficacy and quality of life may be better measured using self-report data, health service utilisation may provide proxy or complementary data to inform assessments of service effectiveness.…”

Frequent Attendance to the Emergency Department after Release from Prison: a Prospective Data Linkage Study

“…The composite measure for mental illness, substance use disorder, and dual diagnosis exposure was ascertained from a unique combination of retrospectively linked state-wide hospital, ED, and prison medical records. Our analyses were adjusted for episodes of reincarceration during follow-up, which are more common among frequent ED attenders, 56 using prospectively linked correctional records. Our study also censored for deaths using linked prospective national death records.…”

Prospective study of retention in opioid agonist treatment and contact with emergency healthcare following release from prisons in Victoria, Australia

“…1 Imprisonment disrupts healthcare and exacerbates poor health, social and economic circumstances 1 2 ; contributing to substantially elevated morbidity and mortality after release. 1 International 3 and Australian research [4][5][6][7][8][9] has documented high rates of ED and ambulance contact following release from prison, with substance use, mental illness, accidents, injuries and assaults accounting for most postrelease emergency healthcare contacts. 4 5 8 9 Previous research has sought to understand people at increased risk of postrelease emergency healthcare contact to inform postrelease support.…”