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The purpose of this commentary is to draw upon available literature and practices related to COVID-19 and management of older incarcerated adults in Australia to highlight key matters for better risk management and care of this population during this and future infectious disease pan/epidemics.

The present commentary draws on current policies, practices and literature regarding the health, needs and management of older incarcerated adults in Australia to discuss risk, care and early release for this population during the COVID-19 pandemic.

Incarcerated persons experience poorer health and accelerated age-related decline compared to those in the general community. The present situation offers the opportunity to fill knowledge and practice gaps, including policies for staff training, identification of dementia and cognitive decline, assessment of mobility issues, addressing barriers to health-seeking, possibilities of medical or compassionate release, risk assessment and release protocols and post-release needs.

While Australian prisons have acknowledged the vulnerability of older persons, more focused adaptation of COVID-19-related policies to consider adults as young as 45 years are needed. Appropriate ethical identification and management of cases in this population is needed, as is discussion on issues of decarceration and medical release. Re-conceptualisation of incarcerated adults as “citizens in need of care”, rather than as “offenders to be secured”, will be beneficial. Robust, local evidence is needed to assist decision-making.

This is a comprehensive, focused review of relevant evidence, policies and practices for a growing subpopulation of prisoners worldwide with complex needs and particular vulnerability to the COVID-19.

Given that prisoners have significant health needs across most areas, the paucity of prisoner health research, and the difficulties involved in the conduct of research in this setting, there is a need to develop research priorities that align with key stakeholder groups. One such group are those responsible for health service provision in prisons – prison health service directors. The paper aims to discuss these issues.

Prison health service directors in each Australian state and territory were invited to participate in a national (deliberative) roundtable where the consensus building nominal group technique was utilized. This involved the identification of research priorities and organizational issues in conducting research with prisoners, and ranking research priorities. A thematic analysis was conducted on organizational issues.

In total, 13 participants attended the roundtable. Participants identified 28 research priorities and 12 organizational issues. Top ranked research priorities were mental health, cognitive and intellectual disability, post-release health maintenance, ageing prisoners, chronic health conditions and Aboriginal and Torres Strait Islander health. Themes identified from the organizational issues included prisoner access to research participation, health and research literacy of custodial staff, and institutional protectionism in response to research that may discover negative information about the custodial setting.

These findings should inform future efforts to improve research infrastructures to undertake research to improve the health of people in Australian prisons, and help to align researchers’ efforts with those of a key organizational stakeholder.

This is the first paper to determine the research priorities and organizational issues in conducting research in prisons of prison health service directors.

When properly designed and implemented, prison-to-community transition programs targeting older prisoners could potentially save resources, reduce reoffending rates and contribute to improved public protection and safety. However, older prisoners transitioning to community are often neglected and overlooked, and thus, interventions targeted to address their needs are limited. The purpose of this study was to identify barriers and enablers to health and social services for older prisoners transitioning to community.

A qualitative study was conducted using focus group discussions with corrections officers, community corrections officers and parole officers (n = 32) in four correctional centres, two community corrections offices (CCOs) and one parole unit in New South Wales (NSW) in 2019. The authors used thematic analysis to analyse the findings.

The study identified three main themes relating to barriers and enablers: organisational, social and economic and individual and family and seven sub-themes: planning the transition, communication, assisting prisoners, transition programs, officers’ knowledge and scope of work, social and economic issues and offenders’ conditions

The processes required to ensure effective prison-to-community transition of older prisoners are not well-developed suggesting the need for more systemic and organised mechanisms. Implications of the barriers and enablers for policy, research and practice are discussed.

This study identified a composite of barriers and enablers to health and social services for older prisoners in NSW prisons and CCOs.

The rise in the incarceration of Aboriginal and Torres Strait Islander mothers is a major public health issue with multiple sequelae for Aboriginal children and the cohesiveness of Aboriginal communities. The purpose of this paper is to review the available literature relating to Australian Aboriginal women prisoners’ experiences of being a mother.

The literature search covered bibliographic databases from criminology, sociology and anthropology, and Australian history. The authors review the literature on: traditional and contemporary Aboriginal mothering roles, values and practices; historical accounts of the impacts of white settlement of Australia and subsequent Aboriginal affairs policies and practices; and women’s and mothers’ experiences of imprisonment.

The review found that the cultural experiences of mothering are unique to Aboriginal mothers and contrasted to non-Aboriginal concepts. The ways that incarceration of Aboriginal mothers disrupts child rearing practices within the cultural kinship system are identified.

Aboriginal women have unique circumstances relevant to the concept of motherhood that need to be understood to develop culturally relevant policy and programs. The burden of disease and cycle of incarceration within Aboriginal families can be addressed by improving health outcomes for incarcerated Aboriginal mothers and female carers.

To the authors’ knowledge, this is the first literature review on Australian Aboriginal women prisoners’ experiences of being a mother.

The purpose of this study is to describe what a sample of men in prison believe works well for the delivery of prison-based group alcohol and other drug (AoD) treatment programs. The authors hope the findings will help inform future practise in AoD program delivery in prison.

A qualitative research paper reporting on a thematic analysis of in-depth interviews with 30 male prisoners on their perspectives on AoD group treatment approaches.

Results indicate that matching readiness and motivation to start treatment is important for group success. Program content must be relevant and delivered by empathic facilitators who maintain confidentiality. It would be advantageous if one of the program facilitators was a peer with personal experience of overcoming an AoD use disorder.

According to the authors’ knowledge, this is one of few qualitative studies into the delivery of AoD treatment for men in prison and the only study of its kind in Australia. The consumer perspective is an important element in improving quality of treatment provision.

The Australian prisoner population has experienced a dramatic increase in the number of older inmates over the past decade, consistent with the greying of the prisoner population that is being observed worldwide. Reviews suggest the need for further evidence and practice outside of the USA. This paper aims to review and discuss the cost and social implications of the rising health-care needs of this population in Australia.

A review of international research and policies is presented, as well as the results of basic economic modelling relating to the expected rise in health-care costs of the ageing prisoner population in Australia.

Taking into consideration the continued rise in incarceration rates, the calculations show that the health costs of prisoners could increase by anywhere between 17% and 90% depending on whether the increase of older prisoners continues as it has in the past decade. These trends are likely to continue over the next decade and will result in higher health costs of prisons under a number of different imprisonment scenarios. Policy responses in Australia have been slow so far, with most initiatives being undertaken in the USA with promising results.

The authors suggest that in the absence of a coordinated policy response, covering a range of interventions, costs will continue to increase, particularly as this population continues to age more rapidly than the general population due to an accumulation of risk factors. Well-conceived interventions would be a worthwhile investment from both financial and social perspectives.

To the best of the authors’ knowledge, this is the first commentary to acknowledge this rising public health issue and to both review and model its implications for the future.

Our objective was to compare the physical health status of adult prisoners with and without a mental illness. Mental illness was diagnosed in a sample of 557 Australian prisoners using the Composite International Diagnostic Interview (CIDI). Physical health measures included self‐reported chronic health conditions, recent health complaints and symptoms, self‐assessed health using the Short‐Form 36 Health Survey (SF‐36), and markers of infectious diseases known to be highly prevalent among prisoner populations (hepatitis A, hepatitis B, and hepatitis C). Men and women with a mental illness had lower scores on the SF‐36 compared with those without a mental illness indicating poor overall health. Adjusting for age and sex, a diagnosis of any mental illness (symptoms of psychosis, anxiety or affective disorder) was positively associated with a history of head injury, back problems, asthma, peptic ulcers, cancer, and epilepsy/seizures. There was a significant association between post traumatic stress disorder and asthma, a history of head injury, peptic ulcers, and cancer. There was no significant difference in the proportion of current tobacco smokers in the mentally ill and nonmentally ill groups (81% vs. 77%, p = 0.33). However, those with a mental illness were less likely than those with no diagnosis to exercise in the past 4 weeks (79% vs. 89%, p = 0.002). Mentally ill prisoners also have significant physical co‐morbidity compared with the non‐mentally ill. These findings suggest that those providing mental health services to prisoners should adopt a holistic approach embracing both mental and physical health.

Background: Post‐traumatic stress disorder (PTSD) is over represented in the prisoner population and is predictive of violence and suicide. This raises issues in relation to prisoner management, as well as theoretical issues such as why there is a range of vulnerability for PTSD. The current study examines the relationship between PTSD and personality profiles of prisoners. Method: Data from 1305 participants in the NSW survey of health in prisoners are examined to identify relationships between personality profiles derived from the Temperament and Character Inventory (TCI) and PTSD. Participants are grouped as experiencing no trauma; with a trauma history but no PTSD; and being diagnosed with PTSD. A logistic regression modelled significant predictors of PTSD. These data indicated that women prisoners report PTSD at twice the rate of males. An increased risk for PTSD is associated with high Harm Avoidance, low Self‐Directedness, high Persistence and high Self‐Transcendence. Conclusions: A combination of both temperament and character traits influences the trajectory towards PTSD development. Targeted treatment of these traits is needed in addressing the problems of prisoners with PTSD and managing the associated risks of violence and suicide.

Between July and November 2001, a health survey of New South Wales (NSW) inmates was conducted by NSW Justice Health. A cross‐sectional random sample of inmates stratified by age, gender and Aboriginality (Aboriginal people are over‐represented in the NSW inmate population) that included approximately 10% of the male and 34% of the female inmate population participated in the study (n = 914). Of those invited to participate, 83% of males and 84% of females consented. One element of the study was the use of the Hayes Ability Screening Index. Inmates identified to be at risk for intellectual disability on the screening tool were referred to a psychologist who administered the Wechsler Adult Intelligence Scale Revised (n = 167). This paper discusses the implications of the results in terms of full scale IQ, in which 3% of men and 12.5% of women of those identified as being at risk on the screening index were identified as having an intellectual disability, and the overall cognitive profile of those tested. The implications for health education and therapy in prisons are considered.

The poor health of prisoners was highlighted in the results of two comprehensive health surveys conducted with prisoners in New South Wales (NSW), Australia. The capacity of a dedicated service to address the health needs of prisoners was tested through analysis of the health of two prisoner cohorts: a continuously serving cohort, and a cohort of prisoners who had been incarcerated and released during the period of interest, 1996‐2001. It appears that mental health services best addressed the needs of a stable prisoner population. Short‐stay prisoners do not gain any degree of benefit. Primary health and drug and alcohol services address the needs of prisoners less effectively, irrespective of their duration of stay. Women’s health was very poor on all measures that were assessed. With the exception of mental illness, the health inequalities that prisoners experience are not addressed by existing prisoner health services. This may be due to the magnitude of the burden of ill health among prisoners, or due to inadequate resources ‐ or some combination of both. While these results should not be taken as supportive of coercive institutionalisation (i.e. imprisonment) as a therapeutic option, there may be benefit in more humane and compassionate institutions for some of society’s most vulnerable individuals. The results highlight the potential for prisoner health service providers in redressing years of health neglect and the low levels of service utilisation by this group while in the communi