BACKGROUND:Self-harm and suicide are common among prison inmates, but less is known about these phenomena in those with psychosis. OBJECTIVES:The aim of this study was to examine self-harm behaviour in New South Wales (NSW) prisons in Australia among inmates diagnosed with psychosis. This study also examined self-harm-related alerts applied by Corrective Services to assist staff with the management of the security and well-being of inmates. DESIGN AND SETTING:A retrospective case-control data-linkage study was conducted using administrative data collections in NSW, Australia. PARTICIPANTS:The study included all individuals diagnosed with psychosis and incarcerated between 2001 and 2020 in NSW as cases and an age and sex matched control group with no such diagnosis with a record of incarceration in the same time period. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome measure was self-harm among the cases and controls. The secondary outcome measure was the application of alerts by Corrective Services in relation to self-harm incidents. RESULTS:Multivariate regression analysis was used to examine predictors of self-harm in prison. Prisoners with psychosis (n=14 900) were more likely to self-harm than controls (n=2713), with 15.0% versus 3.6% engaging in self-harm (highest odds of self-harm observed in those with schizophrenia and related psychoses, aOR=4.84, 95% CI: 3.93 to 5.98). Those of Aboriginal heritage had an increased risk of self-harm (aOR=1.58, 95% CI: 1.43 to 1.75). Factors associated with a lower risk of self-harm were male sex and older age (≥25 years) at the time of their first incarceration. 35.6% of those released from prison with a prior psychosis diagnosis had at least one alert applied during incarceration compared with 10.1% of prisoners without a diagnosis of psychosis. Overall, 35 individuals with psychosis and 1 individual from the control group died while in prison between 2001 and 2020. 17 prison suicides were recorded from the study population; all occurred in the psychosis group. CONCLUSIONS:Given the heightened risk of self-harm in those with histories of psychosis, consideration should be given to sharing mental health information between agencies to improve the care and management of this group during incarceration. Prison alerts may be a useful tool to help staff manage inmates' well-being if used appropriately.

Background:Biological studies suggest serotonin modulation via selective serotonin reuptake inhibitors (SSRIs) might reduce impulsive violence, however, robust evidence in offender populations is limited. We aimed to determine whether sertraline reduces violent reoffending compared with placebo in highly impulsive men with recurrent violent offending. Methods:We conducted a double-blind, placebo-controlled, randomised clinical trial in community settings in New South Wales, Australia. Eligible participants were men aged 18 years or older with ≥2 prior violent convictions and a Barratt Impulsiveness Scale score ≥70. Following a 4-week single-blind active run-in phase with sertraline, participants were randomly assigned (1:1, minimization stratified by key factors) to receive oral sertraline (100 mg daily) or matching placebo for 12 months. The primary outcome was the first convicted violent offence within 12 months, assessed via linkage to the state Reoffending Database. The primary analysis followed the intention-to-treat principle. The trial is registered with ANZCTR (ACTRN12613000442707) and is closed to new participants. Findings:Between October 28, 2013, and July 13, 2021, 630 eligible men were randomly assigned: 319 to sertraline and 311 to placebo. By 12 months, only 204 participants remained engaged with the study. All participants were included in the primary analysis. A primary outcome event (violent offence within 12 months) occurred in 72 (22.6%) of 319 participants assigned sertraline and 70 (22.5%) of 311 assigned placebo (Relative Risk 1.00, 95% CI 0.75-1.34; p = 0.99). Serious adverse events occurred in 22 (6.9%) participants receiving sertraline and 29 (9.3%) receiving placebo. Interpretation:Sertraline did not significantly reduce the risk of violent reoffending compared with placebo. Post-hoc analyses suggested a possible selective effect on domestic violence offending. Funding:Initial funding for the ReINVEST trial was provided from an Australian National Health and Medical Research Council partnership grant No. 533559. From 2018, subsequent funding was provided by the NSW Department of Communities and Justice.

This report responds to an urgent need to enhance the management of violence among individuals with psychosis in Australia. It reviews treatment pathways, emphasising community-based care over incarceration. The Mental Health Review Tribunals (MHRTs) play a vital role in treatment oversight for those with psychosis in Australia and worldwide who are at risk of violence, with community treatment orders (CTOs) identified as effective harm prevention strategies. An exploratory study analysed data from 141,302 individuals diagnosed with psychosis in New South Wales from 2001 to 2021, revealing that 26.8 percent had MHRT contact due to violence risk, with 14.2 percent placed on CTOs. Marginalised groups were notably under-represented in MHRT interactions. Findings show higher health service use and offending behaviour among those in contact with the MHRT, highlighting the need for focused research on CTO effectiveness and equitable service access. The report advocates for a multidisciplinary approach between health and justice sectors to improve outcomes for this population.

Importance People living with psychosis experience excess premature mortality and are overrepresented in criminal legal systems, but little is known about mortality associated with criminal sanctions or diversion in this population. Objective To examine associations of different types of recent (past 2 years) criminal sanction, including court diversion, with mortality among people with psychosis. Design, Setting, and Participants This population-based, retrospective, data-linkage cohort study was conducted using 6 routinely collected administrative data collections from New South Wales, Australia, relating to health, court proceedings, imprisonment, and mortality. Participants (adults aged >= 18 years hospitalized for psychotic disorders) entered observation at the time of discharge from their first psychosis-related hospital admission (or their 18th birthday if aged <18 years) between July 2001 and November 2017 and were followed-up until May 2019. Data were analyzed between February 2023 and April 2024. Exposures Recent (past 2 years) criminal sanction type, a time-varying variable with 5 categories: no recent criminal sanction, recent mental health court diversion, recent community sanction, current imprisonment, and recent prior imprisonment (ie, recent prison release). Main Outcomes and Measures Causes of death were described, and age- and sex-specific mortality rates by recent criminal sanction type were calculated. In those younger than 65 years, Cox regression was used to examine associations of all-cause and external-cause mortality with recent criminal sanction type, adjusting for sociodemographic, health-related, and offense-related confounders. Results The cohort included 83 071 persons (35 791 female [43.1%]; 21 208 aged 25-34 years [25.5%]; median [IQR] follow-up, 9.5 [4.8-14.2] years), of whom 25 824 (31.1%) received a criminal sanction. There were 11 355 deaths. In those aged younger than 65 years, recent mental health court diversion, community sanctions, and prior imprisonment were associated with increased hazards of all-cause and external-cause mortality compared with no recent sanction, with the largest adjusted hazard ratios (aHRs) observed for recent prior imprisonment (all-cause mortality: aHR, 1.69; 95% CI, 1.50-1.91; external-cause mortality: aHR, 2.64; 95% CI, 2.27-3.06). Conclusions and Relevance In this cohort study of people with psychosis, recent criminal sanctions were associated with increased mortality irrespective of sanction type. These findings suggest that future research should develop strategies to improve health and safety in people with psychosis who have criminal legal system contact.

Background and setting Domestic and family violence (DFV) is a significant societal problem that predominantly affects women and children. One behaviour that has been linked to DFV perpetration is coercive control. While various definitions have been proposed, it involves “acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten a victim” ranging from emotional to social and financial abuse. One potentially rich source of information on coercive control are police reports. In this paper we determine whether it is possible to automatically identify behaviours linked to coercive control from DFV police reports and present the prevalence of such behaviours by age and sex. Methods We modified an existing rule-based text mining method to identify 48 coercive control related behaviours from 406,196 DFV reports involving a single person of interest (POI) (i.e., an individual suspected or charged with a DFV offence) against a single victim from NSW Police Force records between 2009 and 2020. Results 223,778 (54.6%) DFV events had at least one identifiable coercive control behaviour with the most common behaviour being verbal abuse (38.9%) followed by property damage (30.0%). Financial (3.2%) and social abuse (0.4%) were the least common behaviours linked to coercive control. No major differences were found in the proportion of DFV events between male and female POIs or victims. The oldest POI group (≥ 65 years) had the largest proportion for behaviours related to verbal abuse (38.0%) while the youngest POI group reported the highest proportion of DFV involving property damage (45.5%). The youngest victim group (< 18 years old) had the highest proportion of DFV events involving verbal abuse (37.3%) while victims between 18 and 24 years old reported the most harassment through phone calls and text messages (3.1% and 2.4% respectively); double that of those in the oldest (≥ 65 years) victim group (1.4% and 0.7% respectively). Conclusions Police data capture a wide variety of behaviours linked to coercive control, offering insights across the age spectrum and sex. Text mining can be used to retrieve such information. However, social and financial abuse were not commonly recorded emphasising the need to improve police training to encourage inquiring about such behaviours when attending DFV events.

Background:Olfactory deficits have a diverse etiology and can be detected with simple olfactory tests. Key olfactory pathways are located within the frontal and temporal lobes where they are vulnerable to damage due to head trauma. Orbitofrontal cortex (OFC) integrity is important for olfaction and aspects of behavioral regulation. We measured olfactory identification ability in a sample of impulsive violent offenders to determine its associations with history of traumatic brain injury (TBI) and a range of neuropsychiatric indices, including proxies for cognitive ability, impulsivity and social connectedness.Methods:Male participants were drawn from the ReINVEST study, a randomized controlled trial of sertraline to reduce recidivism in violent impulsive offenders. Criteria for participation in the study included a minimum age of 18 years, a documented history of two or more violent offenses, and a score of 70 or above on the Barratt Impulsiveness Scale (BIS-11). The 16-item "Sniffin sticks" (SS) odor identification test (OI) was administered as were standardized questionnaires regarding previous TBI, additional measures to screen cognition [word reading test of the Wechsler Individuals Achievement Test (WIAT), social connectedness (the Duke Social Support Scale), and a range of other neuropsychiatric conditions or symptoms]. The sample SS scores were compared against published age-specific norms. Univariate and multivariate analyses were performed with SS score (linear regression, within those without hyposmia) or hyposmia (logistic regression) as the outcome.Results:The mean OI scores were lower than population norms and 16% of participants were classified as hyposmic. Univariate analyses showed associations of SS score with age, WIAT score, impulsivity, TBI and TBI severity, social connectedness, childhood sexual abuse, suicidality and current use of heroin. In multivariate analyses, age, TBI severity and WIAT remained as significant independent predictors of SS score (within the normosmic range) or hyposmia (logistic regression).Conclusion:Olfactory performance was associated with multiple behavioral phenomena in a pattern that would be consistent with this serving as a proxy for orbitofrontal functioning. As such, OI testing may have utility in further studies of offenders. In future, we will examine whether olfactory score predicts recidivism or response to the administration of sertraline, in terms of reducing recidivism.

Objective: While psychosis is considered a risk factor for offending, little is reported about mental health service utilisation in offenders with psychosis and its relationship with reoffending. We examined the association between contact with mental health services and reoffending in those diagnosed with psychosis. Methods: We linked health and offending records in New South Wales (Australia) and identified all individuals with a diagnosis of psychosis and a subsequent offence resulting in a non-custodial sentence between 2001 and 2012. We examined the incidence and risk factors for reoffending, and time to reoffending between 2001 and 2015 using Cox regression and Kaplan-Meier survival methods. We specifically examined the association between clinical contact with community mental health services following the index offence and reoffending. Results: Of the 7393 offenders with psychosis, 70% had clinical contact and 49% reoffended. There was a linear relationship between an increased number of clinical contacts and reduced risk of reoffending: those with no clinical contact had more than a fivefold risk of reoffending compared to those with the highest number of contacts (adjusted hazard ratio = 5.78, 95% confidence interval = [5.04, 6.62]). Offenders with substance-related psychosis and those convicted of non-violent offences had fewer clinical contacts and higher rates of reoffending when compared with controls (adjusted hazard ratio = 1.29, 95% confidence interval = [1.13, 1.47] and adjusted hazard ratio = 1.26, 95% confidence interval = [1.18, 1.35], respectively). Conclusion: This study supports an association between more frequent mental health service use and reduced risk of reoffending. Efforts to enhance mental health service utilisation in those with psychosis who are at a higher risk of reoffending should be promoted.

Background An association exists between psychosis and criminal offending, which evidence suggests can be reduced by effective mental health care for this vulnerable population. However mental health services often lose contact with people after diagnosis. The association between the first episode of psychosis and criminal offending highlights the need for effective mental health care for this vulnerable population. Aims To investigate the association between the first diagnosis of psychosis (FDP) in prison or hospital and subsequent mental health service contact following release from prison or discharge from hospital. Materials and methods Individuals with a FDP either in prison (n = 492) or hospital setting (n = 24,910) between July 2006 and December 2011 in NSW (Australia), were followed post-release or discharge until their first mental health service contact in the community, the occurrence of an offence, death, or completion of the study period at the end of December 2012. Cox regression models were used to examine the predictors for the mental health service contacts following release or discharge. Results Over 70% of those with a FDP in prison or hospital had a psychosis-related or any community-based mental health service contact following release or discharge between July 2006 and December 2012. Those with a FDP in prison were more likely to have no contact with mental health services than those in hospital with no prior offence record (hazard ratio, HR = 3.14, 95% CI: 2.66–3.72 and adjusted hazard ratio, aHR = 3.05, 95% CI: 2.56–3.63) within a median follow-up time of 25 days for the prison group and 26 days for hospital group. Males, individuals of Aboriginal heritage and individuals diagnosed with substance-related psychoses compared to those with schizophrenia and related psychoses were less likely to have a mental health service contact following release or discharge in both the univariable and multivariable analysis. Conclusion This study suggests that prior offending or a previous prison episode represents a barrier to mental health service contact in the community for those with a FDP. Effective rehabilitation planning while exiting prison and discharge planning from hospital are essential to the successful reintegration of these individuals with a FDP.

IntroductionConsiderable evidence supports an association between poor impulse control (impulsivity) and violent crime. Furthermore, impulsivity and aggression has been associated with reduced levels of serotonergic activity in the brain. Selective serotonin reuptake inhibitors (SSRIs) are a class of anti­depressants that aim to regulate brain serotonin concentrations. Several small studies in psychiatric populations have administered SSRIs to impulsive­–aggressive individuals, resulting in reduced impulsivity, anger, aggression and depression. However, no clinical trial has been undertaken in a criminal justice population. This protocol describes the design and implementation of the first systematic study of the potential benefits of SSRIs in impulsive­­–violent offenders who are at high risk of reoffending.Methods and analysisA randomised, double-blinded, multicentre trial to test the clinical efficacy of an SSRI, sertraline hydrochloride, compared with placebo on recidivism and behavioural measures (including impulsivity, anger, aggression, depression and self-reported offending) over 12 months. 460 participants with histories of violence and screening positive for impulsivity are recruited at several local courts and correctional service offices in New South Wales, Australia.Ethics and disseminationResults will be submitted for publication in a peer-reviewed journal. Possible implications of the effectiveness of this pharmacological intervention include economic benefits of reducing prison costs and societal benefits of improving safety. This study has received ethical approval from the University of New South Wales, Aboriginal Health & Medical Research Council, Corrective Services NSW and the NSW Justice Health and Forensic Mental Health Network.Trial registration numberACTRN12613000442707.

This population-based case-control study examines the association between psychosis and criminal convictions in New South Wales (NSW), Australia, using data from several health and offending administrative data collections. Cases were individuals diagnosed with psychosis between 2001 and 2012 (n= 86,461). For each case, two age- and sex-matched controls with no diagnosis of psychosis were selected. Criminal convictions were identified using the NSW Reoffending Database. Cases were approximately 5 times more likely to offend compared with controls, adjusted odds ratio (aOR) = 4.68, 95% confidence interval (CI) = [4.55, 4.81], and accounted for 10% of all criminal convictions in NSW between 2001 and 2015. The prevalence of at least one criminal conviction was 30% among cases compared with 6% among controls. The results from this study confirm previous work regarding the association between psychosis and criminal convictions. More work is needed to better articulate the mechanisms for this association to enable prevention strategies to be developed.

Individuals with psychosis are over-represented in the criminal justice system and, as a group, are at elevated risk of re-offending. Recent studies have observed an association between increased contacts with mental health services and reduced re-offending, as well as reduced risk of re-offending in those who are ordered to mental health treatment rather than punitive sanctions. In furthering this work, this study examines the effect of disengagement from mental health treatment on probability of re-offence in offenders with psychosis over time. Data linkage was conducted with judicial, health and mortality datasets from New South Wales, Australia (2001–2015). The study population included 4960 offenders with psychosis who received non-custodial sentences and engaged with community-based mental health treatment. Risk factors for leaving treatment and/or reconviction were examined using multivariate cox regression. Further, a multi-state model was used to observe the probabilities associated with individuals moving between three states: conviction, disengagement from mental health treatment and subsequent re-conviction. A threefold increase was observed in the risk of re-offending for those who disengaged from treatment compared to those who did not (aHR = 2.76, 95% CI 1.65–4.62, p < 0.001). The median time until re-offence was 195 days, with the majority (67%) being convicted within one year of leaving treatment. A higher risk of leaving treatment was found for those born outside of Australia, with substance-related psychosis, and a history of violent offence. The findings argue for an emphasis on continued engagement with mental health services following release for offenders with psychosis and identify subgroups within this population for whom concentrated efforts regarding treatment retention should be targeted.

Importance:Psychosis is a known risk factor for offending behavior, but little is known about the association between clinical contact with mental health services after an offense and reoffending.Objective:To examine the association between early contact with mental health services and reoffending after an index offense in individuals with psychosis.Design, Setting, and Participants:In this cohort study, individuals diagnosed with psychosis before their index offense from July 1, 2001, to December 31, 2012, and who received a noncustodial sentence were identified by linking health and offending databases in New South Wales, Australia. The incidence of and risk factors for reoffending and time to reoffending within 2 years from the index offense were examined using Cox proportional hazards regression and Kaplan-Meier survival estimates. Specifically, the association between contact with mental health services within 30 days after an offense and reoffending was examined. Data were analyzed from July 1, 2019, to March 5, 2020.Exposures:Hospital admission, emergency department presentation, and contact with community mental health services associated with psychosis.Main Outcomes and Measures:Reoffending within 2 years of the index offense was compared in individuals with and without clinical contact with mental health services within 30 days after an offense, with adjustment for potential confounders.Results:Of the 7030 offenders with psychosis (4933 male [70.2%]; median age at the index offense, 34 [interquartile range, 26-42] years), 2605 (37.1%) had clinical contact with mental health services within 30 days after the index offense. The risk of reoffending was significantly lower in those with vs without clinical contact (adjusted hazard ratio [AHR], 0.83; 95% CI, 0.76-0.91). The risk of reoffending was 30% less in male offenders with 5 or more clinical contacts compared with male offenders with no clinical contact (AHR, 0.71; 95% CI, 0.59-0.84). Reoffending in both male and female offenders was associated with younger age (eg, AHR for male offenders aged <18 years, 3.31 [95% CI, 2.39-4.59]; AHR for female offenders aged <18 years, 2.60 [95% CI, 1.69-3.99]) and offending history (eg, AHR for male offenders with ≥4 prior offenses, 2.28 [95% CI, 1.98-2.64]; AHR for female offenders with ≥4 prior offenses, 2.22 [95% CI, 1.67-2.96]).Conclusions and Relevance:In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group. More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.

BackgroundWith significant numbers of individuals in the criminal justice system having mental health problems, court-based diversion programmes and liaison services have been established to address this problem.AimsTo examine the effectiveness of the New South Wales (Australia) court diversion programme in reducing re-offending among those diagnosed with psychosis by comparing the treatment order group with a comparison group who received a punitive sanction.MethodThose with psychoses were identified from New South Wales Ministry of Health records between 2001 and 2012 and linked to offending records. Cox regression models were used to identify factors associated with re-offending.ResultsA total of 7743 individuals were identified as diagnosed with a psychotic disorder prior to their court finalisation date for their first principal offence. Overall, 26% of the cohort received a treatment order and 74% received a punitive sanction. The re-offending rate in the treatment order group was 12% lower than the punitive sanction group. ‘Acts intended to cause injury’ was the most common type of the first principal offence for the treatment order group compared with the punitive sanction group (48% v. 27%). Drug-related offences were more likely to be punished with a punitive sanction than a treatment order (12% v. 2%).ConclusionsAmong those with a serious mental illness (i.e. psychosis), receiving a treatment order by the court rather than a punitive sanction was associated with reduced risk for subsequent offending. We further examined actual mental health treatment received and found that receiving no treatment following the first offence was associated with an increased risk of re-offending and, so, highlighting the importance of treatment for those with serious mental illness in the criminal justice system.

Background Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed. Aims Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison. Method This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006–2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison. Results Of the 38 489 diagnosed with psychosis for the first time, 1.7% ( n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79–2.89), Aboriginality (OR = 1.81, 95% CI 1.49–2.19), older age (OR = 1.70, 95% CI 1.37–2.11 for 25–34 years and OR = 1.63, 95% CI 1.29–2.06 for 35–44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42–5.69). Eight out of ten were diagnosed within 3 months of reception. Conclusions Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release. Declaration of interest None.

Objective: From time to time misconceptions about violence risk assessment raise debate about the role mental health professionals play in managing aggression, with associated concerns about the utility of violence risk assessment. This paper will address some of the misconceptions about risk assessment in those with serious mental illness. Methods: The authors have expertise as clinicians and researchers in the field and based on their accumulated knowledge and discussion they have reviewed the literature to form their opinions. Results: This paper reflects the authors’ views. Conclusion: There is a modest yet statistical and clinically significant association between certain types of mental illness and violence. Debate about the appropriateness of clinician involvement in violence risk assessment is sometimes based on a misunderstanding about the central issues and the degree to which this problem can be effectively managed. The central purpose of risk assessment is the prevention rather than the prediction of violence. Violence risk assessment is a process of identifying patients who are at greater risk of violence in order to facilitate the timing and prioritisation of preventative interventions. Clinicians should base these risk assessments on empirical knowledge and consideration of case-specific factors to inform appropriate management interventions to reduce the identified risk.

The present study aimed to consider the HCR-20 risk profiles of forensic and civil (i.e. general psychiatric) patients referred to forensic mental health services (FMHS), in the state of New South Wales (NSW), Australia. It was hoped that by better understanding patient risk, based on HCR-20 ratings, more could be understood about the differing needs of the two patient groups.Data gathered from comprehensive assessments undertaken by trained clinicians across two service settings, a medium secure forensic facility and the NSW Community Forensic Mental Health Service (CFMHS) was utilised. Data from 129 forensic patients and 105 civil patients were included. T-tests indicated significant differences between means of civil and forensic patients on the HCR-20 and odds ratios (ORs) indicated civil patients referred to FMHS were approximately six times more likely to fall into the high-risk category on the HCR-20 (i.e. score 25 or >) than forensic patients.The nature and level of risk evident between forensic and civil patients referred to FMHS in NSW highlighted two issues: (1) The differing risk/need inherent in two patient groups accessing FMHS; and (2) The level of risk observed in civil patients referred to FMHS and therein the challenges faced by generalist mental health services in managing this patient group. The need for generalist mental health services to be better supported and the need for structured, evidence-based risk management practice to be extended to civil psychiatric patient care was indicated.

INTRODUCTION AND AIMSEstimate the prevalence of co-occurring substance use disorder and mental illness in a sample of Australian prisoners, and describe patterns of co-occurring substance use disorder and mental illness.DESIGN AND METHODSThe sample comprised 1478 individuals (1208 men, 270 women) from two surveys of prisoners' mental health: the 2001 New South Wales Inmate Health Survey, and a consecutive sample of prison receptions. Individuals were drawn from all of the state's 29 prisons. Mental health and substance use disorders were assessed using the Composite International Diagnostic Interview.RESULTSThe overall prevalence of any mental disorder was 42.7% and the prevalence of any substance use disorder was 55.3%. With the exception of alcohol use disorder, women had higher rates than men of mental illness and substance use disorders. The prevalence of a co-occurring mental illness and substance use disorder in the past 12 months was 29% (46% among women vs. 25% among men). The association between cannabis use disorder and psychosis was significant for men only [odds ratio (OR)=2.4]. Among women there was a significant association between affective disorder and co-occurring alcohol use disorder (OR=2.4), and stimulant use disorder (OR=2.4).DISCUSSION AND CONCLUSIONThe results highlight the high prevalence of co-occurring substance use and mental illness among prisoners. These results indicate that mental health services in prisons need to be adequately resourced to address co-occurring mental health and substance use problems, and these services need to be appropriately structured to effectively screen, manage and treat this group.