OBJECTIVE:The aim of this study was to quantify and describe National Health and Medical Research Council (NHMRC) funding for research on the health of justice-involved people (i.e. people who are incarcerated or otherwise under criminal justice supervision). METHODS:We searched the NHMRC funding database for the period 2000-2022 using keywords and names of prominent researchers. Potentially relevant grants were independently reviewed by two authors for inclusion. Information about included grants was independently extracted by the same two authors. RESULTS:Of A$16.4 billion in NHMRC funding over the period 2000-2022, A$38.7 million (0.22%) was for justice health research. Most grants were for research in Australia's most populous eastern states and focused on mental health, substance use and/or infectious disease. Only A$4.5 million (0.03% of the total NHMRC allocation) was for research on the health of justice-involved children and adolescents. CONCLUSIONS:NHMRC funding for justice health research in Australia is out of step with the substantial health and economic burden associated with Australian criminal justice systems. Greater investment in independent, high-quality research in the justice health field has the potential to improve public health, reduce costs and reduce health inequities. More funding for research on non-communicable disease, disability, and the health of justice-involved children and adolescents is required.

BACKGROUND:The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source. METHOD:We used three data sources - self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement. RESULTS:The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0-24.5), 14.8% (95%CI 9.6-18.1), and 44.2% (95%CI 33.2-54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3-11.5), 26.8% (95%CI 18.9-33.5), and 40.9% (95%CI 30.1-48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources' agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses. CONCLUSIONS:Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced.

In many jurisdictions world-wide, the government agency that manages prisons also provides prison health care services. However, the World Health Organization (WHO) and United Nations (UN) have recommended that health ministries provide prison health care. In Canada, the province of British Columbia (BC) transferred responsibility for correctional health services to the health ministry in accordance with this guidance. The objective of this study was to estimate the association between the transfer in BC and all-cause and overdose mortality within 1 year of release from prison. We used a retrospective cohort study design employing the difference-in-differences (DiD) method to compare mortality among formerly-incarcerated people in the pre- and post-transfer periods against a matched community control group to control for province-wide trends in mortality. The data source was a longitudinal linkage of administrative databases. The DiD effect was estimated with survival time-to-event models. In the formerly-incarcerated group (N = 6912), all-cause (3.7

BACKGROUND:The Growth and Empowerment Measure was developed by and for Aboriginal and Torres Strait Islander adults to measure social and emotional well-being and empowerment. This study aimed to co-design and validate a version of the Growth and Empowerment Measure with Aboriginal and Torres Strait Islander young people experiencing youth detention. METHOD:103 Aboriginal and Torres Strait Islander young people experiencing youth detention participated. Participants directed seven adaptations from the Growth and Empowerment Measure for adults to create a Growth and Empowerment Measure-Youth (GEM-Youth). 78 participants completed the GEM-Youth version 7 and 57 participants completed both the full GEM-Youth version 7 and the Kessler psychological distress scale (K10). Cronbach's alpha and inter-item correlations were calculated for two components of the GEM-Youth: how I feel about myself and thinking about my everyday life. Associations between K10 and GEM-Youth scores were quantified using Pearson's correlation. RESULTS:How I feel about myself questions had a mean inter-item correlation of (0.21) and good internal consistency (α = 0.80). Thinking about my everyday life questions had a mean inter-item correlation of 0.18 and internal consistency of α = 0.69. How I feel about myself showed a strong negative correlation (r(55) = -0.61, [95% confidence interval: -0.42, -0.75] p < 0.001) with K10. Thinking about my everyday life showed a moderate negative correlation with K10 (-0.31, [95% confidence interval: -0.05, -0.52] p = 0.02). IMPLICATIONS:The GEM-Youth provides a culturally grounded and validated measure to assess social and emotional well-being and empowerment for Aboriginal and Torres Strait Islander young people in detention settings. This measure has therapeutic and research value that should be further refined and explored. Future research should adapt and validate this tool for use with other groups and settings.

Background Presentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide. Methods This was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months. Findings During the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%-19.3%) at 12-months and 24.3% (95%CI, 23.9%-24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%-0.7%) at 12-months and 1.0% (95%CI, 0.9%-1.1%) at 24-months. Interpretation One in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority. Copyright (c) 2024 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background:People who experience incarceration often have complex healthcare needs and poorer health than the general population. Australia has the eighth-largest custodial population in the Western Pacific. Understanding the breadth and quality of research on this population's health is crucial for advancing health equity both in Australia and across the region. This scoping review synthesised health research involving people in contact with the criminal justice system in Australia. Methods:We searched eight databases for primary, peer-reviewed research reporting on the health of people incarcerated or previously incarcerated in Australian prisons or youth detention settings. Findings:Our search identified 11,731 unique records, and 508 met the inclusion criteria. Over half (51%) were published between 2015 and 2024. Relatively few studies provided evidence on cognitive disabilities (16%), non-communicable diseases (14%), or sexual and reproductive health (6%). Few focused on youth detention (15%) or post-release health (24%). Only 27 studies (5%) focused exclusively on the health of First Nations Australians. Most studies (86%) came from Australia's most populous states-New South Wales, Queensland, and Victoria-which account for 68% of people incarcerated each year, and 58% of incarcerated First Nations peoples. Interpretation:Despite considerable growth in the number of peer-reviewed studies on the health of people who experience incarceration, critical health issues, key populations, and Australian jurisdictions with the highest incarceration rates require urgent attention. Further high-quality research is needed to fill these evidence gaps and translate research into evidence-based strategies that address the complex and diverse health needs of justice-involved people. Funding:SP was supported by a Australian Government Research Training Program Scholarship.

BACKGROUND:Incarcerated individuals experience mental illness (MI), substance use disorders (SUD), and their co-occurrence - dual diagnosis - at higher rates than the general population. By systematically reviewing the literature on dual diagnosis in custody, we aimed to (1) estimate the pooled prevalence of dual diagnosis among adults in custody, and (2) identify the psychosocial, health-related, and criminal justice correlates of dual diagnosis. METHOD:We searched CINAHL, CINCH, Embase, Medline, PsycINFO, and Web of Science for studies investigating dual diagnosis among adults in custody. We also conducted backward citation chaining of a previous systematic review of dual diagnosis in Australian prisons. We used random-effects meta-analysis to generate a pooled prevalence estimate of dual diagnosis and conducted a narrative synthesis of the identified correlates of dual diagnosis in the literature. RESULTS:Twenty-five studies met the inclusion criteria; 20 had sufficient data for meta-analysis. The pooled prevalence estimate of dual diagnosis among adults in custody was 25.3 % [95 %CI: 18.6, 32.7]. Correlates of dual diagnosis included illicit substance use before 15 years old, living with someone who used substances before incarceration, violence victimisation, increased suicide risk, and a lifetime history of multiple convictions. CONCLUSIONS:Our findings suggest that approximately one out of every four adults in custody have a dual diagnosis, highlighting the need for coordinated mental health and alcohol and other drug services for justice-involved individuals. It is crucial that correctional healthcare providers have the capacity and resources necessary to address the complex needs of adults with dual diagnosis in custody.

BACKGROUND:People released from prison have elevated rates of physical and psychiatric morbidity, and emergency department (ED) presentation when compared with the general population. However, little is known about the specific health concerns that are associated with these high rates of ED presentation. The aims of this study were to (a) ascertain the prevalence of multimorbidity (physical multimorbidity and concurrent psychiatric morbidity) in a sample of adults prior to release from prison, and (b) examine the association between physical multimorbidity, psychiatric morbidity, and ED presentations in this sample following release from prison. METHODS:We prospectively linked pre-release survey data collected between 1 August 2008 and 31 July 2010 from a representative cohort of 1325 sentenced adults in Queensland, Australia, to person-level ED, correctional, and death records. We assessed the multimorbidity of participants using the Cumulative Illness Rating Scale. The association between multimorbidity and rate of ED presentations was assessed by fitting a multivariable Andersen-Gill model to identify sociodemographic and criminal justice covariates. A sensitivity analysis was also conducted in which psychiatric morbidity was disaggregated into a 4-level dual diagnosis variable (none, mental illness only, substance use disorder only, dual diagnosis) and was fit separately from the physical multimorbidity measure to ascertain the degree to which these factors predicted ED presentation rates. RESULTS:502 (48.0%) participants had multimorbidity, 265 (25.3%) had physical multimorbidity, and 608 (58.2%) had psychiatric morbidity. After adjustment for model covariates including dual diagnosis status, there was no statistically significant association between physical multimorbidity and ED presentation rate. However, after adjusting for model covariates including physical multimorbidity, participants with a diagnosis of either mental illness (aHR: 1.48; 95%CI: 1.08-2.03) or both mental illness and substance use disorder (aHR: 1.78; 95%CI: 1.33-2.37) had a higher rate of ED presentation than their counterparts without these diagnoses. CONCLUSION:The presence of psychiatric morbidity is associated with an increased rate of ED presentation. Targeted interventions for adults released from prison with psychiatric morbidity are urgently needed.

To describe a cohort of people transferred from prison to psychiatric hospital care and their mortality outcomes. Retrospective nationwide cohort of people (n = 1320) transferred from prison to a psychiatric hospital in New Zealand from 2009 to 2022. Follow up commenced at the first transfer and ended on 30 June 2023 or death if earlier. Ministry of Health records were used to describe the cohort and their service utilization profile. Records were linked to official mortality data, and mortality ratios were calculated using publicly available life tables. The cohort was 85

Provision of healthcare within short-term custody settings such as police watch-houses presents a complex public health challenge. This area has received limited attention in the literature, particularly the viewpoints of paramedics, who are a key link in the chain of healthcare. This study aimed to describe paramedics' decision-making practices and procedures regarding the transport of patients from the watch-house to the emergency department. A qualitative descriptive study was undertaken utilizing semi-structured interviews with paramedics in Queensland, Australia. A full thematic analysis was not completed due to the small sample and limited data sufficiency. However, interview data were grouped into similar categories with the goal of reporting these novel findings. Six paramedics from five metropolitan, regional, and rural/remote regions participated. Interviews were analysed into four main categories: paramedic's role, challenges, enablers, and suggestions. Paramedics described their role as being autonomous with decision-making, especially regarding transport to hospital. Reported challenges revolved around the complexity of the patient, environment, and competing health/security needs. A key issue identified by paramedics was perceived dissatisfaction from police when their assessment resulted in a recommendation to transport the patient to hospital. Enablers included the controlled environment of the watch-house and access to watch-house embedded healthcare providers. Suggestions related to improving structures (e.g. paperwork, education, hours of on-site healthcare providers) and processes (e.g. communication, transport). This study provides a unique perspective on the key role that paramedics have in the delivery of the healthcare to patients in short-term custody and accords with findings from previous studies with emergency doctors.

Objective Preventable deaths (e.g., those resulting from self-harm, interpersonal violence, injury) among 11-39-year-olds are increasing in high-income countries. To date, limitations of available data have been a roadblock to building the evidence needed to inform preventive health and social policy responses. Administrative data usually lack comprehensive information on earlier life circumstances and experiences, while longitudinal population studies (LPS) have typically lacked the sample size needed for meaningful analysis of early deaths. We aim to overcome these data barriers by combining the strengths of administrative and LPS data, with the goal of informing multisectoral efforts targeting childhood and adolescent influences on preventable deaths between ages 11 and 39. Methods The International Mortality in Early adulthood (TIME) Consortium will harmonise data across eleven Australasian LPS involving >59,000 participants. Linkage to national death records will allow us to capture an estimated 1,100 deaths occurring from 11-39 years of age and ICD-10-AM coded causes. This presentation will discuss the value of combining the strengths of administrative and LPS data. It will also highlight the role of the Melbourne Children's LifeCourse Initiative (LifeCourse) in facilitating cross-cohort collaboration through data alignment and access pathways, as well as exploring models of engagement with policy and lived experience representatives. Results TIME’s design brings focus to multisectoral synergistic prevention opportunities earlier in the life course, prior to the peak period of preventable deaths. The data resource generated will be used to 1) estimate the effects of hypothetical interventions earlier in the life course on preventable mortality risk in the full population and for priority groups, and 2) quantify gains in life expectancy and economic productivity. Our knowledge co-creation processes, involving policy and lived experience advisors, facilitate influence on policy and service development. Conclusions The unique combination of rich early life data with sufficient statistical power will make TIME’s data resource distinctive internationally for its capacity to examine a comprehensive suite of child and adolescent influences on preventable mortality in the general population.

Healthcare in Australian custodial settings is hampered by fragmented care, a lack of consistent standards and a lack of accountability. Creating national minimum standards for healthcare in custodial settings, with the aim of equivalence to community standards, will be an important step in reducing health inequalities for some of Australia's most marginalised people.

BACKGROUND:Children and adolescents exposed to the youth justice system have poor health profiles, but little is known about their subsequent mortality. We aimed to examine mortality outcomes in a large, state-wide cohort of young people in Australia who had contact with the youth justice system. METHODS:We linked youth justice records in the state of Queensland, Australia from July 1, 1993, to June 30, 2014, with adult correctional records and the National Death Index, for records up to Jan 31, 2017. We calculated all-cause and cause-specific crude mortality rates per 100 000 person-years, and age-standardised and sex-standardised mortality ratios with 95% CIs. Calculations were performed for the whole cohort and in subgroups defined by sex, Indigenous status, and youth justice history. We used survival analysis to identify demographic and criminal justice factors associated with all-cause mortality. FINDINGS:Of 49 011 individuals in the study sample, 321 were excluded due to data linkage or data quality issues and 20 were excluded as they did not have an age or date of birth recorded, which resulted in 48 670 (99·3%) participants. 11 897 (24·4%) participants were female, 36 773 (75·6%) were male, and 13 250 (27·2%) were Indigenous. During a median of 13·5 years (IQR 8·4-18·4) of follow-up, we observed 1431 (2·9%) deaths among the 48 670 participants. Median age at end of follow-up was 28·6 years (IQR 23·6-33·6). The most common causes of death were suicide (495 [34·6%]), transport accidents (244 [17·1%]), and accidental drug poisoning (209 [14·6%]). The all-cause crude mortality rate was 218·9 deaths (95% CI 207·9-230·6) and the all-cause standard mortality ratio was 4·2 (3·9-4·4). In multivariable analyses, mortality rates were higher for males (adjusted hazard ratio [aHR] 1·5 [95% CI 1·3-1·7]); those who had been subject to community supervision (aHR 1·3 [1·1-1·5]), or detention (aHR 2·1 [1·8-2·4]) versus charge only; and those under adult correctional supervision in the community (aHR 1·9 [1·5-2·4]) versus unsupervised. More than half of the observed deaths occurred before 25 years of age, and very few (1·6%) occurred in custody. INTERPRETATION:Justice-involved young people are at markedly increased risk of premature death from largely preventable causes. Reducing the burden of preventable death among these young people will require coordinated, multi-sectoral responses that extend beyond the criminal justice system. FUNDING:National Health and Medical Research Council, Australia.

The United States (US) Immigration and Customs Enforcement (ICE) detention network is the largest national immigration detention system in the world, detaining almost 38,000 people on any given day.1ICEICE enforcement and removal operations statistics. Department of Homeland Security, 2024https://www.ice.gov/spotlight/statisticsDate accessed: July 7, 2024Google Scholar ICE "detain [s] non-citizens to secure their presence for immigration proceedings, or their removal from the US"1ICEICE enforcement and removal operations statistics. Department of Homeland Security, 2024https://www.ice.gov/spotlight/statisticsDate accessed: July 7, 2024Google Scholar; this includes asylum seekers found to have credible claims for protection, women and children escaping violence, and long-term US residents—with or without legal status—with strong existing ties to the US, among other vulnerable individuals.2HRWSystemic indifference: dangerous & substandard medical care in US immigration detention. Human Rights Watch, 2017https://static1.squarespace.com/static/5a33042eb078691c386e7bce/t/5a9da33f0d9297a1f84f60f2/1520280385430/HRW_Report.pdfDate accessed: July 4, 2024Google Scholar Although ICE detention is purported to be non-punitive and for administrative purposes only,1ICEICE enforcement and removal operations statistics. Department of Homeland Security, 2024https://www.ice.gov/spotlight/statisticsDate accessed: July 7, 2024Google Scholar and most people detained in ICE custody have no criminal record,3Diaz C. Ortiz V. Sanchez L. et al.Harmful by design—a qualitative study of the health impacts of immigration detention.J Gen Intern Med. 2023; 38: 2030-2037Crossref PubMed Scopus (5) Google Scholar 90.8% are held in private, for-profit detention facilities run by prison operators contracted by ICE.1ICEICE enforcement and removal operations statistics. Department of Homeland Security, 2024https://www.ice.gov/spotlight/statisticsDate accessed: July 7, 2024Google Scholar Despite this, and contrary to repeated calls to implement community-based alternatives to immigration detention,4Ly A. Sprague A. Pierce B. Post C. Heymann J. Immigration detention in the United States: identifying alternatives that comply with human rights and advance public health.Am J Public Health. 2021; 111: 1497-1503Crossref PubMed Scopus (5) Google Scholar the recently introduced 2024 Homeland Security appropriations bill5CongressDepartment of Homeland security appropriations act, 2024; H.R.4367. United States congress.2024https://www.congress.gov/bill/118th-congress/house-bill/4367/textDate accessed: July 6, 2024Google Scholar will further increase ICE funding in order to manage a projected daily immigration detainee population of 41,500 in the financial year 2024–25, at a cost of $3.55 billion USD.6Congress. Fiscal Year 2024 Homeland Security Appropriations BillHouse republicans appropriations.2024https://perma.cc/MN9E-7RT7Date accessed: July 10, 2024Google Scholar A large and growing evidence base has highlighted the adverse conditions, detrimental policies, and harmful practices associated with immigration detention in multiple countries,3Diaz C. Ortiz V. Sanchez L. et al.Harmful by design—a qualitative study of the health impacts of immigration detention.J Gen Intern Med. 2023; 38: 2030-2037Crossref PubMed Scopus (5) Google Scholar,7Filges T. Bengsten E. Montgomery E. Kildemoes M. The impact of detention on the health of asylum seekers: an updated systematic review.Campbell Syst Rev. 2024; 20e1420https://doi.org/10.1002/cl2.1420Crossref Scopus (1) Google Scholar including in relation to US ICE settings.8Parmar P. Ross M. Terp S. et al.Mapping factors associated with deaths in immigration detention in the United States, 2011-2018: a thematic analysis.Lancet Reg Health Am. 2021; 2: 100040https://doi.org/10.1016/j.lana.2021.100040Summary Full Text Full Text PDF Scopus (7) Google Scholar There is strong evidence that immigration detention has an adverse impact on the mental health of those detained,7Filges T. Bengsten E. Montgomery E. Kildemoes M. The impact of detention on the health of asylum seekers: an updated systematic review.Campbell Syst Rev. 2024; 20e1420https://doi.org/10.1002/cl2.1420Crossref Scopus (1) Google Scholar,9Von Werthern M. Robjant K. Chui Z. et al.The impact of immigration detention on mental health: a systematic review.BMC Psychiatry. 2018; 18: 1-19Crossref PubMed Scopus (147) Google Scholar and that conditions in ICE detention facilities have contributed to numerous preventable deaths in recent years.10ACLU. Deadly Failures: Preventable Deaths in U.S. Immigration Detention. American Civili Liberties Union (ACLU)American oversight, and physicians for human rights (PHR) report.2024https://phr.org/wp-content/uploads/2024/06/REPORT-ICE-Deadly-Failures-ACLU-PHR-AO-2024.pdfDate accessed: July 7, 2024Google Scholar Research has highlighted the vulnerabilities and poor health profiles of many people held in immigration detention11Abubakar I. Aldridge R.W. Devakumar D. et al.The UCL–lancet commission on migration and health: the health of a world on the move.LANCET. 2018; 392: 2606-2654Summary Full Text Full Text PDF PubMed Scopus (510) Google Scholar and there have been documented reports of abhorrent human rights abuses occurring in ICE detention.2HRWSystemic indifference: dangerous & substandard medical care in US immigration detention. Human Rights Watch, 2017https://static1.squarespace.com/static/5a33042eb078691c386e7bce/t/5a9da33f0d9297a1f84f60f2/1520280385430/HRW_Report.pdfDate accessed: July 4, 2024Google Scholar Within this context, Annette Dekker and colleagues' Viewpoint12Dekker A. Zeidan A. Nwadiuko J. Jordan E. Parmar P. A call for increased transparency and accountability of health care outcomes in US immigration and customs enforcement detention centers.Lancet Reg Health Am. 2024; 36100825https://doi.org/10.1016/j.lana.2024.100825Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar critiques the existing standards for healthcare provision in ICE detention settings and documents evidence of grossly inadequate mental healthcare, inappropriate and excessive use of solitary confinement, and an 11-fold increase in the suicide rate in ICE detention between 2010 and 2020. Dekker and colleagues provide a much-needed call to action to address the lack of (1) reporting and transparency of ICE healthcare standards, and (2) accountability of healthcare providers in these facilities. In their examination of healthcare standards in ICE detention settings, Dekker and colleagues scrutinise the 2016 revised Performance-Based National Detention Standards (PBNDS) that apply to facilities exclusively housing detained immigrants, and which are largely run by private, for-profit prison operators.1ICEICE enforcement and removal operations statistics. Department of Homeland Security, 2024https://www.ice.gov/spotlight/statisticsDate accessed: July 7, 2024Google Scholar,12Dekker A. Zeidan A. Nwadiuko J. Jordan E. Parmar P. A call for increased transparency and accountability of health care outcomes in US immigration and customs enforcement detention centers.Lancet Reg Health Am. 2024; 36100825https://doi.org/10.1016/j.lana.2024.100825Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar These federally funded facilities currently detain 80% of the average daily ICE detention population.1ICEICE enforcement and removal operations statistics. Department of Homeland Security, 2024https://www.ice.gov/spotlight/statisticsDate accessed: July 7, 2024Google Scholar The authors highlight the unacceptably vague standards in the PBNDS, and the striking absence of specific guidelines to which facilities must adhere. They also highlight serious flaws in PBNDS compliance inspections, including a lack of transparent information about how deficiencies are identified, addressed, and assessed. This opacity is compounded by remarkable variation in how the PBNDS are applied between detention facilities.2HRWSystemic indifference: dangerous & substandard medical care in US immigration detention. Human Rights Watch, 2017https://static1.squarespace.com/static/5a33042eb078691c386e7bce/t/5a9da33f0d9297a1f84f60f2/1520280385430/HRW_Report.pdfDate accessed: July 4, 2024Google Scholar Dekker and colleagues also note the absence of formal standards regarding which health metrics should be monitored, and a lack of quality monitoring and accountability of publicly-funded healthcare outcomes in these facilities. This contributes to a system in which deficiencies in the provision of healthcare are frequently overlooked and, even when identified, result in neither improved conditions nor accountability. Dekker and colleagues' concerns mirror those documented in relation to Australian immigration detention for more than 30 years.13PIACIn Poor Health: health care in Australian immigration detention. Public Interest Advocacy Centre, 2018https://www.piac.asn.au/wp-content/uploads/2018/06/18.06.14-Asylum-Seeker-Health-Rights-Report.pdfDate accessed: July 10, 2024Google Scholar Although all individuals in places of detention—including immigration detention—retain the right to the highest attainable standard of physical and mental health,14UNUN Committee on Economic Social and Cultural Rights (CESCR)General Comment No. 14 (2000): the right to the highest attainable standard of health (art. 12 of the covenant).2000https://digitallibrary.un.org/record/425041?ln=enDate accessed: July 17, 2024Google Scholar in practice these rights have been diminished in both ICE and Australian detention facilities.13PIACIn Poor Health: health care in Australian immigration detention. Public Interest Advocacy Centre, 2018https://www.piac.asn.au/wp-content/uploads/2018/06/18.06.14-Asylum-Seeker-Health-Rights-Report.pdfDate accessed: July 10, 2024Google Scholar In the absence of abolishing immigration detention, Dekker and colleagues argue that reporting of health metrics in detention must be frequent, timely, granular, monitored by an independent body, and publicly reported. We agree and, in addition to these US-based suggestions, we recommend (1) developing tools to routinely assess progress against standardised health outcome measures, and (2) the establishment of an independent panel of clinical experts (including psychologists, psychiatrists, public health experts, dentists, nurses, and other clinicians) to monitor and report regularly on healthcare provision in immigration detention.13PIACIn Poor Health: health care in Australian immigration detention. Public Interest Advocacy Centre, 2018https://www.piac.asn.au/wp-content/uploads/2018/06/18.06.14-Asylum-Seeker-Health-Rights-Report.pdfDate accessed: July 10, 2024Google Scholar Ideally, such a panel would be authorised to provide ongoing monitoring and reporting on culturally appropriate, trauma-informed healthcare provision. A mechanism to ensure that particularly at-risk and/or vulnerable individuals are released on medical or mental health grounds should also be developed and implemented by this independent panel. Meaningful consequences must be enforced for contractors who violate standards, including for facilities following any deaths.10ACLU. Deadly Failures: Preventable Deaths in U.S. Immigration Detention. American Civili Liberties Union (ACLU)American oversight, and physicians for human rights (PHR) report.2024https://phr.org/wp-content/uploads/2024/06/REPORT-ICE-Deadly-Failures-ACLU-PHR-AO-2024.pdfDate accessed: July 7, 2024Google Scholar Dekker and colleagues' Viewpoint draws attention to the ongoing, serious concerns regarding the health and human rights of individuals in immigration detention,2HRWSystemic indifference: dangerous & substandard medical care in US immigration detention. Human Rights Watch, 2017https://static1.squarespace.com/static/5a33042eb078691c386e7bce/t/5a9da33f0d9297a1f84f60f2/1520280385430/HRW_Report.pdfDate accessed: July 4, 2024Google Scholar, 3Diaz C. Ortiz V. Sanchez L. et al.Harmful by design—a qualitative study of the health impacts of immigration detention.J Gen Intern Med. 2023; 38: 2030-2037Crossref PubMed Scopus (5) Google Scholar, 4Ly A. Sprague A. Pierce B. Post C. Heymann J. Immigration detention in the United States: identifying alternatives that comply with human rights and advance public health.Am J Public Health. 2021; 111: 1497-1503Crossref PubMed Scopus (5) Google Scholar,7Filges T. Bengsten E. Montgomery E. Kildemoes M. The impact of detention on the health of asylum seekers: an updated systematic review.Campbell Syst Rev. 2024; 20e1420https://doi.org/10.1002/cl2.1420Crossref Scopus (1) Google Scholar,8Parmar P. Ross M. Terp S. et al.Mapping factors associated with deaths in immigration detention in the United States, 2011-2018: a thematic analysis.Lancet Reg Health Am. 2021; 2: 100040https://doi.org/10.1016/j.lana.2021.100040Summary Full Text Full Text PDF Scopus (7) Google Scholar and highlights the ways in which federally funded—but privately operated—prison operators may profit2HRWSystemic indifference: dangerous & substandard medical care in US immigration detention. Human Rights Watch, 2017https://static1.squarespace.com/static/5a33042eb078691c386e7bce/t/5a9da33f0d9297a1f84f60f2/1520280385430/HRW_Report.pdfDate accessed: July 4, 2024Google Scholar,3Diaz C. Ortiz V. Sanchez L. et al.Harmful by design—a qualitative study of the health impacts of immigration detention.J Gen Intern Med. 2023; 38: 2030-2037Crossref PubMed Scopus (5) Google Scholar while evading public scrutiny for any harms perpetrated.2HRWSystemic indifference: dangerous & substandard medical care in US immigration detention. Human Rights Watch, 2017https://static1.squarespace.com/static/5a33042eb078691c386e7bce/t/5a9da33f0d9297a1f84f60f2/1520280385430/HRW_Report.pdfDate accessed: July 4, 2024Google Scholar With the governments of many countries around the world seeking to outsource and externalise their legal and human rights responsibilities to asylum seekers,15Hedrick K. Borschmann R. The enduring harm from permanent offshore processing arrangements in the Pacific Islands.Aust N Z J Public Health. 2023; 47https://doi.org/10.1016/j.anzjph.2023.100095Crossref PubMed Scopus (1) Google Scholar the authors' investigation into the US immigration detention system should serve as a cautionary tale. Our own recent research,15Hedrick K. Borschmann R. The enduring harm from permanent offshore processing arrangements in the Pacific Islands.Aust N Z J Public Health. 2023; 47https://doi.org/10.1016/j.anzjph.2023.100095Crossref PubMed Scopus (1) Google Scholar which examined the Australian government's costly use of controversial private prison contractor Management and Training Corporation (MTC)—against a backdrop of multiple serious and ongoing allegations in the US—for the new 'enduring form of offshore processing' in the Pacific Island nation of Nauru, highlighted legitimate concerns for the health and wellbeing of current and future asylum seekers detained in MTC-run facilities. Our concerns regarding the risk of preventable psychological and physical harm were further heightened by the lack of transparency and accountability associated with such contractual arrangements, including in relation to the provision of healthcare, and the fact that the Australian government has implemented permanent immigration detention arrangements.15Hedrick K. Borschmann R. The enduring harm from permanent offshore processing arrangements in the Pacific Islands.Aust N Z J Public Health. 2023; 47https://doi.org/10.1016/j.anzjph.2023.100095Crossref PubMed Scopus (1) Google Scholar In the absence of abolishing immigration detention, the timely provision of evidence-based, trauma-informed, and culturally appropriate healthcare services (with interpreter access where necessary) in all ICE detention centres is critical for preventing further harm and ensuring that all people detained in such facilities retain the right to the highest attainable standard of physical and mental health. Unfortunately, as Dekker and colleagues demonstrate so unambiguously, ICE—and all those it contracts—currently falls drastically short of meeting these standards. KH and RB wrote the first draft of this Comment. SK provided critical input to subsequent versions, along with KH and RB. All authors approved the final version. KH is the Director of Community-Minded Psychological Services, a private practice for people from immigrant, asylum seeking, and refugee backgrounds, which has received funding from the Australian government to provide psychological services to asylum seekers. KH receives personal fees from Settlement Services International to provide clinical assessment and psychological support for asylum seekers released from Australian immigration detention. KH has previously received personal fees from the Victorian Foundation for Survivors of Torture to provide psychological support to people from asylum seeking and refugee backgrounds, and from the Australian government's Department of Home Affairs to conduct independent mental health assessments and provide psychological reports for asylum seekers medically evacuated from offshore immigration detention. She has also received personal fees from the Nordic Refugee Determination: Advancing Data Science in Migration Law project, funded by Nordforsk. The views expressed here are her own, and those of her co-authors. RB and SK declare no competing interests. Funding source: No dedicated funding was received for this Comment. RB receives salary and research support from an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (EL2; GNT2008073). A call for increased transparency and accountability of health care outcomes in US Immigration and Customs Enforcement detention centersConcerns over health care in US Immigration and Customs Enforcement (ICE) facilities have grown over the past decade, including reports of medical mismanagement, inadequate mental health care, and inappropriate use of solitary confinement. Despite being a federally funded agency, reporting and accountability of health outcomes in ICE facilities is limited. This manuscript outlines current standards for health in ICE detention, how compliance is evaluated, why this process fails, and how current processes can be improved to achieve transparency and accountability. Full-Text PDF Open Access

BackgroundWhile people who experience incarceration have remarkably poor health profiles, undertaking research to inform evidence-based responses is complicated by difficulties of recruiting people in prison; high rates of socioeconomic marginalisation, study attrition; and legislative and financial barriers to linked data research. There are many advantages to pooling data from multiple studies involving people who experience incarceration, including greater statistical power and geographic and participant heterogeneity. However, there are also challenges that need to be addressed. MethodsWe combined four prospective cohort studies of adults released from prisons in four Australian states. Pre-release interviews, and validated screening assessments, were linked to primary care, medicine dispensing, hospital, alcohol and other drug treatment services, ambulatory mental health, ambulance, corrective services, and death records. Data were harmonised by team members reviewing variable definitions and categories within subject domains. ResultsThe combined cohort consists of 4,232 adults, including 1,544 Indigenous people and 905 women, with a median age of 31 years. Data linkage will enable a median of 9.3 years of prospective follow-up after release from incarceration. Differences in data structures, coding systems between and within datasets, changes over time, and grouping of records belonging to the same event were also addressed. ConclusionThis combined multi-site cohort study is an example of a complex, policy-oriented data linkage project. It was developed to underpin evidence-based, culturally appropriate interventions, health policy and service development for people who were incarcerated. This presentation will discuss the processes and pitfalls experienced while building a multi-sectoral, multi-jurisdictional data linkage project.

BackgroundA scarcity of evidence on the health and social needs of justice-involved young people contributes to persistent health and social inequities. Linking data from multiple sectors provides an opportunity to improve the health, justice, and social systems that this group interacts with, with a view to reducing these inequities. MethodsWe established two population-level cohorts of justice-involved young people using multi-sectoral data linkage: (1) we linked youth justice records in Queensland from 1993-2014 for 48,670 young people to adult correctional records, death records, and coronial records; (2) we linked all youth justice records in Australia from 2000-2019 for 88,110 young people with national emergency department, hospital, primary care, pharmaceutical, and death records. We calculated mortality rates among young people exposed to the youth justice system and compared them with the age- and sex-matched general population. ResultsJustice-involved young people in Queensland died at a 4.1 times higher rate than their non-justice-involved peers. Approximately one-third (34.6%) of deaths were from suicide. There was a 67% increased rate of death due to non-communicable diseases compared to the general population. ConclusionsThe national cohort will fill evidence gaps on health needs and health care use after justice system contact. These two cohorts provide the first comprehensive look into the health of justice-involved young people in Australia and internationally. They form the foundation for routine monitoring and reporting on health needs and trajectories. Multi-sectoral data linkage is essential for sustainable, timely, and evidence-informed decision-making to improve systems, health, and mortality outcomes.

Ted R. Miller, PhD; Lauren M. Weinstock, PhD; Brian K. Ahmedani, PhD; Nancy N. Carlson, PhD, LCPC; Kimberly Sperber, PhD; Benjamin Lê Cook, PhD; Faye S. Taxman, PhD; Sarah A. Arias, PhD; Sheryl Kubiak, PhD; James W. Dearing, PhD; Geetha M. Waehrer, PhD; James G. Barrett, PhD; Jessica Hulsey, BA; Jennifer E. Johnson, PhD