Review: Mental Health of Incarcerated Aboriginal and Torres Strait

This literature review examines the prevalence of mental health issues among incarcerated Aboriginal and Torres Strait Islander people in Australia, focusing on psychological distress, suicide attempts, and the impact of parental incarceration. The review analyzes quantitative and qualitative data from various studies, highlighting the disproportionately high rates of psychological distress among incarcerated Indigenous individuals, with 73% of men and 86% of women experiencing mental disorders. It also addresses conflicting findings regarding suicide attempt rates, noting that one study found a significantly higher prevalence among Indigenous inmates (31.6%) compared to non-Indigenous inmates (18.7%) and the general Australian population (3.2%). The review further explores how parental incarceration, particularly for mothers, exacerbates mental health challenges due to cultural roles and the risk of children being placed in out-of-home care. Ultimately, the review underscores the need for improved mental health support for Indigenous Australians within the criminal justice system and a national approach to reduce their overrepresentation in prisons.

Prevalence of mental illness among incarcerated Aboriginal and Torres Strait Islander
people
Targeted discrimination and intergenerational trauma of Australia's Aboriginal and Torres Strait
Islander population has repeatedly undermined their health and well-being throughout history,
resulting in poorer health status and inequity, and contributing to the over-representation of
Indigenous Australians in Australian prisons. Incarceration can have significant health detriments,
especially for the Indigenous population who represent 28% of the country’s total custodial population
despite being less than 3% of the Australian population (Kendall et al., 2020). Major population surveys
have deemed mental health as one of the major contributing factors to suicide attempts of the
incarcerated indigenous population. This literature review will analyse the prevalence of mental health
amongst imprisoned Aboriginal and Torres Strait Islander peoples by analysing quantitative and
qualitative data from several bodies of literature. The first part of this review will draw on research
findings that focus on psychological distress statistics of incarcerated indigenous Australians, while the
second will focus on the prevalence of suicide attempts. The final portion will attend to literature
exhibiting how these conditions are exacerbated for incarcerated parents. Overall, these findings
contribute to understanding the extent to which mental illness impacts incarcerated Aboriginal and
Torres Strait Islander people, compared to their non-Indigenous counterparts.
Psychological Distress
The term psychological distress refers to symptoms of stress, anxiety, and depression. High levels of
these are indicative of impaired mental health and mental disorders like depressive disorder
(Heffernan et al., 2012). Heffernan et al. (2012) conducted a critical study on 396 Aboriginal and Torres
Strait Islander individuals (331 men and 65 women) incarcerated in Queensland prisons through
Composite International Diagnostic Interviews (CIDI) that found a remarkably high prevalence of
psychological distress; the 12-month prevalence of mental disorder was 73% among men and 86%
among women. With this, they identified that awaiting sentencing (on remand), being housed in a
single occupancy cell, or being convicted of a violent offence are contributing factors. Conversely, using
the same method of CIDI, Heffernan et al. (2009), referring to Andrews & Peters' (2003) survey of 226
males and 51 female indigenous prisoners, reported a less significant – yet still noteworthy –
prevalence of psychotic distress among men (50%), yet found almost identical for that of women
(85%). While Heffernan et al. (2012) conducted an additional interview to confirm the CIDI results,
Andrews and Peters (2003) did not set out to gain validation of the CIDI, and, as a result, the
information they collected was limited. Heffernan et al.'s (2012) efforts to eliminate cultural bias by
employing trained interviewers of Indigenous descent further strengthened their research, contrasting
to Andrews and Peters (2003) study, which lacked cultural consideration.
Suicide
Prison suicide in is a major health concern, occurring between three and eight times more than the
rate observed in the general community (Larney et al.). Larney et al. (2012) conducted a cross-section
survey on a stratified sample of 996 inmates at a New South Wales prison to conclude that 31.6% of
incarcerated indigenous individuals had attempted suicide, compared to 18.7% of non-indigenous
people. They compared their findings with the results of the 2007 National Survey of Mental Health
and Wellbeing, which identified stark disparities between the national prevalence (3.2% of Australian
adults), the incarcerated non-indigenous population (18.7%), and that of Indigenous inmates (31.6%);

(Larney et al., 2012). Comparatively, a study by Butler et al. (2007) in the same NSW prison, but before
that of Larney et al.'s (2012), found no relationship between suicide attempts and incarcerated
Indigenous or non-indigenous peoples. Justification for the inconsistent findings is conceivable. Firstly,
genuine change in the prevalence of suicide attempts occurred between the reports. Alternatively, the
interview method influenced the inmate's responses; those by Larney et al. (2012) took place over the
phone, dissimilarly to Butler et al. (2007), who conducted them face-to-face. Ultimately, further
research on Indigenous inmates and suicide is necessary to determine whether incarcerated
Indigenous individuals propose a greater suicide risk than non-Indigenous people.
Parental Incarceration
So far, the review has highlighted the prevalence of psychological distress and suicide attempts
amongst incarcerated Indigenous people. Many studies consider parental imprisonment a significant
trigger in exacerbating these feelings, especially for women. Jones et al. (2018) explains in their
research that mothering in Indigenous culture differs from conventional ideas and definitions, as for
indigenous women it is an identity. Often, these women care for their biological and non-biological
children within the networks of family and community. Jones et al. (2018) goes on to identify that
mothers experience stress and anxiousness associated with being unable to mother their children
during imprisonment and after release. The outcome of Dowel et al.’s (2018) descriptive study on
maternal incarceration in Western Australia validates Jones et al.’s (2018) findings and these women’s
fears, for 1 in 3 children whose mothers were imprisoned whilst pregnant or in the first two years of
their life, were placed in out-of-home care by their second birthday. In contrast to the 1 in 100
Indigenous and 1 in 300 non-Indigenous children placed in out of home care by the same age whose
mothers had a clean record (Dowel et al., 2018). The culture of the indigenous population contributes
significantly to incarcerated parents’ mental health, for it gives them a sense of identity, and life
purpose, both Dowel et al. (2018) and Jones et al. (2018) conclude that a national approach is essential
in ending the disproportionate incarceration of Indigenous people, including women and mothers.
Despite the disagreement between researchers on whether suicide attempts are more prevalent for
Indigenous Australian inmates, the linking findings in regards to psychological distress support the
notion that mental illness has a greater prevalence among incarcerated indigenous peoples.
Researchers also support the idea that imprisoned mothers experience great distress in relation to
their children and thus are at greater risk of mental disorders. Although reducing the over-
representation of Indigenous Australians in Australian prisons remains a priority, improving their
mental health when in contact with the criminal justice system is an essential step in achieving this
long-term goal.
References

Andrews, G. & Peters, L., (2003). The CIDI-Auto: A Computerised Diagnostic Interview for Psychiatry.
New York: World Health Organization Collaborating Centre for Mental.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878399/pdf/MPR-12-167.pdf.
Butler, T., Allnutt, S., Kariminia, A., & Cain, D. (2007). Mental health status of Aboriginal and non-
Aboriginal Australian prisoners. Australasian Psychiatry: Bulletin of the Royal Australian and
New Zealand College of Psychiatrists, 41(5), 429–435.
https://doi.org/10.1080/00048670701261210.
Dowell, C. M., Mejia, G. C., Preen, D. B. & Segal, L. (2018). Maternal incarceration, child protection, and
infant mortality: a descriptive study of infant children of women prisoners in Western Australia.
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https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-018-0060-y
Heffernan, E., Andersen, K., & Kinner, S. (2009). The insidious problem inside: mental health problems
of Aboriginal and Torres Strait Islander People in custody. Australasian Psychiatry: Bulletin of
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https://doi.org/10.1080/10398560902948696.
Heffernan, E. B., Andersen, K. C., Dev, A., & Kinner, S. (2012). Prevalence of mental illness among
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Jones, J., Wilson, M., Sullivan, E., Atkinson, L., Gilles, M., Simpson, P. L., Baldry, E., & Butler, T. (2018).
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Kendall, S., Lighton, S., Sherwood, J., Baldry, E., & Sullivan, E. A. (2020). Incarcerated aboriginal
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