Do Australian prisons meet the therapeutic needs of inmates?
“Prisons cannot realistically meet the complex therapeutic needs of their populations as imprisonment rates continue to rise. The core problem is that the current system prioritises containment over the stable, long-term therapeutic engagement required for effective trauma-informed care. In Australia, incarcerated individuals require intensive, specialised clinical support rather than standard, security-focused custodial supervision. AIHW (2019) data show that approximately 40% of prison entrants have a diagnosed mental illness, rising to 65% among female entrants; 65% reported illicit drug use in the 12 months before incarceration, and 21% have a history of self-harm. A system designed primarily for security and containment is structurally ill-equipped to serve as a healing setting for people facing these intersecting vulnerabilities. Rising imprisonment rates further weaken therapeutic capacity through what the Productivity Commission (2021) identifies as a resource dilution effect. Between 2000 and 2018, Australia's imprisonment rate increased by 40%, the third-highest growth rate in the OECD, even as the overall offender rate fell by 18%. This growth means the prison system's net operating budget, which has ballooned to over $5.2 billion annually, is increasingly consumed by immediate warehousing costs rather than rehabilitative services. At more than $330 per prisoner per day, overcrowding worsens staff-to-prisoner ratios and restricts access to already limited counselling and mental health services. Key structural features of the current system also undermine therapeutic progress, especially the remand system and short-term sentencing. The Productivity Commission (2021) reports that approximately one-third of the prison population is currently unsentenced and held on remand. This highly unstable cohort often has the least access to support services despite having high therapeutic needs. Compounding this, 35% of convicted prisoners receive sentences of under six months. These short durations are structurally insufficient to design and complete meaningful, evidence-based therapeutic programs for trauma or addiction. Instead, they reinforce a destructive cycle of remand churn and recidivism, where vulnerable individuals cycle rapidly in and out of custody without resolving the root causes of their offending behaviour. While prisons can deliver meaningful care for a smaller, stable population, the present trajectory shows they are being used as a default provider for complex social problems they were never designed to solve. Genuine trauma-informed care requires a systemic shift away from correctional expansion and toward clinical, community-based diversion. The Productivity Commission notes that approximately 42% of imprisoned people are serving sentences for non-violent offences, and 15% are classified as minimal-risk offenders, making them strong candidates for alternative measures. Ultimately, real progress requires reducing prison inflow through strong bail reform to decrease the remand population, and reallocating correctional funds to community-based mental health and addiction services where long-term, stable, and voluntary therapeutic engagement can succeed. This is the necessary policy direction for genuine trauma-informed care.”
Summary
Current Australian data show that roughly 40 % of prison entrants have a diagnosed mental illness (rising to about 65 % for women), around two‑thirds used illicit drugs before incarceration, and about one‑fifth have a history of self‑harm. Overcrowding, high per‑prisoner costs, a large remand population and short‑term sentences limit the capacity for sustained, trauma‑informed treatment. A substantial share of inmates are non‑violent or low‑risk, supporting the argument that community‑based, clinical alternatives would better meet their therapeutic needs.
Sources 59 searched
- The efficacy of ‘modular dosage’ in prison-based psychological interventions to reduce recidivism: A state-wide naturalistic study of convicted people in Australian prisons - ScienceDirect
Indeed, in 2020 the NSW head of state publicly prioritised their aim of increasing “the average hours of treatment to at least 160 hours for 3000 higher risk individuals exiting prison each year” (NSW Government, 2020). Other research has questioned the feasibility of high dosage models of treatment, recognising that very few high-risk participants tend to complete higher dosages of treatment, and the unpredictable nature of the justice system disrupt program completion (e.g., sporadic transfers, paroles and releases, lock downs, or therapeutic staff shortages) (Makarios et al., 2014).
- Health and incarceration research in Australia: a scoping review - ScienceDirect
Violence victimisation and injury (n = 16, 31%), exploring relationships between histories of trauma, mental health challenges, and offending behaviour; and ... Health service use (n = 15, 29%), investigating service needs and histories of service use related to substance dependence and mental health. This is the first comprehensive synthesis of health research involving people exposed to Australian prisons and youth detention.
- Health, Social and Recidivism Outcomes Among People Who Have Been Incarcerated in New South Wales, Australia: Study Protocol and Cohort Profile for the Prison Outcomes STudy (POST) - PubMed
Introduction: We have been funded to examine post-incarceration health and social outcomes for all people incarcerated in New South Wales, Australia, 2000-2022; assess treatment and services for drug dependence and serious mental illness; and project the impact of expanding intervention coverage. We will use a linked cohort, the Prison Outcomes STudy (POST), which we also describe.
- Mental health profile of culturally and linguistically diverse (CALD) women entering New South Wales public prisons: a retrospective cohort study using real-world data - PubMed
RESULTS: During the study period, 924 CALD and 3788 non-CALD women entered NSW public prisons. Reported substance use was lower in CALD than non-CALD women. CALD women were significantly less likely to have mental disorders than non-CALD women, ...
- Does prison labour rehabilitate, punish, discipline or exploit a traumatised and racialised population in Australian and American prisons? - PubMed
This article describes the incarcerated ... is argued that their pre-existing trauma is compounded by trauma arising from both deprivation of liberty in and of itself, and their treatment and conditions in prison....
- Identifying research priorities to improve the health of incarcerated populations: results of citizens' juries in Australian prisons - The Lancet Public Health
However, a diversity of research focal points between different prisons was evident; these focal points included serious mental illness, grief and trauma, medication access and management, access to psychologists, peer support, substance withdrawal, culturally appropriate care, stress from overcrowded prisons and from unemployment after release, and alternatives to isolation as a treatment option.
- Prison-based correctional rehabilitation: An overview of intensive interventions for moderate to high-risk offenders | Australian Institute of Criminology
Offender treatment programs that target cognitive skills training are now a common feature (implemented or planned) in every Australian correctional management strategy (refer Table 2). What is noticeably different in the delivery of cognitive skills programs since the 2004 audit is the ...
- At a crossroads? Offender rehabilitation in Australian prisons
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- Health of people in prison - Australian Institute of Health and Welfare
People who spend time in prison experience higher rates of homelessness, unemployment, mental health disorders, chronic physical health conditions, communicable disease, tobacco smoking, high-risk alcohol consumption, and illicit drug use than ...
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