Mahnoor Muhammad
Almost half of adults in Australian prisons experience a mental illness, cognitive disability, or high psychological distress . These individuals are not only overrepresented, they are underserved. Prisons, by their very nature, are not therapeutic environments, and yet they have become de facto mental health institutions. This reality is a sobering reflection of systemic neglect, underinvestment, and the ongoing criminalisation of mental illness in Australia.
As a Master of Public Health student and PHAA Health Policy Intern, I’ve had the opportunity to explore this issue through policy analysis, collaborative research, and critical reflection. The conclusion is clear: addressing mental health in carceral settings is not just a healthcare issue, it is a matter of justice, equity, and humanity.
A silent crisis
The scale of the mental health crisis in Australian prisons is alarming. A national study found that 51% of adults in custody have had diagnosed mental health conditions. This number jumps significantly among women and Aboriginal and Torres Strait Islander people in custody, who are already overrepresented in the justice system due to structural disadvantage and systemic racism.
Many incarcerated individuals are not violent criminals but people with complex, unmet health and social needs. Often, they are detained for minor offences linked to poverty, trauma, substance use, or untreated mental illness. Incarceration becomes a tragic substitute for community care. And within prison walls, mental health often worsens.
Prison environments aggravate existing conditions through isolation, overcrowding, loss of autonomy, and exposure to violence. Research shows that people with mental health conditions are frequently punished for symptoms of their illness rather than supported with treatment. Solitary confinement, in particular, is disproportionately used on individuals with mental illness, and is known to increase self-harm and suicide risk.
This situation is further complicated by epistemic injustice – the dismissal of individuals’ experiences and credibility due to stigma, power imbalance, or perceived unreliability. Incarcerated people with mental illness are often disbelieved, misdiagnosed, or excluded from decisions about their own care. Their trauma is unseen. Their voices are unheard.
Legal protections, uneven realities
Australia’s legal frameworks, such as the Disability Discrimination Act 1992 and the Mental Health Act (NSW) 2007, affirm the right to health care, including in prisons. However, policy does not always translate into practice. Mental health services in correctional facilities are under-resourced, and access is inconsistent across jurisdictions.
Despite these legislative safeguards, mental health services in many prisons are stretched beyond capacity. Long wait times, staff shortages, and a lack of culturally safe care – particularly for Aboriginal and Torres Strait Islander peoples – all undermine the intent of existing policies.
Even where good practice exists, such as the Justice Health and Forensic Mental Health Network in NSW or Victoria’s Correctional Health Services, these models are not uniformly implemented. The absence of national standards for mental health in custody means that a person’s access to care may depend on where they are incarcerated.
Hope through innovation
While the challenges are significant, there are also signs of hope. Innovative programs across Australia and internationally show what’s possible when rehabilitation, not punishment, guides our approach.
The Throughcare Program in the ACT provides support to people during their transition from prison to the community, including assistance with housing, health, and mental wellbeing. ReLink in Victoria offers culturally safe reintegration support to Aboriginal and Torres Strait Islander women. Telehealth psychiatry has also improved access to care for people in remote prisons.
Globally, Norway’s Halden Prison is often cited as a gold standard. Its inmates are treated with dignity, staff are trained in mental health and rehabilitation, and reoffending rates are among the lowest in the world. In the US, the Crisis Intervention Team model, which operates in most states and the District of Columbia, trains officers in de-escalation and connects individuals to care instead of punishment.
These models are not perfect, but they offer a blueprint for reform – one that is evidence-based, culturally competent, and centred on human rights.
Recommendations
To create a more humane and effective system, we must:
- increase staffing and training: Recruit more psychologists, social workers, and mental health nurses. Ensure all correctional staff receive mandatory training in trauma-informed care, suicide prevention, and mental health crisis response.
- expand access to culturally safe services: Enact mandatory mental health screening on entry to custody. Partner with Aboriginal Community Controlled Health Organisations, and culturally diverse providers to ensure access to appropriate care.
- prioritise rehabilitation over punishment: Embed therapy and mental health support into education, before inmate release, and reintegration programs. Expand proven models like Throughcare and ReLink.
- support peer-led and lived experience programs: Train inmates as peer mentors. Employ people with lived experience of incarceration and mental illness to guide service delivery and policy reform.
Justice through health
Mental health in carceral settings is not a side issue but central to public health, social justice, and human rights. If we want to build a fairer, healthier society, we must stop using prisons as a catch-all solution for unmet mental health needs. Instead, we must invest in systems of care, compassion, and accountability.
Prison should not be the only place someone receives a diagnosis or treatment. And mental illness should never be a life sentence.
Mahnoor Muhammad is a Master of Public Health student at the University of Wollongong, and is undertaking a policy internship at the PHAA.
Image: Eva Rinaldi, Flickr. Modified by the PHAA.
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