Healthcare delivery for women in prison : a medical record review

When women come into prison, many have unmet health needs. In this study we examine the health care provided to women in prison and their identified health needs, and discuss opportunities for improved healthcare delivery. We undertook a medical record review of women released from a minimum 6-week period of incarceration in New South Wales correctional centres between May 2013 and January 2014. Records from 231 periods of incarceration were reviewed. At reception, 52% of women were identified as having anxiety or depression. Hearing health was not documented despite 30% of records being of women from an Aboriginal and Torres Strait Islander background, a high-risk group for whom hearing screening is recommended. Most women had multiple in-prison clinical contacts, including interactions with general and specialised nurses (97%), general practitioners (65%) and psychiatrists (35%). At release, 49% were on psychotropic medication and most required ongoing management for: mental health (71%), substance misuse (65%) and physical health (61%) problems. External specialist appointments were pending in 7% at release. Health management plans generated in prison were not always completed before release for reasons including custodial factors and waits for hospital-based appointments. Provision of effective health care in prison requires improved integration with community health services, including timely access to a wide range of health services while women are in prison, and continuity of care at release.