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Clinical features and mortality outcomes of people transferred from prison to forensic mental health units

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From Māori Health Review Issue 119
Authors:
  • Foulds JA et al.
Summary:

A nationwide cohort study has demonstrated a high mortality rate amongst people transferred from prison to psychiatric hospital care in New Zealand between 2009 and 2022. Of the cohort, 85% were male, 55% were Māori and median age was 31.2 years. A psychotic disorder was present in 74% and bipolar disorder in 11%, and coexisting substance use disorder was common. Median follow-up duration was 7.5 years after the first transfer; 17% of this time was spent in a psychiatric hospital. The mortality rate was 4.7-fold higher in this cohort compared with the New Zealand population, after adjustment for age and sex. Where cause of death was known, 60% were from natural causes and 40% were from injuries including suicide.

Comment:
These findings align with wider evidence indicating that disruptions in continuity of care for imprisoned people – especially in the transition between and from institutional settings (prison, hospital) to primary and community care – are a key factor for poor health outcomes. I see it now in my GP clinic, with no formal handover and minimal information available about prevention, screening and management of chronic conditions. It really reinforces calls for integrated, coordinated and continuous care pathways that bridge the various structures/systems.
Reference: Soc Psychiatry Psychiatr Epidemiol. 2025;60(11):2685-2693.
Abstract
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Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

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