Pre-sentence mental health service use predicts post-sentence mortality in a population cohort of first-time adult offenders

Purpose - With the high risk of death associated with mental disorders and their increased prevalence in offenders, it is judicious to investigate the risk of post-sentence mortality with respect to offenders’ psychiatric treatment history. Methods - Using linked administrative data for a whole-population retrospective cohort of first-time adult offenders (n = 25,537) sentenced to either prison or non-custodial orders in Western Australia, we determined the risk and baseline predictors of post-sentence mortality. Results - Of 192 deaths within 2 years of sentence completion, deaths from injury/poisoning (55.6 %), cancer (13.3 %) and cardiovascular disorders (9.7 %) were the most common. Pre-sentence history of mental health service (MHS) contact doubled the risk of post-sentence all-cause and injury/poisoning-related mortality. Physical comorbidity was the strongest predictor of mortality irrespective of pre-sentence MHS contact. Baseline history of attempted self-harm and being an Indigenous male were associated with an elevated risk of death in offenders with a pre-sentence MHS contact. In offenders without a pre-sentence MHS contact, socio-economic disadvantage and incarceration almost doubled the risk of dying from any cause and injury/poisoning. Conclusions -Mortality risk in the 2 years following sentence completion is associated with pre-sentence health service use and a range of socio-demographic factors for both incarcerated and non-custodial offenders. The opportunity afforded by imprisonment could be exploited by provision of funding to identify and treat mental illness, impart preventive health education addressing modifiable risk factors and provide transitional care to community-based services, all of which may help reduce preventable post-sentence deaths. Diversion to non-custodial sentences is also a plausible option