# Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody

## TL;DR

This study finds high rates of mental illness, substance use disorders, and dual diagnoses among adults in Australian prisons, emphasizing the need for better health resource allocation.

## Contribution

The study combines multiple data sources to provide more accurate prevalence estimates of mental and substance use disorders in prison populations.

## Key findings

- Dual diagnosis prevalence among non-Indigenous adults in custody was 44.2%, significantly higher than mental illness or substance use disorder alone.
- Aboriginal and Torres Strait Islander adults had a 40.9% dual diagnosis prevalence, with higher substance use disorder rates compared to non-Indigenous adults.
- Using multiple data sources revealed higher prevalence estimates than relying on a single source, indicating under-ascertainment in individual data sources.

## Abstract

The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source.

We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement.

The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses.

Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced.

The online version contains supplementary material available at 10.1186/s12963-025-00408-7.