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. 2019 Sep 5;26(6):886–903. doi: 10.1080/13218719.2019.1642259

Psychological wellbeing, distress and coping in Australian Indigenous and multicultural prisoners: a mixed methods analysis

Arran Rose a, Justin Trounson a, Jason Skues b, Michael Daffern a, Stephane M Shepherd a, Jeffrey E Pfeifer b, James R P Ogloff a,✉
PMCID: PMC7033708  PMID: 32128015

Abstract

The Australian prison population is growing and becoming increasingly diverse. Yet very little research has investigated mental health concerns for multi-cultural prisoners. This mixed methods study aimed to identify the prevalence of mental health factors (wellbeing, distress and coping) in a cohort of 530 prisoners from Indigenous, culturally and linguistically diverse (CALD) and English-speaking backgrounds (ESB) at a maximum-security prison in Victoria, Australia. Focus group interviews were also conducted with an additional 40 prisoners. It was found that Indigenous prisoners had significantly higher levels of distress and more symptoms of anxiety and depression than CALD and ESB prisoners. CALD prisoners had a greater sense of ‘feeling in control’ in prison than ESB prisoners. The focus group interviews also identified several factors that contributed to mental health differences between the groups. Findings reinforce the need for a more individualised approach in addressing mental health issues for prisoners cross-culturally.

Key words: Aboriginal, cultural and linguistic diversity, distress and coping, Indigenous, mental health and wellbeing, prisoners

Australia is among the most ethnically and culturally diverse countries (Australian Bureau of Statistics, ABS, 2016). Almost half (49%) of the Australian population were either born overseas or had a parent born overseas, and 21% of Australia’s population speak a language other than English at home (ABS, 2016). The increasing diversity of Australian society is mirrored in Australia’s prison population in which there are a growing number of prisoners from various ethnic and racial backgrounds. Aboriginal and Torres Strait Islanders remain the most over-represented group in the Australian prison system, accounting for 28% of the total prison population,1 yet fewer than 3% of the general population (ABS, 2017b).

There is also an increasing number of culturally and linguistically diverse (CALD) prisoners in Australian prisons (Bartels, 2011). The initialism ‘CALD’ refers to people in Australia from non-English-speaking backgrounds (Queensland Government, 2010). CALD individuals represent heterogeneous groups of people who have varying migration experiences and may differ across socio-economic, cultural, educational and language factors (Shepherd, 2016; Queensland Government, 2010). This is different from people originating from developed countries with English-speaking backgrounds (ESBs), such as New Zealand, Canada, the United Kingdom, United States and Ireland (Queensland Government, 2010).

Police and corrections agencies only record whether a person was born in Australia or overseas, which renders identifying the exact percentage of CALD prisoners unachievable (Bartels, 2011). Despite the challenges associated with identifying the cultural backgrounds of prisoners from agency records, it is estimated that at least 20% of the Australian prison population can be classified as CALD (ABS, 2017a). Additionally, groups of people from CALD backgrounds, including Vietnamese, Chinese, Lebanese, Sudanese, Iraqi, Malaysian and Samoan, are over-represented in Australian prisons (ABS, 2017a).

Mental health issues for prison populations

A key challenge facing prison populations is significantly high rates of mental illnesses compared to those in the general community (Fazel & Danesh, 2002; Fazel & Seewald, 2012; Ogloff, Davis, Rivers, & Ross, 2007). A systematic review and meta-regression analysis by Fazel and Seewald (2012) of 109 samples, including 33,588 prisoners, in 24 countries revealed disproportionate levels of psychosis and major depression among prisoners. Butler, Allnutt, Cain, Owens, and Muller (2005) examined the prevalence of mental illness in remand and sentenced prisoners from 28 correctional centres in Australia and found elevated rates of psychotic symptoms (9%), mood disorders (20%) and anxiety-related illnesses (36%). Additionally, posttraumatic stress disorder (PTSD) was present in 26% of remanded prisoners and 21% of sentenced prisoners (Butler et al., 2005). Studies have also revealed that prisoners with mental health issues are more likely than other prisoners to engage in self-harm, have problematic behaviours in prison and have poorer social outcomes after leaving jail, including a higher likelihood of recidivism (Cutcher, Degenhardt, Alati, & Kinner, 2014; Fazel, Grann, Kling, & Hawton, 2011; Forsythe & Gaffney, 2012; Jakobowitz et al., 2017).

Wellbeing, distress and coping in prison populations

To understand the mental health of prisoners, it is important to assess key factors such as wellbeing, distress and coping. This is in line with the dual continua model in which mental health is not simply regarded as the absence of mental illness, but includes positive psycho-social functioning as well (Peter, Roberts, & Dengate, 2011). Wellbeing refers to a person’s capacity to maintain a positive emotional state while functioning effectively in the various aspects of their life (Deci & Ryan, 2008). Wellbeing is defined as a multi-faceted concept comprising factors such as environmental mastery, personal growth and positive relations (Ryff & Keyes, 1995). Although the link between wellbeing and mental illness has not been definitively established, low levels of wellbeing are likely to be related to mental illness (Keyes, 2002). For the purposes of this research, we assume that higher levels of mental illness symptoms are associated with lower levels of wellbeing.

Another key mental health concept is distress, which refers to emotional suffering and discomfort that manifests in response to stressful experiences and circumstances. Distress is generally characterised by depressive (lack of motivation, despondency and hopelessness), anxiety (agitation and edginess) and, less frequently, somatisation symptoms (Keyes, 2002; Kirmayer, 1989). Past research has found that almost one third (31%) of inmates in Australia report experiencing high or very high levels of psychological distress (Australian Institute of Health and Welfare, AIHW, 2015).

Another key mental health term is coping, which refers to the ways that an affected person mitigates the impact of stressful circumstances (Snyder, 1999). Lazarus and Folkman (1984) defined coping as regularly altering cognitive and behavioural efforts to deal with demands deemed difficult or beyond the capacity of the person. Prisoners can manage their mental health by using and developing functional coping strategies (Maschi, Viola, Morgen, & Koskinen, 2015; Van Harreveld, Van der Pligt, Claassen, & Van Dijk, 2007).

Past research into CALD and Indigenous prisoner groups

Most Australian prison research makes no distinction between CALD and ESB prisoners. This is problematic as some CALD populations have experiences and cultural practices that differ from those of the general Australian population and may affect wellbeing, distress and coping (Shepherd, 2016). Many CALD groups have faced challenges not ordinarily experienced by the general Australian ESB population. For example, a number of people from CALD backgrounds have been subjected to traumatic and distressing conditions prior to arriving in Australia (Shepherd, 2016). The mental health problems stemming from exposure to premigratory trauma for certain CALD groups (e.g. Burmese, Sudanese) may be worsened by challenges during resettlement in Australia (Khawaja, McCarthy, Braddock, & Dunne, 2012; Schweitzer, Brough, Vromans, & Asic-Kobe, 2011; Schweitzer et al., 2006).

Those from CALD backgrounds who were born in Australia can also be detrimentally impacted by factors such as acculturation, discrimination, language barriers and socio-economic factors (Shepherd, 2016). These circumstances can lead to CALD groups being at increased risk of developing mental health issues (Nickerson, Bryant, Steel, Silove, & Brooks, 2010; Schweitzer et al., 2006, 2011; Shakespeare‐Finch & Wickham, 2010; Silove, Momartin, Marnane, Steel, & Manicavasagar, 2010) and may require consideration when assessing the mental health of CALD prisoners.

The mental health of Indigenous prisoners has received more research attention than that of CALD prisoners. Among Indigenous people, mental health is often conceptualised as ‘social and emotional wellbeing’, a culturally appropriate holistic approach that refers to the wellbeing of an individual and their community at large with a co-occurring spiritual dimension (Victorian Government, 2017). Research has found that significant numbers of Indigenous prisoners experience ongoing issues with mental illness. In a sample of 396 Indigenous Australian prisoners, it was discovered that 73% of men and 86% of women had at least one mental health issue, including anxiety, depressive, psychotic and substance misuse disorders (Heffernan, Andersen Dav, & Kinner, 2012).

Other research has found that Indigenous prisoners are exposed to elevated levels of trauma and live with high rates of PTSD and self-harming behaviours (Heffernan, Andersen, Davidson, & Kinner, 2015). Distress has also been found to be an ongoing issue for Indigenous prisoners (Shepherd, Ogloff, & Thomas, 2016). A study by the Australian Institute of Health and Welfare (2015) of 1,100 Indigenous and non-Indigenous prisoners, found that 17 to 20% of Indigenous prisoners exhibit high rates of distress. Research has also found that coping strategies are important in building psychological resilience and reducing the development of mental health issues, for Indigenous prisoners (Ogloff et al., 2013). Factors such as substance use issues, exposure to abuse, life stressors, witnessing violence and experiencing racism worsen the social and emotional wellbeing of Indigenous prisoners (Ogloff, Pfeifer, Shepherd, & Ciorciari, 2017).

Although some research exists regarding Indigenous prisoners’ mental health, studies have generally not investigated cross-cultural differences between Indigenous and non-Indigenous prisoners (Heffernan, Andersen, & Kinner, 2009). This lack of research specific to Indigenous prison populations is concerning given the high rates of recidivism for this group and that mental health issues among Indigenous prisoners are widespread and may be related to increased rates of recidivism (Fleming, Gately, & Kraemer, 2012; Smith & Trimboli, 2010). Moreover, factors such as unemployment, socio-economic disadvantage, substance use, lack of education and experiencing prejudicial behaviour disproportionately impact Indigenous people and increase the development of mental illnesses (Heffernan et al., 2012; Indig et al., 2010; Weatherburn, Jones, Snowball, & Hua, 2008).

The current research

This study investigates the mental health, wellbeing, distress and coping in a sample of Australian prisoners. Most studies have not investigated differences across cultural subgroups. The current lack of research means that cross-cultural differences across key mental health factors such as wellbeing, distress and coping have not been examined for Australian prisoners. The aims of this study are (a) to assess the mental health of CALD, Indigenous and ESB prisoner groups; (b) to assess whether there are significant differences in wellbeing, distress and coping between CALD, Indigenous and ESB prisoners; and (c) to investigate key factors in the prison environment contributing to differences in wellbeing, distress and coping in CALD, Indigenous and ESB prisoners.

Method

Participants

Approximately 800 prisoners at Port Phillip Prison (PPP) were invited to participate in a survey pertaining to mental illness and related factors. Prisoners housed in the units for people with cognitive impairments and mental illnesses were not invited to participate in the survey. PPP is a maximum-security prison housing remanded and sentenced male inmates in Victoria, Australia. Victoria is a state with 6.5 million people, more than 5 million of whom live in Melbourne, the state capital.

A total of 530 prisoners took part in the survey, which represents approximately two thirds of eligible prisoners. The sample was reduced to 477 due to incomplete surveys, atypical responding or having a score above 12 on the Paulhus Deception Scales Impression Management subscale (Paulhus, 1998).2 A further 13 participants were excluded as they did not answer key demographic items required to identify to which prisoner cultural group they belonged. Additionally, a minority of participants did not answer every item on the survey. However these participants’ surveys were retained as the rate of missing data was unlikely to bias the study results (Alison, 2009).

Relying on the demographic questions, the sample included CALD (n = 82, 17.7%), Indigenous (n = 64, 11.6%) and ESB (n = 328, 70.7%) prisoners. The mean age of participants (M = 34.23 years, SD = 10.13, range = 18–79 years) was not significantly different across the three groups. The sample comprised remanded (52.7%) and sentenced (44.6%) prisoners.

In the second phase of the study, 40 prisoners participated in focus groups. This sample included CALD (n = 10, 25%), Indigenous (n = 6, 15%) and ESB (n = 24, 60%) prisoners. The mean age of focus group participants (M = 31.90 years, SD = 11.35, range = 18–64 years) was not significantly different across the three groups. Both remanded (35%) and sentenced (65%) prisoners participated in the focus groups.

Procedure

The research team invited participants to complete the survey by advertising the study on message boards in prisoner units and in the programme building. Those who agreed to participate were assigned weekly sessions over a number of months in which prisoners completed the surveys in small groups in the presence of a member of the research team, who assisted them with literacy issues. At the commencement of the process, an explanatory statement outlining the voluntary and confidential nature of the study, as well as contact information for the research team, was provided to participants. Informed consent was obtained by having participants check the box to indicate that they had read and agreed with the information contained in the explanatory statement. The surveys took participants approximately 50 min to complete and included demographic items, subjective experiences of stress and stress management, current levels of wellbeing and coping skills.

Following the collection period for the surveys, members of the research team attended prisoner group meetings and education programmes advertising that focus groups would be run. Those prisoners who expressed interest in the groups were given explanatory statements. The research team then worked with the therapeutic services team at PPP to assign prisoners to different focus groups. Prior to the beginning of the focus groups, participants were required to provide informed consent and to complete a brief demographic questionnaire. Each focus group took 90–120 min to complete, and the groups were held over different days in the programme building at PPP. Groups were facilitated by one postgraduate and two clinical psychologists who were employed as researchers. Focus groups were recorded and later transcribed. Extensive notes were also taken during the course of the interviews.

Measures

Demographics questions

Information about the cultural backgrounds, country of birth and languages spoken at home was obtained. Responses to these questions were used to allocate participants to cultural subgroups.

Kessler Psychological Distress Scale (K–10)

The K–10 was used to assess general psychological distress over the past four weeks (Kessler et al., 2002). The K–10 comprises 10 items examining symptoms and emotions commonly associated with distress. These are measured on a 5-point scale from 1 (none of the time) to 5 (all of the time). Scores are aggregated to create a total score ranging from 0 to 50. Scores from 22–29 indicate high levels of distress, and 30–50 indicate very high levels of distress (ABS, 2017c). Research supports the reliability and validity of the K–10 in predicting psychological distress (Furukawa, Kessler, Slade, & Andrews, 2003; Kessler et al., 2003).

General Health Questionnaire–28 (GHQ–28)

This scale was used to assess mental health disorder symptoms over the past few weeks (Goldberg, 1978). The GHQ–28 includes 28 items across four subscales: Somatic, Anxiety/Insomnia, Social Dysfunction and Severe Depression. Items are rated on a 4-point scale: (0) not at all, (0) no more than usual, (1) rather more than usual and (1) much more than usual. Scores above four on a the scale, suggest the likely presence of elevated mental illness symptoms (Sterling, 2011). Research supports the reliability and validity of the GHQ–28 in screening for mental health issues (Failde, Ramos, & Fernandez-Palacin, 2000; Sterling, 2011).

The PTSD–Civilian Version (PCL–C)

This scale was used to assess PTSD symptoms over the past month (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996). The PCL–C comprises 17 items that assess a range of symptoms associated with PTSD, rated on a 5-point scale: (1) not at all, (2) a little bit, (3) moderately, (4) quite a bit and (5) extremely. Total scores range from 17 to 85, with higher scores reflecting elevated levels of PTSD symptoms. There is no absolute cut-off score for the PCL–C, but score above 35 suggest problematic PTSD symptom levels (U.S. Department of Veteran Affairs, 2012). Research supports the reliability and validity of the PCL–C in measuring PTSD symptoms (Conybeare, Behar, Solomon, Newman, & Borkovec, 2012; Wilkins, Lang, & Norman, 2011).

The Paulhus Deception Scale (PDS)–Impression Management subscale

This subscale was used to assess socially desirable responding and to identify participants likely to be dishonest when responding to survey items (Paulhus, 1998). This 20-item subscale is designed to be administered in a battery of assessments with other instruments as a way of testing their validity. Respondents are measured on a 5-point scale from 1 (not true) to 5 (very true). Research supports the reliability and validity of this subscale with forensic populations, with scores above 12 revealing unacceptable levels of social desirability (Lanyon & Carle, 2007; Tully, Tully, Bailey, & Bailey, 2017).

The Brief Cope Inventory (Brief COPE)

The Brief COPE (Carver, 1997) includes 28 items that assess 14 different coping strategies and techniques: self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioural disengagement, venting, positive reframing, planning, humour, acceptance, religion/spirituality and self-blame. Items are rated on a 4-point scale: (1) I haven’t been doing this at all, (2) I’ve been doing this a little bit, (3) I’ve been doing this a medium amount and (4) I’ve been doing this a lot. Research supports the reliability and validity of the Brief COPE in measuring coping in diverse populations (Carver, 1997; Monzani et al., 2015).

Ryff’s Psychological Wellbeing Scale (PWB)

This scale was used to assess wellbeing (Ryff & Keyes, 1995). The PWB includes 42 items, rated on a 6-point scale (from strongly disagree to strongly agree) that assess wellbeing. Although the PWB is made up of six subscales, we only included three subscales in this study: Personal Growth, Positive Relations and Environmental Mastery. This is because prior research has found significant item overlap on the PWB, rendering it unnecessary to include all (Kafka & Kozma, 2002; Springer & Hauser, 2006).

Semi-structured interview guide

A semi-structured interview guide was developed for use in the focus group interviews. This was to help ensure that the same topics were covered across different groups. Topics discussed included factors in the prison environment impacting on the wellbeing, distress and coping of prisoners.

Data analysis

The study employed a sequential explanatory design. The quantitative data (surveys) were collected first and analysed, followed by the qualitative data (focus groups). Focus group data were used to supplement and provide greater insight into the survey data (Hanson, Creswell, Clark, Petska, & Creswell, 2005). Quantitative analyses were carried out using SPSS Version 22. The study used multiple one-way analyses of variance (ANOVAs) to assess differences between CALD, Indigenous and ESB prisoners on the K–10, PCL–C and the Brief COPE measures. The data on these measures met the assumptions necessary to run one-way ANOVAs (Field, 2013). To reduce the likelihood of Type I error, the Bonferroni correction was employed to assess the accuracy of significant results occurring on the one-way ANOVA tests. Additionally, Kruskal–Wallis H tests were also used to assess differences between, CALD, Indigenous and ESB prisoner groups on the GHQ–28 and the PWB subscales. The data on these measures violated key one-way ANOVA assumptions, but met the necessary requirements to run Kruskal–Wallis H tests (Field, 2013). Pairwise comparisons were performed using Dunn’s (1964) procedure with Bonferroni correction for multiple comparisons. Adjusted p-values are reported.

For the qualitative analysis, prisoners were again allocated to cultural subgroups based on the answers they gave on the brief demographic questionnaire. The analyses were carried out using NVIVO qualitative statistical software. To assess those factors affecting the wellbeing, distress and coping of CALD, Indigenous and ESB prisoners, a thematic analysis of the focus group data occurred using the Braun and Clarke (2006) guidelines. A process of sorting and classifying these main categories or themes was undertaken by a process of comparing, combining and coding sections of the text.

Results

On the K–10, 23.7% of prisoners reported high levels of distress, and 39.3% of prisoners reported very high levels of distress (M = 27.68, SD = 9.94). On the PCL–C, 70.3% of prisoners reported problematic levels of PTSD symptoms (M = 47.49, SD = 16.15). On the GHQ–28 Somatic subscale, 21.3% of prisoners reported problematic levels of somatic symptoms (M = 2.40, SD = 2.23). On the GHQ-28, 57.4% of prisoners reported elevated levels of mental illness symptoms. The review of GHQ-28 subscales, found that the most elevated scores were on the anxiety/insomnia symptoms (M = 3.01, SD = 2.53), then somatic symptoms (M = 2.38, SD = 2.23), then social dysfunction symptoms (M = 2.24, SD = 2.31) and then severe depression symptoms (M = 1.98, SD = 2.50). On the Brief COPE the most reported coping styles were acceptance (M = 5.74, SD = 1.76), self-distraction (M = 5.67, SD = 1.70), planning (M = 5.45, SD = 1.86) and active coping (M = 5.33, SD = 1.81).

Cross-cultural differences across mental health scores

The mean and standard deviations for the K–10, PCL–C and Brief Cope (BC) across the cultural groups are presented in Table 1. The K–10 mean score differences across cultural groups were significantly different, F(2, 409) = 4.34, p < .05, with the highest scores for Indigenous prisoners (M = 31.14, SD = 9.89), followed by ESB prisoners (M = 27.49, SD = 9.84) and CALD prisoners (M = 25.83, SD = 9.93). Post hoc analysis revealed that the difference between Indigenous and CALD prisoners (5.31, 95% confidence interval, CI [.97, 9.64]) was statistically significant, p = .01, as was the difference between Indigenous and ESB prisoners (3.65, 95% CI [0.14, 7.17]), p = .04. There were no other significant differences in group scores.

Table 1.

Mean and standard deviations across K–10, PCL–C and Brief Cope measures.

  Total M (SD) CALD M (SD) Indigenous M (SD) ESB M (SD) F
K–10 27.68 (9.94) 25.83 (9.93) 31.14 (9.89) 27.49 (9.84) F(2, 409) = 4.34*
PCL–C 47.49 (16.15) 44.45 (14.61) 49.47 (16.96) 47.90 (16.32) F(2, 394) = 1.69
BC          
 Self-distraction 5.67 (1.70) 5.60 (1.67) 6.08 (1.84) 5.62 (1.68) F(2, 402) = 1.62
 Active coping 5.33 (1.81) 5.26 (1.74) 5.65 (1.85) 5.29 (1.81) F(2, 407) = 0.85
 Denial 3.71 (1.87) 4.01 (1.79) 4.04 (2.10) 3.58 (1.84) F(2, 406) = 2.38
 Substance use 3.85 (2.27) 4.02 (2.32) 4.04 (2.35) 3.79 (2.25) F(2, 408) = 0.46
 Emotional support 3.95 (1.71) 4.13 (1.62) 4.04 (1.98) 3.89 (1.69) F(2, 403) = 0.61
 Instrumental support 4.37 (1.82) 4.88 (1.84) 4.41 (1.93) 4.26 (1.79) F(2, 400) = 3.01
 Behaviour disengagement 3.97 (1.78) 3.89 (1.73) 4.11 (1.83) 3.96 (1.78) F(2, 400) = 0.204
 Venting 4.02 (1.63) 4.41 (1.81) 4.06 (1.70) 3.93 (1.57) F(2, 402) = 2.38
 Positive reframing 4.96 (1.80) 4.93 (1.86) 5.17 (1.78) 4.93 (1.79) F(2, 408) = 3.70
 Planning 5.45 (1.86) 5.63 (1.79) 6.04 (2.05) 5.31 (1.82) F(2, 400) = 3.65
 Humour 3.95 (1.97) 4.12 (1.95) 3.90 (2.07) 3.92 (1.97) F(2, 403) = 0.30
 Acceptance 5.74 (1.76) 5.48 (1.64) 6.08 (1.86) 5.74 (1.76) F(2, 405) = 1.67
 Religion 4.04 (2.06) 5.26 (2.11) 4.16 (2.16) 3.74 (1.92) F(2, 404) = 15.78**
 Self-blame 5.05 (1.91) 5.00 (2.02) 5.34 (1.96) 5.02 (1.88) F (2, 405) = 0.65
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Note. N = 464. K–10 = Kessler Psychological Distress Scale; PCL–C = PTSD–Civilian Version, where PTSD = posttraumatic stress disorder; BC = Brief Cope; CALD = culturally and linguistically diverse; ESB = English-speaking background.

*p < .05.

**p < .000.

On the PCL–C, scores were higher for Indigenous prisoners (M = 49.47, SD = 16.96), followed by ESB prisoners (M = 47.90, SD = 16.32) and CALD prisoners (M = 44.45, SD = 14.61). There were no significant differences in group scores, F(2, 394) = 1.69, p = .19.

Scores on the BC Religion/Spirituality subscale differed significantly across cultural groups, F(2, 404) = 15.78, p < .005. Scores were highest for CALD prisoners (M = 5.26, SD = 2.11), followed by Indigenous prisoners (M = 4.16, SD = 2.16) and ESB prisoners (M = 3.74, SD = 1.92). Post hoc analysis revealed that the mean difference between CALD and Indigenous prisoners (1.09, 95% CI [0.21, 1.97]) was statistically significant, p = .01, as was the difference between CALD and ESB prisoners (1.51, 95% CI [0.88, 2.15]), p = .001. There were no other significant differences in group scores on the other BC subscales.

Results from the GHQ–28 and PWB are presented in Table 2 and are summarised here. Median scores on the GHQ–28 Anxiety/Insomnia subscale differed significantly across cultural groups, χ2(2) = 6.32, p = .04. Post hoc analysis revealed statistically significant differences between Indigenous prisoners (Mdn = 4) and CALD prisoners (Mdn = 2, p = .04), but neither group’s scores differed significantly from those of ESB prisoners (Mdn = 3).

Table 2.

Mean and standard deviations across GHQ–28 and PWB subscales.

  Total M (SD) CALD M (SD) Indigenous M (SD) ESB M (SD) χ2
GHQ–28          
 Somatic subscale 2.38 (2.23) 1.90 (2.05) 2.62 (2.20) 2.46 (2.26) 4.67
 Anxiety/Insomnia subscale 3.01 (2.53) 2.50 (2.45) 3.64 (2.44) 3.02 (2.54) 6.32*
 Social Dysfunction subscale 2.24 (2.31) 1.89 (2.16) 2.28 (2.18) 2.32 (2.36) 1.46
 Severe Depression subscale 1.98 (2.50) 1.33 (2.12) 2.54 (2.61) 2.03 (2.54) 7.51*
PWB          
 PG 24.18 (6.65) 24.87 (5.50) 24.15 (7.28) 24.02 (6.79) 1.76
 PR 22.27 (6.40) 23.20 (6.72) 23.53 (6.88) 21.84 (6.21) 5.18
 EM 20.46 (6.39) 22.38 (6.00) 21.13 (7.06) 19.90 (6.28) 11.41*
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Note. N = 464. GHQ–28 = General Health Questionnaire–28; PWB = Ryff’s Psychological Wellbeing Scale; PG = Personal Growth; PR = Positive Relations; EM = Environmental Mastery; CALD = culturally and linguistically diverse; ESB = English-speaking background.

*

p < .05.

On the GHQ–28 Severe Depression subscale, median score differences across cultural groups were significantly different, χ2(2) = 7.51, p = .02. Post hoc analysis revealed statistically significant differences in the Severe Depression subscale scores between Indigenous prisoners (Mdn = 2) and CALD prisoners (Mdn = 1, p = .02), but no other statistically significant differences with ESB prisoners (Mdn = 1). There were no other significant differences in group scores on the other GHQ–28 subscale scores.

On the PWB Environmental Mastery subscale, median score differences across cultural groups were significantly different, χ2(2) = 11.41, p = .003. Post hoc analysis revealed statistically significant differences in Environmental Mastery subscale scores between CALD prisoners (Mdn = 21.50) and ESB prisoners (Mdn = 18.90, p = .003), but no statistically significant differences with Indigenous prisoners (Mdn = 21.43). There were no other significant differences in group scores on the other PWB subscale scores.

Qualitative analysis

Focus group data were thematically analysed by assessing key factors in the prison environment that may impact the mental health of CALD, Indigenous and ESB prisoners: family, living situation in prison, access to programmes and services, and coping with prison.

Family

A number of CALD, Indigenous and ESB prisoners stated that separation from their families and partners had a strong negative effect on their wellbeing, as it left them feeling isolated, lonely and paranoid. Prisoners also reported difficulties contacting and seeing their loved ones. The primary method most prisoners used to speak to their families was via landline telephones in their units. However, the expense, strong demand to use the phones and the need for calls to be made to a landline phone reportedly prevented some prisoners from contacting their families and partners as regularly as they wanted.

Similarly, prisoners from all backgrounds reported that they found it distressing to see the treatment their families received when entering the prison, including being spoken to harshly, made to wait and sometimes being stripped searched. One prisoner stated that a lot of families ‘who aren’t connected to anything, just average normal people, are treated like they’re criminals’. The prison environment was described as overwhelming for some family members and unsuitable for children. Supposedly, it even caused some inmates to tell their families not to visit as they found it too distressing seeing their families treated this way.

A number of Indigenous prisoners commented that being separated from their families and communities was especially challenging, as these things are a ‘big part’ of their Indigenous culture. A number of Indigenous prisoners also stated that their distress was increased by the challenging circumstances facing their families on the outside. For instance, one Indigenous prisoner stated that whenever he would ring his family, ‘it’s just problem after problem. It’s your cousin got bashed, or . . . this is happening to your kids’. As a consequence, this prisoner reported that he no longer contacts his family. Indigenous prisoners also stated that family members’ mental health and substance use issues outside of prison are sources of stress. As one Indigenous prisoner commented, ‘we’re not psychologists or fucking counsellors or shit like that. We’re already fucking finding it hard to cope ourselves’.

Living situation in prison

Numerous prison living issues were identified by CALD, Indigenous and ESB prisoners as detrimental to their wellbeing and distress levels. For instance, several prisoners found it to be challenging living in an environment where intimidation, threats and physical violence are a common occurrence and that it is necessary to be constantly vigilant. Likewise, it was challenging living in an environment where there are many unwritten rules and hierarchies that if violated (even inadvertently) can lead to violent physical repercussions. One prisoner stated ‘there’s nothing handed to you when you first time come into jail going . . . don’t do this because the consequences are going to be drastic’. These factors, along with getting used to the regimentation of prison, were identified as key reasons for why the prison environment is especially challenging for inmates new to prison.

Many prisoners expressed displeasure with many of the prison officers who they believed to be ‘rude’ and lacking ‘respect’. Prisoners reported that if they responded to these officers, they would face punitive measures, including being placed into management and having their privileges taken away. A number of inmates also felt frustrated by the inconsistent application of rules by prison officers. Similarly, prisoners expressed irritation that many officers ignored and failed to assist them with relatively straightforward issues.

Many inmates indicated that they found living in the prison while on remand especially challenging. The remand period was described as a ‘pressure cooker’ and an ‘awful experience’ for prisoners, as they did not know the duration of their incarceration. This uncertainty was identified as stress inducing and allegedly led to some inmates pleading guilty to get clarity about their legal situation. In contrast, sentenced prisoners complained about living in units that housed high numbers of remanded prisoners, as this resulted in regular turnover and instability in the units with many prisoners coming and going. One prisoner remarked that sentenced inmates do not want to deal with people ‘coming in off the street withdrawing from drugs or just still bouncing around a bit and not understanding where they’re going’. Both remanded and sentenced prisoners also stated that they find it frustrating being forced to spend ‘24 hours a day’ in small and overcrowded units, seeing the same prisoners every day. Similarly, prisoners who shared a cell found their lack of privacy an ongoing challenge and irritation.

A number of Indigenous prisoners also commented that being housed in various units around the prison reduced their wellbeing, as it restricted their ability to see fellow Indigenous inmates, many of whom they reported being related to or knowing prior to imprisonment. One Indigenous prisoner commented that time together with other Indigenous people is important, because ‘they’re part of our family . . . we are brothers, and we get to talk to them and it helps us relax’. It was alleged that when living together, Indigenous prisoners feel better protected, supported and more in control of their environment, which reduces their distress levels. In addition, some Indigenous inmates also reported being victims of discrimination in prison.

Poor access to services and programmes

CALD, Indigenous and ESB prisoners stated that a lack of access to mental health services and programmes had a detrimental impact upon their wellbeing. A number of prisoners spoke about the high rates of mental illness in the prison population and their own mood, anxiety, substance, trauma and psychotic disorders. It was reported that the prison did not provide adequate services to support prisoners with mental health problems. A number of prisoners stated that they wanted to improve their mental health but found it difficult accessing the necessary services in prison, including mental health professionals and other therapeutic services. Some prisoners stated that even when suicidal, they are not given access to mental health services, but are placed in an empty cell for a period of time.

There were also criticisms about the quality and long wait time to see medical professionals in prison. Prisoners also complained about the extended time it took to access educational and training courses and the limited courses to choose from, as well as the lack of recreational opportunities in the prison, including restrictions on using the gym, sports equipment, library and yards. It was commented that in general there is a lack of recreational ‘programmes’ and ‘activities’ in the prison to help ‘release stress’. A number of remanded prisoners also complained about being prohibited from undertaking educational courses and programmes available to sentenced prisoners. This is despite some of these prisoners communicating that they had been remanded in jail for up to two years.

For some CALD prisoners, limited English language capacity meant they could not undertake some educational courses and programmes that require a basic level of reading and writing, as well as accessing mental health services and purchasing items on the computerised ordering system. It was also stated that while there are Aboriginal Liaison Officers who assist Indigenous prisoners, there is no equivalent for CALD prisoners. These workers were regarded as being particularly important for CALD prisoners who do not speak English fluently and subsequently are at increased risk of being isolated in the prison.

Moreover, a number of Indigenous prisoners expressed a desire for more programmes in which they learnt about Indigenous traditions and customs. They reported that there had previously been more opportunities to undertake these programmes. One Indigenous prisoner stated, ‘We don’t get to do our Koori programmes properly. Every second Monday we used to get to Koori garden so all us mob can get away, but they don’t do that no more’. It was stated that for Indigenous prisoners, connecting to their culture and heritage is very important to their welfare. Other Indigenous prisoners criticised the current programmes and learning opportunities available to them, indicating they wanted programmes that ‘actually interact and help with culture and that’. In particular, Indigenous prisoners wished for greater access to painting materials, emphasising the cultural importance of this activity and that it acted as a form of meditation. Indigenous prisoners also expressed a desire for greater access to Elders in the prison, due to their cultural significance and the advice that they could give. Older Indigenous inmates also spoke about wanting to provide advice to younger Indigenous prisoners about how to be safe in prison and avoid using illicit substances.

Coping with prison

CALD, Indigenous and ESB prisoners indicated a number of strategies to cope with the stress of prison. A common coping strategy was exercising and going to the gym, since for many prisoners this helped to improve their mood and made them feel healthier. Equally common was speaking to fellow prisoners and peer listeners (inmates paid by the prison to assist other prisoners) about the difficulties they were experiencing. A number of prisoners interviewed also mentioned that they used humour to cope with being in prison, trying to make light of their situation. Other prisoners identified that they tried to keep as busy in prison as possible, establish a routine and distract themselves from their present situation by working, doing programmes and education (when available), playing cards and exercising. It was also suggested that many prisoners used illicit and non-prescribed drugs to cope with their incarceration. Participants also stated that they used religion and spiritual practices to cope with being in prison, attending religious and spiritual ceremonies, speaking with religious figures or elders and reading religious scripts. It was agreed that it was relatively easier accessing religious/spiritual based services than other services in the prison.

It was also stated that some CALD prisoners found it relatively easier to cope in the prison environment due to experiencing more extreme and distressing conditions in their countries of origin. For instance, one CALD prisoner stated that in his country of origin he would mostly just get one ‘cup of rice’ each day and was expected to live off that. This prisoner consequently stated that he had been ‘through worse situations’ than being imprisoned in Australia. A number of prisoners in the focus groups also mentioned that in prison there are some large groups of CALD inmates from African, Asian, Pacific Islander and Arabic backgrounds. It was agreed that belonging to one of these groups in prison came with safety benefits, as no one can physically assault any prisoner belonging to these groups without consequences. This led to these inmates reportedly feeling safer than prisoners not in this position, especially those who find themselves isolated. As one CALD prisoner stated: ‘You just don’t have any support. If something happens you’re on your own. Whereas those groups, no one can touch you without there being repercussions.’

Discussion

This is the first Australian study to assess differences in key mental health factors between adult male CALD, Indigenous and ESB prisoners. This topic is generally understudied internationally. The focus on assessing wellbeing, distress and coping among CALD, Indigenous and ESB prisoners provides important information into the mental health of these cross-cultural groups. Furthermore, the focus group discussions enabled a deeper contextual insight into environmental issues in prison that can impact the mental health of these groups. Consistent with the international and Australian literature (Butler et al., 2005; Fazel & Seewald, 2012), the study found significantly high rates of mental health disorder symptoms for all three prison groups surveyed, as well as significant mental health differences across cross-cultural prison groups. These findings are also reflected in the focus group discussions in which a number of prisoners reported that mental health problems are a major issue facing the prison population.

Mental health differences across cross-cultural prison groups

The study found significant mental health differences across the three groups. Indigenous prisoners reported lower rates of wellbeing and higher rates of distress than CALD and ESB prisoners. This is based on Indigenous prisoners exhibiting significantly higher symptom levels of insomnia/anxiety and depression than CALD prisoners, as well as significantly higher levels of distress than CALD and ESB prisoners. Although previous research has reported comparatively high levels of depression, anxiety and distress in Indigenous Australians in correctional settings (Heffernan et al., 2015; Heffernan et al., 2012; Ogloff, Pfeifer, Shepherd, & Ciorciari, 2017; Shepherd, 2016), there is no previous research that has quantitatively identified differences in mental health issues between adult male CALD, Indigenous and ESB prisoners.

The focus groups with Indigenous prisoners offers some insight into factors that may contribute to their difficulties, including separation from their families and communities, worrying about socio-economic and mental health issues facing their families outside of prison and perceived discrimination. The focus groups also revealed that practices in prison are potentially reducing the wellbeing of this group, as they involve Indigenous prisoners being separated into different units in the prison and having limited access to Elders, painting materials and other culturally significant programmes. These practices reduce the time Indigenous prisoners spend together and perhaps also the connection they feel to their heritage and culture. Past research has found that a lack of connection to Indigenous culture and heritage, and separation from family and community, reduces Indigenous prisoners’ social and emotional wellbeing (Ogloff et al., 2017; Shepherd, Delgado, & Paradies, 2018).

The results of the study also found no significant differences between CALD and ESB prisoners in symptoms of mental health disorders. There was a difference, however, in the levels of wellbeing between these groups. CALD prisoners appeared to have higher levels of environmental mastery than ESB prisoners. Environmental mastery is a key factor in assessing wellbeing overall, involving feeling in control of one’s own living environment (Ryff & Keyes, 1995). Consequently, the study found that in the prison environment, CALD inmates feel more comfortable, self-assured and in control than ESB inmates. There is no past research that has assessed differences in environmental mastery between CALD and ESB prisoner groups. However, the focus group interviews with CALD participants did provide some possible reasons for this trend. For instance, for some CALD prisoners experiencing extreme conditions in their countries of origin helped prepare them for the onerous conditions of imprisonment in Australia. It was also suggested that in prison there are groups containing a large number of CALD inmates. This may increase the safety and security of these CALD prisoners as they are less likely to be physically assaulted by other prisoners.

It was also found that CALD inmates are more likely to use religious/spiritual practices and beliefs to cope with being in prison than either Indigenous or ESB prisoners. This is significant given that the focus group interviews revealed that the use of religious/spiritual practice is a common coping strategy across all three prisoner groups. There is no previous forensic literature that has assessed differences in coping techniques and strategies between CALD, Indigenous and ESB prisoners. However, prior research has found that in stressful circumstances, such as in prison, the use of religious belief as a coping strategy is associated with lower levels of distress and better mental health (e.g. Mandhouj, Aubin, Amirouche, Perroud, & Huguelet, 2014).

Limitations

A limitation of the study is the heterogeneous nature of the term CALD, as it represents a diverse range of people who may differ significantly on cultural factors and traditions. To more accurately report on the experiences of CALD prisoners, it is necessary that future research divides CALD prisoners into more specific groupings. This can provide a more accurate assessment of mental health factors in these diverse populations. Additionally, the recruitment of participants for this project occurred exclusively at an adult male prison, restricting the generalisability of the findings of this study. There is a need for future research that assesses the mental health of CALD, Indigenous and ESB women and juvenile prisoners.

Implications

The study found significantly high rates of mental health issues across all three groups of prisoner surveyed, which according to first-hand accounts by prisoners is worsened by lack of access to mental health services in the prison. It is apparent that there are shortages of services available to help prisoners deal with their mental health issues. For this situation to improve, the Australian prison system need’s to make available a greater level of mental health services, including greater access to mental health workers, as well as other medical professionals and reducing the time it takes for prisoners to access these services. A lack of access to mental health services is concerning given the detrimental impact of mental health issues on prisoners and also that prisoners experiencing these issues are more likely to recidivate and engage in various problematic behaviours in prison (Cutcher et al., 2014; Forsythe & Gaffney, 2012; Jakobowitz et al., 2017). Similarly, increasing the amount of educational and recreational opportunities available in the prison could perhaps also improve the mental health of prisoners (Fazel, Hayes, Bartellas, Clerici, & Trestman, 2016; Gallant, Sherry, & Nicholson, 2015). It is also important that remanded prisoners have the same level of access to services as sentenced prisoners.

There is also a range of other factors in the prison environment that were identified by prisoners as impacting negatively upon their distress and wellbeing. These include challenges in contacting and seeing their families, the dangerous nature of the prison environment, issues with how some prison officers enforce and apply rules, and sentenced and remanded prisoners living together in the same units. There is a need for future research to study the relationship between these environmental factors in prison and the mental health of inmates.

Furthermore, the study demonstrated that some key mental health differences exist between cultural groups, highlighting the need for future research into Australia’s prison population to consider these groups as distinct from each other. The study also indicated that CALD prisoners exhibited high rates of mental health disorder symptoms, despite these rates being lower or roughly equal to those of Indigenous and ESB prisoners. This highlights the need for culturally sensitive services for CALD prisoners, employing people in the prison to specifically work this population and ensuring that CALD inmates have the same access to services as other inmates in the prison.

Moreover, another key finding was that Indigenous prisoners had higher rates of distress than CALD and ESB prisoners and higher rates of anxiety/insomnia and depression symptoms than CALD prisoners. This indicates the need for a greater emphasis on improving the mental health of Indigenous prisoners, the most over-represented group in the Australian prison system. The focus group interviews identified a number of issues that seem to contribute to this trend for Indigenous prisoners. A number of these factors reflect wider society generally and the systemic disadvantage facing many Indigenous people in Australia. However, the focus group interviews also identified a number of practices and conventions that fall under the purview of the prison system, including a lack of access to culturally significant programmes and activities, perceived discrimination and separation from fellow Indigenous prisoners. These can be modified by the Australian prison system and would be likely to improve the social and emotional wellbeing of Indigenous prisoners.

Conclusion

This study is the first in Australia to examine key mental health factors between adult male CALD, Indigenous and ESB prisoners. It was found that mental health issues are a significant concern across cross-cultural groups, demonstrating the need for increased mental health services and other modifications to the prison system. The study also found significant mental differences between the groups, which indicate the heterogeneous nature of the prison population and the need for a more individualised approach in addressing mental health issues in this population.

Ethical standards

Declaration of conflicts of interest

Arran Rose has declared no conflicts of interest

Justin Trounson has declared no conflicts of interest

Jason Skues has declared no conflicts of interest

Michael Daffern has declared no conflicts of interest

Stephane M. Shepherd has declared no conflicts of interest

Jeffrey E. Pfeifer has declared no conflicts of interest

James R. P. Ogloff has declared no conflicts of interest

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study

Notes

1

The rate of Indigenous incarceration varies across different states and territories in Australia, from 8% in Victoria to 84% in the Northern Territory (Australian Bureau of Statistics, ABS, 2015).

2

Scores above 12 on the Impression Management subscale suggest that a participant is probably being dishonest and may be presenting a ‘false’ favourable impression (faking good) (Paulhus, 1998).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The authors are grateful to the staff at Port Phillip Prison and the prisoners who participated in this research and to Dennis Roach and Jacinta Connor for their contributions to the research. The views expressed in this article do not necessarily reflect the views of G4S Australia or the Government of Victoria.

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