OP60 The patterning of post-imprisonment mortality and mental health and substance use-related health contacts: findings from a nationwide retrospective cohort study using linked administrative data (RELEASE)

Citation

Kjellgren R, Savinc J, Hunt K & Connell C (2026) OP60 The patterning of post-imprisonment mortality and mental health and substance use-related health contacts: findings from a nationwide retrospective cohort study using linked administrative data (RELEASE). In: Society for Social Medicine Annual Scientific Meeting Abstracts, London, 09.09.2026. BMJ Publishing Group Ltd, pp. A30.2-A31. https://doi.org/10.1136/jech-2026-ssmabstracts.60

Abstract
Background The prison population is characterised by elevated rates of mental health and substance use problems. Imprisonment and release are associated with transitional challenges, including interruption of care, stigma, marginalisation, and inaccessible health services. This contributes to increased use of emergency services and mortality, largely driven by poor mental health and substance use. Evidence on the patterning of post-imprisonment mortality and health contacts is critical to prevent adverse outcomes. This research aims to: understand the causes and timing of post-imprisonment mortality; quantify differences in health service contact for mental health and substance use pre- and post-release from prison; and explore variations between subgroups based on sociodemographic, health and criminological risk factors. Methods We linked prison, health and mortality data and conducted the first whole-system, nationwide, retrospective cohort study of post-imprisonment health contacts internationally, and the most contemporary UK study of post-imprisonment mortality. Everyone released from a Scottish prison in 2015 was included in the cohort (n=8,313) and observed for four-years following index release. Primary outcomes were mortality rates and health contacts for mental health and substance use in nine health services (community prescribing, mental health outpatient, substance use outpatient, 24-hour tele-helpline, out-of-hours general practice, emergency department, ambulance, psychiatric inpatient, general inpatient). Incidence rate ratios (IRRs) with 95% confidence intervals (CI) were used to compare pre- and post-imprisonment contact rates. Negative binomial models were estimated to examine subgroup variation across services. Descriptive statistics were used to explore post-imprisonment all-cause mortality and drug-related death rates, with survival analysis and more detailed analyses underway. Results 712 (crude mortality rate: 8.6%) deaths occurred within four-years of index release. Mean time-to-death was 736 days (sd=446). Drug-related deaths account for the largest proportion of post-imprisonment mortality (57%). Service contact rates increased post-imprisonment in five out of nine services, with the largest increases for out-of-hours primary care (IRR=2.17[CI:1.37-3.80]) and general inpatient hospitalisations (IRR=1.40[CI:1.01-1.99]). Sociodemographic, health and criminological factors contribute to variability in post-imprisonment service contacts and demonstrate complex patterns across services. People with multiple previous prison episodes have increased rates of post-imprisonment contacts in eight out of nine services, including ambulance contacts (adjusted IRR=1.12[CI:1.09-1.15]) and emergency department admissions (adjusted IRR=1.18[CI:1.15-1.21]). Conclusion Criminological risk factors contribute to different post-imprisonment experiences and variability in health service contacts, and most deaths occurring are drug-related. Criminal justice and health policymakers must consider how imprisonment and release exacerbate mental health and substance use needs, and ensure harms of imprisonment are minimised.