Abstract

Author(s)

Steven Hutchinson & Jac Fortunaso

Affiliations

Central Adelaide Local Health Network

Introduction

Anxiety and depression are significant concerns among people in custody, with nearly half reporting a diagnosed mental health disorder. Without access to Medicare, prisoners are excluded from Mental Health Care Plans and digital self-help therapies, creating a treatment gap for those with mild to moderate symptoms. Untreated mental illness not only affects psychological wellbeing but also contributes to poorer physical health outcomes—such as sleep disturbance, chronic disease risk, and substance misuse—further compounding health inequities in this population. This project aimed to evaluate the effectiveness of self-directed workbooks designed to improve mental health, emotional regulation, and physical health behaviours during incarceration.

Method

Ethics approval was granted prior to implementation. Five themed workbooks—anxiety, depression, emotional regulation, exercise, and drugs in prison—were co-designed with prisoners and health professionals. Participants across seven South Australian prisons completed pre- and post-intervention assessments using DASS-21 and HADS to measure changes in anxiety and depression.

Results and Findings

Eighty-nine participants enrolled, with 76 completing at least two workbooks and 49 completing all five. Post-intervention scores showed a reduction in anxiety and depression on both DASS-21 and HADS. Participants also reported improved sleep quality, healthier lifestyle choices (diet and exercise), and greater motivation to reduce substance use—highlighting the workbooks’ impact on physical as well as mental health.

Discussion

The Mindfulness Wellbeing Program empowered participants to manage their mental and physical health through self-awareness, behaviour change, and skill-building. By addressing exercise, sleep, and nutrition alongside emotional wellbeing, the program promoted a holistic model of care, reducing reliance on acute services and encouraging early intervention. Integration into standard SAPHS wellbeing services supports sustainable improvements in both mental and physical health and informs future collaborations, including Behavioural Activation research in custodial settings.