NHMRC Partnership Projects · Application 2057961

HOPE

Health Outcomes and Post-incarceration Evaluation

Australia's first large-scale causal study of how incarceration affects health. HOPE links justice and health records across 410,000+ cases to answer a question that correlational studies cannot: what does prison itself do to people's health, and what would have happened under a community sentence instead?

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13× higher mortality risk after release vs. general population
27× overdose risk in the first two weeks after release
410,000+ linked justice-health cases in scope
$6.8B annual public expenditure on prisons in Australia

The problem

Australia has a $6.8 billion prison system and almost no causal evidence on what it does to health.

Over 80% of people entering custody have a diagnosed mental disorder. Up to two-thirds have substance dependence. Aboriginal and Torres Strait Islander peoples are incarcerated at 16 times the rate of non-Indigenous Australians. Yet existing evidence is almost entirely correlational — it describes who goes to prison, not what prison does to them.

Without causal evidence, it is impossible to know whether custody worsens health outcomes relative to community-based alternatives, and by how much. Large investments in correctional healthcare, diversion, and reintegration programs risk being poorly targeted or only partially effective.

HOPE is designed to fill that gap — not with another descriptive study, but with the strongest causal design currently feasible at this scale in Australia.

The approach

A quasi-experimental design that makes causal inference possible at scale.

The core insight is simple: matters are quasi-randomly allocated to magistrates who differ in their tendency to impose custody. By comparing otherwise similar people who faced stricter or more lenient decision-makers, HOPE can estimate the effect of incarceration itself — not just the health profile of people who happen to go to prison.

Data

NSW Reoffending Database · Justice Health clinical records · ABS Person Level Integrated Data Asset (PLIDA). Conducted in secure public-sector environments.

Design

Judge-leniency instrumental variable. Compares custodial and non-custodial outcomes more credibly than standard observational studies.

Scale

410,000+ linked cases · 5-year project · ~$1.36M total · Expandable to Queensland through a separate data linkage pathway.

Health outcomes include hospital and ED use, mental health service use, pharmaceutical use, chronic disease management, mortality, and post-release trajectories. The project gives particular attention to outcomes for Aboriginal and Torres Strait Islander peoples, people with disability, and other groups facing concentrated risk.

Partner value

What partners receive in return.

HOPE is structured as a partner-facing evidence platform, not a one-way academic exercise. Partners shape questions, receive tailored outputs, and gain access to analysis directly relevant to their policy and operational decisions.

Who we are seeking

Partners across justice, health, and community sectors.

HOPE is seeking formal partners — government agencies, peak bodies, and community organisations — who can contribute data access, in-kind expertise, or cash contributions (up to $500,000 per partner). Tailored briefs are available for each of the following.

Justice & Corrections

NSW Department of Communities and Justice · Corrective Services NSW · Queensland Corrective Services. HOPE can extend to shared-clients analysis linking custody data to child protection, housing, and disability outcomes.

Health & Clinical

NSW Health · Justice Health and Forensic Mental Health Network · Department of Health, Disability and Ageing. Focused on continuity of care, avoidable harm, and mental health and AOD demand across the custody–community transition.

Sentencing & Policy

Queensland Sentencing Advisory Council · Attorney-General's Department. HOPE adds downstream evidence on health and reintegration consequences to sentencing reform conversations and justice reinvestment agendas.

Community & Aboriginal-Controlled

Community Restorative Centre · Rainbow Lodge · ATSILS · other throughcare and reintegration organisations. Community partners shape research questions, support co-design, and help ensure findings are accountable to affected communities.

Data & Research Infrastructure

BOCSAR · CHeReL · ABS/PLIDA. These partners provide the linkage spine, analytical infrastructure, and justice-system measurement that make the project possible at scale.

Not sure where you fit?

Get in touch and we will send the brief most relevant to your organisation's mandate and priorities. Partnerships can be tailored around data access, policy input, community engagement, or evaluation framing.

Research team

Senior collaborators across five universities.

HOPE brings together expertise in quasi-experimental methods, justice-health data, sentencing research, forensic mental health, health economics, addiction epidemiology, Indigenous health, and translational public health. Chief Investigator spots for the current round are being held for incoming partners.

Carleen Thompson

Griffith University

Justice-health data

Don Weatherburn

UNSW · Former Director, BOCSAR

Sentencing data, ROD development, judge-leniency methods

Stuart Kinner

Curtin University · University of Melbourne

Justice health, offender wellbeing, linked data systems

Benjamin Spivak

Swinburne University of Technology

Forensic mental health and justice-health data

Rachel Sutherland

UNSW

Drug trends, harm reduction, translational public health

Steven Larkin

University of Adelaide

Indigenous health, justice, culturally informed research

Rachael Morton

University of Sydney

Health economics and cost–benefit analysis

Rui Wang

University of Sydney

Health equity and economic evaluation

Jenny Williams

University of Melbourne

Econometrics and health policy

Teagan Weatherall

University of Adelaide

Aboriginal health and community research

Robert Breunig

Australian National University

Public policy economics

John Paget

Former Inspector of Custodial Services

Custodial systems expertise

Participating institutions: Griffith University · University of Sydney · UNSW · Swinburne University · University of Adelaide. Earlier iterations also involved senior collaborators from Corrective Services NSW, Legal Aid NSW, and Justice Health.

Interested in partnering?

We are currently in active outreach for the next NHMRC Partnership Projects round. If HOPE is relevant to your organisation's priorities, we would welcome an initial conversation.