Mental health profile of culturally and linguistically diverse (CALD) women entering New South Wales public prisons: a retrospective cohort study using real-world data

Abstract Background Women in prison with culturally and linguistically diverse (CALD) backgrounds are at higher risk of marginalisation, isolation, and discrimination than non-CALD women. Despite this, the mental health of CALD women in prison is under-researched and there is limited evidence to inform practice. This study aimed to investigate the mental health profile of CALD women entering New South Wales (NSW) public prisons. Methods A retrospective cohort study utilising routinely collected data managed by the Justice Health and Forensic Mental Health Network including all women entering NSW public prisons from 1 January 2015 to 30 June 2024. Reception Screening Assessment (RSA) forms were used to identify women who entered prison. Women were identified as CALD if they were born in countries other than the main English-speaking countries or their preferred language was not English. Mental disorders were identified from active health conditions recorded in the Justice Health electronic Health System. Descriptive statistics were produced for women’s characteristics and substance use and compared using Chi-square test. Multivariable logistic regression models were used to compare mental disorders between CALD and non-CALD women. Results During the study period, 924 CALD and 3788 non-CALD women entered NSW public prisons. Reported substance use was lower in CALD than non-CALD women. CALD women were significantly less likely to have mental disorders than non-CALD women, except for schizophrenia spectrum and other psychotic disorders, which did not significantly differ in prevalence by CALD status. Depressive disorders were the most prevalent type of mental health disorder among CALD women (12.1%). The greatest difference was in bipolar-related disorders which were less prevalent among CALD than non-CALD women (1.4% vs. 4.5%, adjusted odds ratio (AOR) 0.35, 95% confidence interval (CI) 0.19–0.65). Conclusions While CALD women had a lower recorded prevalence of mental disorders, this likely reflects a combination of systemic under-detection and differences in the characteristics and criminal justice pathways of CALD women in custody. A multifaceted approach is needed to ensure accurate identification and treatment, including culturally responsive practice, effective interpreter access, and creating an environment where women feel safe to report their mental health concerns.