Ms Azar Kariminia, biostatistician at The University of NSW and the Centre for Health Research in Criminal Justice in Sydney, and her co-authors, studied rates of suicide and drug overdose in recently released prisoners in NSW between 1988 and 2002.
They found rates of suicide or drug overdose were higher in the immediate period following release from prison compared with other periods at liberty, particularly for those prisoners who had been admitted to the prison psychiatric hospital.
There was no increased risk of suicide soon after release from prison for women or Indigenous Australians, possibly due to better family ties and community support.
"Our findings suggest that the initial adjustment period after release is a time of extreme vulnerability, particularly for men," Ms Kariminia says.
"Suicides in prison receive considerable attention from prison authorities. In contrast, far less attention is paid to the post-release period, when the duty of care shifts from the custodial authorities to the community.
"This shift in responsibility is rarely formalised and these people often return to the community with few supports in place.
"Without adequate measures to ensure that responsibility for care flows seamlessly from the prison to the community, despair and death among these people will likely continue unabated."
Ms Kariminia says the increased risk of death from drug overdose is likely due to a reduced tolerance to opioid drugs following prolonged abstinence or infrequent use while in prison.
"There is a need to expand drug treatment programs in the pre-release period, especially for those with both mental illness and opioid dependence."
The Medical Journal of Australia is a publication of the Australian Medical Association.