Research: Released prisoners face mental health and substance use crisis

The University of Stirling-led research, tracking more than 8,000 prisoners over four years, shines a spotlight for the first time on their unmet needs on release from prison.

It reveals that those released from prison had eight times more contact with ambulances for mental health and for substance use than people who had not recently been in prison. They had eight times more substance use related contact with accident and emergency (A&E) and five times more mental health related contact with A&E. 

The study found that 24 per cent of people released from prison had contact with the ambulance service for mental health and substance use related concerns in the four years following prison release, and 21 per cent with A&E. Only two per cent of the comparison group, who had not been in prison, had contact with the ambulance service and A&E over the same time period.  

The authors of the study say Scotland’s health and social services need to do better to support this vulnerable population, especially at a time of prison overcrowding and an overwhelmed NHS. They say the impact on health services and public health is “huge”, leading to higher costs and individual harm.

The RELEASE study looked at every person released from Scottish prisons in 2015 and tracked their contacts with health services for mental health and substance use for four years after their release. They then compared the rate of contact with a sample of people – matched on sex, age, postcode and deprivation indices – who had not been in prison five years prior. The research cohort comprised 8,313 people released from prison, and 41,213 matched individuals.

The study, which was funded by the Scottish government’s Chief Scientist Office, used data from the Scottish Prison Service, Public Health Scotland and National Records Scotland. It also involved Edinburgh Napier University, the University of Strathclyde and University of the West of Scotland.

Dr Catriona Connell, RELEASE lead investigator and senior research fellow at the Salvation Army Centre for Addiction Services and Research at the University of Stirling, said: “There are high levels of mental health and substance use problems among people in prison. These don’t go away when people are released, and may get worse without support.  We know from other research that there are high rates of suicide and drug-related and alcohol-related deaths on release.

“Scotland’s prisons are overcrowded and Scotland has very high rates of imprisonment. At the same time, people return to an environment where drug-related deaths, alcohol-related deaths and suicides are much higher compared to the rest of the UK. All of these create the perfect storm for people following release from prison.

“This is the first study to show the long-term outcomes for prisoners after release. The impact on our health services is huge, and one that health and justice policymakers should address immediately with proper resources. That could then have a positive impact on individuals, health services and our public health budgets and resources in the long-term.”

The findings come at a crucial time for Scotland’s justice system. Scotland’s prison population reached a record high of 8,431 in November 2025. In November 2024, Scottish Parliament passed legislation to help reduce the high-prison population by early release of short-term prisoners. Earlier this month, the Sentencing and Penal Policy Commission urged a rethink of Scotland’s approach to sentencing and imprisonment. 

Dr Connell added: “It is vital that sentencing considers the mental health and substance use harms of a sentence.”

These are the first results from the RELEASE project, the first UK study into the long-term outcomes for prisoners after release, and the first internationally to compare a national cohort of released prisoners with a matched general population, across a range of health services, and for specific conditions.