Severe mental illness in prisoners

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7165.1025 (Published 17 October 1998) Cite this as: BMJ 1998;317:1025

A persistent problem that needs a concerted and long term response

  1. Tom Fryers, Professor,
  2. Traolach Brugha, Senior lecturer,
  3. Adrian Grounds, Lecturer and consultant forensic psychiatrist,
  4. David Melzer, Clinical senior research associate
  1. Section of Social and Epidemiological Psychiatry, University of Leicester, Leicester General Hospital, Leicester LE5 4PW
  2. Institute of Criminology, University of Cambridge, Cambridge CB3 9DT
  3. Institute of Public Health, University of Cambridge., Cambridge CB2 2SR

    It will surprise few that mental health problems are common in people in prison, especially those on remand. 1 2 But in the light of the longstanding policy consensus that people with severe mental illness should be cared for in health and social services, the results of a recent national survey of mental disorders in prisons are still a shocking indication of inappropriate and inadequate psychiatric care on a huge scale.

    The survey, funded by the Department of Health,3 was based on semistructured clinical interviews and is the latest in the important series of studies of psychiatric epidemiology in Great Britain carried out by the Office for National Statistics.4 Its most dramatic finding is the high rate of functional psychosis: 7% of sentenced men, 10% of men on remand, and 14% of women in both categories were assessed as having a psychotic illness within the past year. Although methodological differences render comparisons with previous studies of prisoners difficult, the key comparative figure is 0.4% for adults in the general population.4People with a dual diagnosis of mental illness and substance abuse pose a special problem, also a current concern in the United States. …

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