Prisons, too, are institutions for psychiatric care

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.824 (Published 12 April 2003) Cite this as: BMJ 2003;326:824
  1. Jay E Smith, consultant in forensic rehabilitation (jay.smith{at}ukgateway.net)
  1. John Howard Centre, London E9 2AT

    EDITOR—In their editorial on the reinstitutionalisaton of mental health care Priebe and Turner overlook an important current place of institutional psychiatric care—the prison service.1 Like the expansion of forensic psychiatric services, this has been a global phenomenon, reported in the United Kingdom, the United States, and Europe.

    In UK prisoner populations 4-10% of prisoners on remand and 2-7% of sentenced prisoners have psychotic illnesses.2 Numbers become much higher if those with personality disorders and substance misuse are included. Figures such as these prompted one American psychiatrist to call prisons the last mental hospitals left open after the closure of the asylums.3

    The reasons for this development are complex; a review from Germany of the role of prisons as new asylums identified diverse factors causing this unfortunate development.4 They included changes in the provision of psychiatric care and the reluctance of general psychiatric services to accept offenders with mental disorders because of a lack of secure accommodation, beds, and staff with appropriate skills and experience.

    A large amount of still unmet need has partly driven the expansion of forensic psychiatric services. Rather than “sucking” resources away from those most in need of psychiatric care, forensic services could be seen as failing to keep pace with the mental health needs of an expanding prison population. The appropriate manner to deliver mental health services to this neglected and needy group is an important question for the whole of psychiatry. In the meantime an old institution seems to be taking on a new role.


    • Competing interests None declared.


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