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  1. Gill Mezey, reader in forensic psychiatry (gmezey@sgul.ac.uk)
  1. 1Division of Mental Health, St George's University of London, London SW17 0RE

    Strategies to enhance social inclusion are as important as medical interventions

    According to a recent MORI poll, doctors are viewed by the public as the most trusted professionals; more than 90% of the public trust doctors to be truthful and 80% view them as helpful.1 However, a qualitative study reported in this week's BMJ by Howerton and colleagues found that most offenders did not trust their general practitioners enough to ask them for help, despite experiencing high levels of distress, self harming behaviour, and emotional problems.2

    Childhood abuse and early traumatic life events are associated with increased rates of neurotic disorders, including post-traumatic stress disorder, substance misuse, self harm, and antisocial personality disorder in adulthood.3 4 Survivors of abuse have problems in trusting others (particularly figures in authority), and both victims and perpetrators of crime commonly have feelings of low self esteem, shame, and helplessness.5 6 Male prisoners have high rates of lifetime traumatic experiences,2 3 4 and not surprisingly these “offender-victims” experience high levels of psychological distress, yet are reluctant to seek help from health professionals.

    Even in the general …

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