Analysis Healthcare in Prisons

Dealing with mental disorder in prisoners

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7280 (Published 22 November 2012) Cite this as: BMJ 2012;345:e7280

This article has a correction. Please see:

  1. Stephen Ginn, Roger Robinson editorial registrar
  1. 1BMJ, London WC1H 9JR, UK
  1. mail{at}stephenginn.com

Psychiatric disorders are common among prisoners in England and Wales but many do not receive adequate treatment, says Stephen Ginn

Figures quoted for psychiatric morbidity in prison are often very high. Around 90% of prisoners in England and Wales are reported to have at least one type of mental disorder or substance misuse problem.1 This is not just a British phenomenon: a systematic review of surveys from Western countries2 found 3.7% of male prisoners had psychotic illness, 10% major depression, and 65% personality disorder, figures that are much higher than in the general population (table).

View this table:

Prevalence of mental disorders among prisoners in Western countries compared with general population estimates2

Although crime has been consistently associated with severe mental illness,3 there is no agreed explanation for the high prevalence of mental disorder in prison. Many studies assume that prisoners’ mental health difficulties predate imprisonment.4 An opposing view is that the prison experience worsens mental health, and anxiety and depression are understandable reactions to prison regimes.4 Another perspective is that prisons are behaving as intended. If the purpose of prison is to contain “difficult” sections of the population, then a substantial number of mentally disordered people in prison is to be expected.5

In this article I focus on prisons in England and Wales and examine three broad concerns: how to keep mentally disordered people out of prison, how to recognise and treat them when in prison, and what happens on their release back into the community.

Keeping mentally disordered people out of prison: diversion

“Diversion” is a process by which someone who is in contact with the criminal justice system is identified and directed towards appropriate mental healthcare, particularly as an alternative to imprisonment.6 Diversion can take place at any stage in the criminal justice process. For instance, at the time …

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