Intended for healthcare professionals


Mentally ill offenders are being wrongly held in prisons

BMJ 2004; 328 doi: (Published 06 May 2004) Cite this as: BMJ 2004;328:1095
  1. Paul Stephenson
  1. London

    The government must act to ensure that courts divert mentally ill offenders away from custodial sentences or into appropriate hospital or other treatment facilities, to cope with the mental health crisis in prisons, ministers were told this week.

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    The call came at a conference in London on the mental health problems of male prisoners, held by the Prison Reform Trust and mental health charity Mind and addressed by the prisons minister, Paul Goggins, and the chief inspector of prisons, Ann Owers.

    The conference heard how prison staff, who are not trained to be mental health professionals, struggle to cope with the high number of men with mental health problems.

    Around two thirds of the more than 70 000 adult male prisoners in England and Wales have a diagnosis of a personality disorder and two fifths show symptoms of at least one neurotic disorder, such as depression, anxiety, and phobias, according to Mind. Among the general population less than a fifth of men are affected by these disorders.

    Moreover, men in prison have a high rate of severe mental health problems such as schizophrenia or delusional disorders—nearly 10% compared with less than 1% of the general population.

    Home Office officials have acknowledged that thousands of prisoners should be transferred immediately to secure psychiatric settings.

    Mind's policy director, Sophie Corlett, said, “Unless you are very ill you just don't get anything. There is almost a continuum of non-care to some extent, because mental health care in the community is poor: when they [prisoners] are in prison it is not dealt with adequately, and when they come out the schemes are poor.”

    The charities called on the NHS and the prison service to focus on early intervention and accessible and appropriate mental healthcare facilities. They also called for:

    • An increase in the number of court diversion schemes across the country, so offenders who are acutely ill or at risk of suicide can be given hospital places or treatment

    • Courts to be encouraged to use alternatives to custody for men with mental health problems who have committed minor offences

    • The prison service to meet NHS standards, policies, protocols, and targets, particularly regarding staff

    • An independent agency to monitor mental health provision in prisons.

    Both charities acknowledged that moving responsibility for prison health from the Home Office to the Department of Health had improved things and that devolution down to the level of primary care trusts was likely to be beneficial.

    Mr Goggins was expected to tell the conference, being held as the BMJwent to press, that the Home Office was already doing a lot of what had been called for.

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