Dealing with mental disorder in prisoners

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⇓).

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.