Levels of mental illness amongst prisoners are high, but little is known about the situation of those serving community sentences. More information is needed at a time when the UK Department of Health is seeking to improve mental health service access for all offenders. To estimate the prevalence of both current and lifetime mental illness, an epidemiological survey was conducted on individuals under probation supervision in Lincolnshire, England. Assessment included the Mini International Neuropsychiatric Inventory and other measures of mental health. We estimate that around 39% of individuals in this probation population are suffering from current mental illnesses, anxiety disorders being the most common. Furthermore, around 60% have substance abuse problems and around 48% have personality disorders. Lifetime mental illness, co-morbidity and dual diagnosis were also found to be high. In common with other groups of offenders, the prevalence of mental health problems in those serving community sentences is high
Objective: Repetitive transcranial magnetic stimulation (rTMS) has been reported to be as effective as electroconvulsive therapy (ECT) for major depression. The authors conducted a multicenter randomized, controlled trial to test the equivalence of rTMS with ECT.
Method:Forty-six patients with major depression referred for ECT were randomly assigned to either a 15-day course of rTMS of the left dorsolateral prefrontal cortex (N=24) or a standard course of ECT (N=22). The primary outcome measures were the score on the 17-item Hamilton Depression Rating Scale (HAM-D) and the proportion of patients with remissions (Hamilton score, ≤8) at the end of treatment. Secondary outcomes included mood self-ratings on the Beck Depression Inventory-II and visual analogue mood scales, Brief Psychiatric Rating Scale (BPRS) score, and both self-reported and observer-rated cognitive changes. The patients were followed up after 6 months.Results: HAM-D scores at the end of treatment were significantly lower for ECT, with 13 patients (59.1%) achieving remission in the ECT group and four (16.7%) in the rTMS group. However, at 6 months the HAM-D scores did not differ between groups. Beck scale, visual analogue mood scale, and BPRS scores were lower for ECT at the end of treatment and remained lower after 6 months. Self-and observerrated cognitive measures were similar in the two groups.Conclusions: rTMS was not as effective as ECT, and ECT was substantially more effective for the short-term treatment of depression.
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