Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder

Abstract

BackgroundHigh levels of psychiatric morbidity in prisoners have important implications for services. Assessing Needs for Psychiatric Treatment in Prisoners is an evaluation of representative samples of prisoners in a male and a female prison in London. This paper reports on the prevalence of mental disorders. In a companion paper, we describe how this translates into mental health treatment needs and the extent to which they have been met.MethodsPrisoners were randomly sampled in a sequential procedure based on the Local Inmate Data System. We interviewed roughly equal numbers from the following groups: male remand; male sentenced prisoners (Pentonville prison); and female remand; female sentenced prisoners (Holloway prison). Structured assessments were made of psychosis, common mental disorders, PTSD, personality disorder and substance abuse.ResultsWe interviewed 197 male and 171 female prisoners. Psychiatric morbidity in male and female, sentenced and remand prisoners far exceeded in prevalence and severity than in equivalent general population surveys. In particular, 12% met criteria for psychosis; 53.8% for depressive disorders; 26.8% for anxiety disorders; 33.1% were dependent on alcohol and 57.1% on illegal drugs; 34.2% had some form of personality disorder; and 69.1% had two disorders or more. Moreover, in the year before imprisonment, 25.3% had used mental health services.ConclusionsThese rates of mental ill-health and their similarity in remand and sentenced prisoners indicate that diversion of people with mental health problems from the prison arm of the criminal justice system remains inadequate, with serious consequences for well-being and recidivism.

An updated picture of the mental health needs of male and female prisoners in the UK: prevalence, comorbidity, and gender differences

“…Rates of mental disorder in the current study were well above those of the general population reported in meta-analyses and large population studies, consistent with previous research in the area [4][5][6], suggesting that mental disorder continues to be highly prevalent amongst individuals in prisons. In particular, prevalence rates were 4.5-5 times higher than that found in the general population for personality disorder (54.8% vs. 12.2% [23]), anxiety (36.2% vs. 6.7% [24]), mood disorders (24.5% vs. 5.4% [24]), and PTSD (16.4% vs. 2%; [25]).…”

“…Prevalence rates for both pre-existing and current mental health needs were generally higher among women compared to men, consistent with previous research [4-7, 28, 29]. Prevalence rates across the range of mental disorders screened for varied slightly to other previous UK-based research in the area [5,6]. For example, rates for drug and alcohol dependence were much lower and rates of anxiety were slightly higher.…”

“…Rates of previous contact with mental health services and having a lifetime diagnosis of a mental disorder are similar to those reported in previous research with UK prison samples [5,7], indicating that a significant proportion of prisoners continue to arrive in prison with pre-existing mental health issues. Despite this, less than half of participants with a pre-existing diagnosis reported current contact with Mental Health Inreach.…”

“…Both the National Audit Office Report [2], and the recently updated NICE guidelines on mental health in the criminal justice system [3], identified a need for new epidemiological research into the mental health of individuals in the criminal justice system; to examine how the mental and social functioning of individuals in prison in the UK has changed since the last major epidemiological study conducted in 1997 (The Office of National Statistics [ONS] Survey of Psychiatric Morbidity among Prisoners in England and Wales) [4]. Since the ONS survey, UK-based research in this area has predominantly focused on screening for the prevalence of individual disorders (or clusters of disorders) across a small number of establishments, and those studies which have conducted more in-depth screenings of multiple disorders collected data over 10 years ago [4][5][6][7]. In the last 20 years there have been a number of significant changes to the prison system (e.g., increase in…”

High Psychiatric Morbidity and Comorbidity Among Female Prisoners in Hunan, China

“…In the survey, they included 471 female prisoners in Hunan female prison in 2004 and found the prevalence of lifetime and current PTSD were 15.9 and 10.6% respectively. But similar to Huang's study, both lifetime and current prevalence of PTSD in our study are lower than studies in Western countries (7,31,32). The prevalence of drug use disorder and alcohol use disorder in this sample appears to be higher than the survey in Guangxi (29), but lower than in Western studies (ranged from 10 to 24%, and 30 to 60% in alcohol use disorder and drug use disorder, respectively) (24,32,33).…”