ABSTRACT
BACKGROUND: Mental illness is common among prisoners, but little evidence exists regarding changes in symptoms in custody over time. AIMS: To investigate the prevalence and predictors of psychiatric symptoms among prisoners during early custody. METHOD: In a prospective cohort study, 3079 prisoners were screened for mental illness within 3 days of reception. To establish baseline diagnoses and symptoms, 980 prisoners were interviewed; all remaining in custody were followed up 1 month and 2 months later. RESULTS: Symptom prevalence was highest during the first week of custody. Prevalence showed a linear decline among men and convicted prisoners, but not women or remand prisoners. It decreased among prisoners with depression, but not among prisoners with other mental illnesses. CONCLUSIONS: Overall, imprisonment did not exacerbate psychiatric symptoms, although differences in group responses were observed. Continued discussion regarding non-custodial alternatives for vulnerable groups and increased support for all during early custody are recommended.
Subject(s)
Mental Disorders/epidemiology , Prisoners/psychology , Adult , Female , Humans , Male , Mass Screening , Prevalence , Prisoners/statistics & numerical data , Prisons/statistics & numerical data , Prospective Studies , Psychiatric Status Rating Scales , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Time Factors , United Kingdom/epidemiology , Young AdultABSTRACT
Prison mental health inreach teams have been established nationwide in England and Wales over the past 3 years to identify and treat mental disorders among prisoners. This paper summarises the policy content and what has been achieved thus far, and poses challenges that these teams face if they are to become a clear and effective component in the overall system of forensic mental healthcare.
Subject(s)
Community Mental Health Services/organization & administration , Mental Disorders/therapy , Prisons , Community Mental Health Services/standards , England , Humans , Patient Care Team/organization & administration , Patient Care Team/standards , Program Evaluation , WalesABSTRACT
Guidelines for good medical practice do not reflect the complex reality of the ethical problems that arise in prison. Perhaps the best a doctor working in prison can do is realise that there are ethical dilemmas everywhere, try to recognise them and feel the tension.
Subject(s)
Delivery of Health Care/organization & administration , Ethics, Medical , Mental Disorders/therapy , Patient Satisfaction , Prisons/ethics , Health Care Rationing , Humans , Patient Advocacy/ethics , Physician-Patient Relations/ethics , Practice Guidelines as Topic , State MedicineABSTRACT
BACKGROUND: Mental disorder is more prevalent among people in prison than in the general population. Prisoners who require transfer to psychiatric hospitals for treatment face long delays. Doctors working in prisons regularly face ethical and legal dilemmas posed by prisoners with mental illness. AIMS: To develop a policy for providing treatment under the common law to prisoners with mental disorders who lack treatment decision-making capacity, while arrangements are made to transfer them to hospital. METHOD: The policy was developed through literature review and consultation with the Faculty of Law at Southampton University and health care staff at Winchester prison in the UK. RESULTS: The policy provides guidelines for establishing decision-making capacity, standards for documentation, and guidelines for implementation based on the Mental Health Act Code of Practice, other best-practice guidelines and case law. CONCLUSIONS: It can be argued that case law allows more-extensive treatment to be provided in the best interests of the incompetent prisoner, beyond emergency situations. The policy has ethical implications and its use should be carefully monitored.
