MENTAL HEALTH COURTS

Examine the Roles That Mental Health Workers Play In the Provision of Services to Mentally Ill Populations in Jails and Prisons

Examine the Roles That Mental Health Workers Play In the Provision of Services to Mentally Ill Populations in Jails and Prisons

Introduction

Availability of data on the prevalence of mental disorders in prisons is crucial in helping to better plan mental health services and facilitates prevention of criminal behaviour related to psychiatric pathology. Since the 1990s, studies of prison populations across the world have concluded that there is a fourfold to sixfold higher probability of suffering a psychotic disorder or severe depression than in the general population and around 10 times greater probability of having anti-social personality disorder. One of four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. Several studies carried out with prisoners in Europe [European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2009] have shown that habitual consumption of illegal drugs prior to entering prison range from a third to a half. Once in prison, most drug users reduce their consumption of drugs or give them up, but 27% of prisoners have admitted to using drugs during their imprisonment (King, 2005).

To date, most epidemiological studies of mental disorders among prisoners have had limitations with regard to the size and heterogeneity of the samples and to the assessment instruments applied. Penal and forensic legal systems, together with population demographics, vary sufficiently between countries that data from one country do not necessarily apply to another. Even within Europe, there may be considerable differences. United States, for example, has a higher rate of imprisonment (160/100,000) than most other European countries. In 2008, 73,558 people were in prison for the whole year, of whom 54,746 (50,626 men and 4,120 women) were sentenced, 17,849 (16,073 men and 1,776 women) were on remand, and around 600 were forensic psychiatric patients and the rest were in other penal administrative situation (weekend arrest, transfers, etc.) [Instituto Nacional de Estadística (INE), 2010]. Data available from an internal report by the American Home Office Report (2007) show an estimated prevalence of mental disorders of 46% among American prisoners.

The aim of this paper is to examine the roles that mental health workers play in the provision of services to mentally ill populations in jails and prisons. This paper is within the framework of a wider project evaluating the effects of imprisonment on quality of life and the social and health care that people with mental disorders receive in the prison environment.

Our study is the largest and most thorough study of mental disorder among prisoners to be carried out in United States. It shows clearly that the prevalence of psychiatric pathology among prisoners in United States is higher than in the general population. In a American general population sample, Haro et al. (2006) estimated the lifetime prevalence of mental disorder in men to be 15.7%. According to our study, the prevalence of mental disorders among prisoners is about five ...