title: Prisoners with psychosis in England and Wales: diversion to psychiatric inpatient services?
abstract: The prevalence of psychosis among prisoners in England and Wales is ten times that in the household population and UK government policy is that prisoners should receive equivalent care to those in the community. This study investigated the implications of policy to divert more from the criminal justice system for psychiatric treatment. Psychotic prisoners were compared with psychotic persons in households and with other prisoners in two surveys of psychiatric morbidity in representative samples of the UK population. Psychotic prisoners were younger, more from ethnic minorities, with comorbid anxiety, substance misuse, ASPD, and childhood behavioural problems compared to psychotic persons in households. Less than a third had received previous inpatient treatment. Psychotic prisoners had similar criminal histories and higher psychopathy scores than non-psychopathic prisoners. Diversion is unfeasible without improved screening for psychosis and increasing bed numbers at higher levels of security to accommodate more patients who would pose high risk to the public. Future research should investigate why UK psychiatric services fail to identify psychotic prisoners and provide aftercare.
authors.affiliation: Queen Mary University of London, Wolfson Institute of Preventive Medicine, St. Bartholomew's Hospital, London EC1A 7BE, UK. j.w.coid@qmul.ac.uk
authors.forename: Jeremy
authors.initials: J
authors.lastname: Coid
authors.forename: Simone
authors.initials: S
authors.lastname: Ullrich
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D014852:Wales / Q000453:epidemiology; D055815:Young Adult