Point prevalence of mental disorder in unconvicted male prisoners in England and Wales

Abstract Objectives: To determine prevalence of mental disorder among male unconvicted prisoners and to assess the treatment needs of this population. Design: Semi-structured interview and case note review of randomly selected cross section of male remand population. Non-attenders were replaced by the next name on prison roll. Setting: Three young offenders' institutions and 13 adult men's prisons. Subjects: 750 prisoners, representing 9.4% cross sectional sample of male unconvicted population. Main outcome measures: Prevalence of ICD-10 diagnoses of mental disorder, and associated treatment needs. Results: Psychiatric disorder was diagnosed in 469 (63%) inmates. The main diagnoses were: substance misuse, 285 (38%); neurotic illness, 192 (26%); personality disorder, 84 (11%); psychosis, 36 (5%); other and uncertain, 36 (0.5%). Subjects could have more than one diagnosis. The average refusal rate was 18%. In total 414 inmates (55%) were judged to have an immediate treatment need: transfer to an NHS bed, 64 (9%); treatment by prison health care services, 131 (17%); motivational interviewing for substance misuse, 115 (15%); and therapeutic community placement, 104 (14%). Conclusions: Mental disorder was common among male unconvicted prisoners. Psychosis was present at four or five times the level found in the general population. Extrapolation of our results suggests that remand population as a whole probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 prisoners with serious mental illness. Key messages We conducted a survey of the point prevalence of psychiatric disorder in men remanded in custody in England and Wales and assessed their treatment needs A diagnosis of psychiatric disorder was made in 63% of those surveyed, including 5% with psychosis Over half of these prisoners were judged to have an immediate treatment need—most could be treated inside prison, but 9% needed transfer to a psychiatric bed outside prison By extrapolation, the remand population probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 with serious mental illness Prison treatment facilities for unconvicted prisoners need substantial expansion