Prevalence of mental disorder in remand prisoners: consecutive case study

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Abstract
Objective: To define the prevalence of mental disorder and need for psychiatric treatment in new remand prisoners and to determine to what extent these are recognised and addressed in prison. Design: Study of consecutive male remand prisoners at reception using a semistructured psychiatric interview. Setting: Large remand prison for men (HMP Durham). Subjects: 569 men aged 21 years and over on remand, awaiting trial. Main outcome measures—Prevalence of mental disorder at reception, prisoners need for psychiatric treatment, identification of mental disorder by prison reception screening, and numbers placed appropriately in the prison hospital. Results: 148 (26%) men had one or more current mental disorders (excluding substance misuse) including 24 who were acutely psychotic. The prison reception screening identified 34 of the men with mental disorder and six of those with acute psychosis. 168 men required psychiatric treatment, 50 of whom required urgent intervention; 16 required immediate transfer to psychiatric hospital. Of these 50, 17 were placed on the hospital wing because of mental disorder recognised at prison screening. Conclusion: Not only is the prevalence of mental disorder, in particular severe mental illness, high in this population, but the numbers identified at reception are low and subsequent management in prison is poor. In this study in Durham prison 26% had a serious mental disorder Only about a quarter of the mentally disordered patients were recognised by the prison doctor and hospital officer Only two fifths of patients who required urgent psychiatric treatment were put into the prison hospital Improved diagnosis of psychiatric illness in prison will greatly increase the pressure on psychiatric beds