A persistent question that needs a concerted and drawn out term response It will surprise scarcely any that mental health problems are used by all in people in prison.

A persistent question that needs a concerted and drawn out term response

It will surprise scarcely any that mental health problems are used by all in people in prison, especially those onward remand.[1,2] But in the light of the longstanding policy consensus that the bulk of mankind with severe mental illness should be cared for in health and social services, the terminates of a recent national observe of mental disorders in prisons are still a shocking indication of inappropriate and inadequate psychiatric care forward a huge scale.

The take a view of funded by the Department of Health,[3] was based upon semistructured clinical interviews and is the latest in the important series of studies of psychiatric epidemiology in Great Britain carried abroad by the Office for National Statistics.[4] Its in the greatest degree dramatic finding is the high rate of functional psychosis: 7% of sentenc men 10% of men in succession remand, and 14% of women in as well-as; not only-but also; not only-but; not alone-but categories were assessed as having a psychotic illness within the past year. Although methodological differences present comparisons with previous studies of prisoners difficult, the key-note comparative figure is 0.4% for adults in the general population.[4] the public with a dual diagnosis of mental illness and substance abuse put to a stand a special problem, also a existing concern in the United States.[5]

a certain number of may discount neurotic symptoms as inevitable--even the rate of 75% of women in succession remand--for who would not be droped or anxious? But the 20% of men and 40% of women who have attempted suicide at least one time [over 25% of women in the previous year, 2% of men and women in the previous week) recommends that these symptoms are not wholly related to their general situation. The high prevalence of antisocial personality disorder also may not cause greatly surprise in this population: 63% of remanded men 49% of sentenc men and 31% of women in the two groups. But it suggests that longer period of time strategies are needed beyond punishment for specific offences

In 1996 Farrar from the NH Executive could write that sway policy had been consistent in 1983-95 in advocating that mentally ill delinquents "should be cared for in health and social classifications and not the criminal justice system"[6] Six years after the Re report commended diverting many people from prison into psychiatric care,[7] and in spite of near initial growth of court diversion schemes and transfers of mentally disordered prisoners to hospitals,[8] the numbers in our prisons are still substantial. Five years after the Health of the Nation strategy made mental illness a clew area and drew specific attention to the destitutions of mentally ill offenders[9] there is little evidence that command policy is effecting the fundamental changes required.

The policy implications are important and far reaching. Firstly, fast hospital accommodation is already inadequate and subject to pressure. Uncertainty surrounds the time to come of the high security special hospitals, and any reduction or reconfiguration of them would shift patients into the NH The Secretary of State for Health's policy initiative emphasising safety for the pair patients and the public may also add to the demand for fast NHS provision.[10] Addressing these influences concurrently will require vision, dedication, and resources.

Secondly there are many centurys of men and women remanded in prison for lengthy periods of time, many of whom endure from longstanding mental disorder, in every one's mouth mental illness, or both. For them, effective treatment is an issue of basic human rights, as is the ne to continue speeding up the criminal justice proces itself.

Thirdly, many men and women now in prison are no threat to the public and their primary ne is for convenient psychiatric treatment and long name care. They should not be in the criminal justice body but we have not solv all the puzzles of providing alternative care. It is not a circumscribed medical enigma or merely a matter of compliance with medicine regimes; indeed, traditional medical moulds are seriously limited in this connection Long term care is be in want ofed mostly in the community, and--though it has been said endlessly before--it must be at partnership and team-work between medical, social, educational, and criminal justice agencies. Clear leadership is also lacked and a commitment to a rehabilitation agriculture that has never been widely adopted.

An effective service combining individual care and public protection must be a flexible, 24 hour service. If this means something more assertive than aftercare and more paternalistic than popular practice, so be it, further community care programmes for these clients must recognise their peculiar lifestyles. abroad of prison many are essentially homeles with limited, not remarkably supportive, social networks, often terminate to alcohol and drug tillages Routine health care cannot easily assist them. We need to find a certain number of way of mobilising individual continuing care packages which will address the two their mental health and social vexed questions and reduce the risk of their reoffending.