Statistics 8: The Criminal Justice System

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Introduction

Prisoners and mental health

How many prisoners have mental health problems?
Differences between remand prisoners and sentenced prisoners
How many prisoners have attempted suicide?
How common is self-harm amongst the prison population?
Psychosis amongst prisoners
Personality disorders amongst prisoners
Antisocial personality disorder (ASPD)
Paranoid and borderline personality disorders

Hazardous alcohol use in prisoners

Drug dependency amongst prisoners

Prisoners and the mental health act

How many people are sent to hospital (rather than prison) under Part III of the Mental Health Act?
How many people are detained in high security hospitals under Part III of the Mental Health Act?

Crime and risk in the community

What is the risk of being killed by someone with a mental heath problem?

References

Introduction

This factsheet has been largely, though not exclusively, based on a survey carried out by the Office for National Statistics (ONS) in 1997 on behalf of the Department of Health.[1]

The survey was based on interviews with prisoners and provides statistical information on mental disorders and related issues within the criminal justice system. However, the survey did not attempt to address specific treatment needs.

This factsheet is targeted at mental health professionals, journalists and students. However, it is also our aim to present statistics in a way that makes this factsheet accessible to all those who are interested in mental health.

Note: The language used in this factsheet reflects the sources referred to. The use of such language does not imply Mind’s automatic acceptance of it.

Prisoners and mental health

How many prisoners have mental health problems?

According to the 1997 ONS survey, a large proportion of prisoners in England and Wales have some sort of mental health problem.

In the week before interview, 39 per cent of sentenced males and 75 per cent of female remand prisoners had significant neurotic problems, such as anxiety, depression and phobias. Rates for all groups were much higher than the 12 per cent of men and 18 per cent of women found to have significant levels of neurotic symptoms in a similar household survey[2] carried out by the ONS (called the OPCS in 1995).

Differences between remand prisoners and sentenced prisoners

Remand prisoners had higher rates of neurotic disorder than sentenced prisoners and women had higher rates than men. The survey revealed that 58 per cent of men and 75 per cent of women remand prisoners were assessed as having significant neurotic symptoms. The figures were lower for sentenced prisoners, with 39 per cent of men and 62 per cent of women showing some form of neurotic disorder.[3]

How many prisoners have attempted suicide?

In the ONS survey, many respondents reported suicide attempts, particularly women and remand prisoners. Just under one in four men and nearly two in five women reported a suicide attempt at some time in their life. Over a quarter of female remand prisoners reported attempting suicide in the year before the interview.

How common is self-harm amongst the prison population?

Self-harm during the current prison term, without the intention of suicide, was reported by just under 10 per cent of female respondents and just under 6 per cent of males. The rates reported by remand and sentenced prisoners were similar. However, two thirds of remand prisoners had been in prison for less than three months compared with only about a quarter of the sentenced prisoners.

Suicide and self harm in prisons in England and Wales[4]

For standard errors please refer to the original source.

Psychosis amongst prisoners

In the ONS survey, a random sample of one in five of those interviewed were selected for an additional interview by a clinician to assess personality disorder and functional psychoses, such as schizophrenia and manic depression (but not organic psychoses such as dementia). In this follow-up interview, 14 per cent of the women, 10 per cent of the men on remand and 7 per cent of the sentenced men were assessed as having a functional psychosis, in the year prior to interview. These rates for psychosis are much higher than for the general population, where the figure is only 0.4 per cent.[5]

Prevalence of psychosis amongst prisoners[6]

Personality disorders amongst prisoners

The ONS survey found that over three quarters of the men on remand, nearly two thirds of the males sentenced, and half of the women sentenced fitted a diagnosis of personality disorder.

Antisocial personality disorder (ASPD)

The most common type of personality disorder, seen in the ONS survey, was antisocial. This was found in 63 per cent of males on remand, 49 per cent of males sentenced and 31 per cent of all female prisoners. This would be expected, since the category of ASPD requires the presence of antisocial behaviour before the age of 15 years and persisting into adulthood. Criminal behaviour is often seen as antisocial, so many prisoners are therefore likely to be diagnosed with this disorder. The figures are broadly in line with the results of studies carried out within the United States prison system.

Paranoid and borderline personality disorders

Paranoid and borderline personality disorders were the next most common types of disorder. A total of 29 per cent of male remand, 20 per cent of male sentenced and 16 per cent of female prisoners were assessed as having paranoid personality disorder. The equivalent figures for borderline personality disorder were 23 per cent, 14 per cent and 20 per cent respectively.

According to the ONS, paranoid personality disorder is often combined with ASPD in criminal populations and is characterised by pervasive mistrust and suspiciousness. People with borderline personality disorder are considered to be highly impulsive, experience brief mood swings, have a poor sense of self-image and have difficulty in sustaining close relationships. They are the group most often seen by psychiatric services.

Another survey also found that prisoners in England and Wales have very high rates of mental illness, substance misuse and personality disorder.[7]

Prevalence of personality disorder[8]

Hazardous alcohol use by prisoners

The prevalence of hazardous drinking, in the year prior to coming to prison, was higher in men than in women. This applied to over half the men sampled: 58 per cent on remand and 63 per cent sentenced. This compared to 36 per cent of female remand prisoners and 39 per cent of female sentenced prisoners.

Drug dependence amongst prisoners

In the 1997 ONS survey, drug dependence (as shown by the use of a drug every day for two weeks or more and, for cannabis, some other sign of dependence), in the year before coming to prison, was very common. Drug dependence was reported by 51 per cent of male remand, 43 per cent of male sentenced, 54 per cent of female remand and 41 per cent of female sentenced prisoners.

The 1997 ONS survey reported that the rates of all types of mental disorder, especially drug and alcohol dependency, are higher for prisoners than for the general population.

Remand prisoners were more likely than sentenced prisoners to report dependence on opiates (heroin or non-prescribed methadone) alone or in combination with other drugs, in the year before coming to prison. Opiate dependence was reported by 41 per cent of females and 26 per cent of males on remand, but only 23 per cent of females and 18 per cent of males sentenced.

Prisoners and the mental health act

How many people are sent to hospital (rather than prison) under Part III of the Mental Health Act?

During 2004-05, the courts in England sent a total of 1,664 people to hospital for treatment under the Mental Health Act (Part III).[9] Some were sent by the courts at the time of sentencing, while others were transferred from prison to hospital. During 2004-05 the courts in Wales sent 67 people to hospital.[10]

How many people are detained under Part III of the Mental Health Act in high security hospitals?

In England, a total of 5,100 people were sent to secure hospitals (Place of Safety Orders) during 2004-05. Most of these were to an NHS hospital. That is an increase of 76 per cent since 1999-2000 when the number of Place of Safety Orders was 2,900.[11] In Wales, a total of 229 people were sent to Place of safety detention in 2004-05. The figures are lower than in 2003-04 when 262 people in Wales were sent to secure hospitals. [12]

Crime and risk in the community

What is the risk of being killed by someone with a mental heath problem?

The public perception is that community care policy has failed and that there are now more people with mental health problems on the streets. Many believe that this means an increased risk of being harmed by somebody diagnosed with a mental health problem. A report by the Audit Commission[13] points out that most people with schizophrenia live relatively normal lives in the community and the risk to the public has actually decreased since the community care reforms. The report cites evidence that the number of homicides by people with mental health problems has not increased, while the number committed by others has more than doubled.

In January 1999, psychiatrists carried out a study[14] based on Home Office Figures. The study shows that the majority of homicides are not linked to care in the community. Contrary to popular belief, the number of homicide convictions of people considered to be mentally disordered has fallen to half that reached in 1979 - before the rush to close old asylums. Compared with all killings, the number committed by people with mental health problems has fallen even faster. The proportion has dropped from almost half in the 1960s, to little more than one in ten today. Although homicide convictions have multiplied fivefold since the late 1950s to more than 500 annually, the number involving a mentally disordered offender has fallen to around 60.

According to the psychiatrists who carried out the study, the likelihood of someone being killed by somebody with a mental disorder is probably less than that of winning the National Lottery outright. Even then, victims are likely to be someone known to the killer, rather than a stranger. Although people today are at slightly increased risk of being killed by a stranger, according to the psychiatrists, that person is highly unlikely to have a mental disorder.[15]

There were 699 homicides in 1995. In 423 cases, the victim was known to the suspect; in 169 the suspect was a stranger; in 88 cases no suspect was identified. In only 32 cases (4.6 per cent) was the suspect ‘mentally disturbed’.[16]

The Confidential Enquiry into Homicides and Suicides[17] shows that serious mental disorders are rare, and affect only four out of every 1,000 adults. Serious violence is even more rare – there are between 600 and 700 homicides each year, but few of them are carried out by people with mental health problems. The enquiry, which took place over a period of 33 months, identified only 39 homicides in England by people in contact with specialist mental health services in the previous year (between five and six per cent of all homicides).

In 2004, The British Medical Journal published a study which concluded: ‘Stranger homicides have increased in the recent years, but the increase is not the result of homicides by mentally ill people and therefore the "care in the community" policy. Stranger homicides are more likely to be related to alcohol or drug misuse by young men.[18]

People with mental health problems are, in fact, at far greater risk of harming themselves than other people and are at increased risk of suicide. (See Mind’s factsheet Mental Health Statistics 2: Suicide, available from the Mind Information Unit.)

This factsheet was updated by Inger Hatloy, Information Officer, Mind, July 2006

References

[1] Singleton, N et al. 1998, Psychiatric morbidity among prisoners: summary report. Office for National Statistics.
[2] Meltzer, H et al. 1995, OPCS Surveys of Psychiatric Morbidity in Great Britain Report 1: The prevalence of psychiatric morbidity among adults living in private households, HMSO.
[3]Singleton, N et al. 1998.
[4] Singleton, N et al. 1998.
[5] Meltzer, H et al. 1995.
[6] Singleton, N et al. 1998.
[7] Singleton, N., Meltzer, H. & Gatward, R. 1997, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London.
[8] Singleton, N et al. 1998.
[9] IC, 2006, Inpatients Formally Detained in Hospitals under the Mental Health Act 1983, England 1994-95 to 2004-05, available online at: www.ic.nhs.uk/pubs/inpatientdetmha94to05/mhbulletin/file
[10] National Assembly for Wales, Statistical Bulletin, 2005, SB/2005, Admissions of Patients to Mental Health Facilities in Wales, 2004-05.
[11] IC, 2006, Inpatients Formally Detained in Hospitals under the Mental Health Act 1983, England 1994-95 to 2004-05, available online at: www.ic.nhs.uk/pubs/inpatientdetmha94to05/mhbulletin
[12] National Assembly for Wales, Statistical Bulletin, 2005, SB/2005, Admissions of Patients to Mental Health Facilities in Wales, 2004-05.
[13] Reed, J. 1997, ‘Risk Assessment and Clinical Risk Management: The Lessons from Recent Enquiries’, British Journal of Psychiatry, 170, supplement 32, pages 4-7.
[14] Taylor, P. & Gunn, J., Institute of Psychiatry Research, quoted in The Guardian, Wednesday January 6 1999.
[15] Taylor, P. & Gunn, J. 1999.
[16] Parliamentary Written Answers, 14 October 1996.
[17] Royal College of Psychiatrists, 1996, Confidential Enquiry into Homicides and Suicides by Mentally Ill, People, London.
[18] BMJ 2004;328:734-737 (27 March), doi:10.1136/bmj.328.7442.734, available at: http://bmj.bmjjournals.com/cgi/content/full/328/7442/734