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Introduction
Prisoners and mental health
Number of prisoners with mental health problems
Differences between remand and sentenced prisoners
Self-harm among prisoners
Attempted suicide among prisoners
Suicide among prisoners
Psychosis among prisoners
Personality disorders among prisoners
Hazardous alcohol use in prisoners
Drug dependency among prisoners
Prisoners and the Mental Health Act
People sent to hospital (rather than prison) under Part III of the Mental Health Act
People detained in high security hospitals under Part III of the Mental Health Act
Crime and risk in the community
Risk of being killed by someone with a mental health problem
References
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.
According to the ONS (the Office of National Statistics), a large proportion of prisoners in England and Wales have a mental health problem.
In one survey they found that in the week before the 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 carried out by the ONS.
Remand prisoners (prisoners awaiting trial) have higher rates of neurotic disorder than sentenced prisoners and women have higher rates than men. ONS suggest that 58 per cent of men and 75 per cent of women remand prisoners experience significant neurotic symptoms . The figures are lower for sentenced prisoners, with 39 per cent of men and 62 per cent of women showing some form of neurotic disorder.
Another survey found that 45 per cent of suicides in prisons were by people held on remand and who were still waiting to go to trial.
ONS has found that self-harm during the current prison term, without the intention of suicide, is just under 10 per cent for female prisoners and just under 6 per cent for 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.
Women represent more than 50 per cent of all self-harm cases in prison. This is worrying as women represent only 5 per cent of the prison population. The rate of self-harm is particularly high among women under 21. At two women's prisons they have reported around 10 cases of self-harm per day.
Between 2004 and 2008, incidents of self-harm in prisons increased by 25 per cent. In female prisons the increase was 42 per cent in the same period. The total number of self-harm cases in 2008 was 10,466 for men and 12,560 for women - a total of 23,026.
ONS has found that a high number of prisoners have tried to take their own lives, 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. In one survey, over a quarter of female remand prisoners reported attempting suicide in the year before the interview.
The suicide rate among prisoners went down from 92 in 2007 to 61 in 2008. However, it is important to note that this followed a sharp increase in the numbers from 67 in 2006 to 92 in 2007. Although the numbers are going down, the suicide rate for prisoners is still alarmingly high with 91 suicides per 100,000 in the prison population compared with 8.5 per 100,000 in the general population.[ This means that the risk of suicide is more than 10 times higher for a prisoner than for the general population.
In an ONS survey, a random sample of one in five prisoners interviewed previously 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 all 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.
Mental health in-reach teams (MHIRT) confirms high rates of psychosis among prisoners. A survey of clinical records of prisoners treated by the MHIRTs showed that 18 per cent had a diagnosis of schizophrenia and another 18 per cent had a diagnosis of psychosis.
ONS suggests 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. Another survey shows that, among prisoners treated by MHIRT, around 17 per cent have a diagnosis of personality disorder, usually in combination with another diagnosis.
Antisocial personality disorder (ASPD)
The most common type of personality disorder seen in prisons, according to the ONS, is antisocial. This has been 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 are the next most common types of disorder seen in prison, according to ONS. 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 in prisons.
Another survey also found that prisoners in England and Wales have very high rates of mental illness, substance misuse and personality disorder.
Prevalence of personality disorder
|
|
Male |
Male |
Female |
|
|
|
Remand |
Sentenced |
All |
|
|
|
Per cent |
|
||
|
Type of personality disorder |
|
|
|
|
|
Antisocial |
63 |
49 |
31 |
|
|
Paranoid |
29 |
20 |
16 |
|
|
Borderline |
23 |
14 |
20 |
|
|
Avoidant |
14 |
7 |
11 |
|
|
Obsessive-compulsive |
7 |
10 |
10 |
|
|
Narcissistic |
8 |
7 |
6 |
|
|
Schizoid |
8 |
6 |
4 |
|
|
Dependent |
4 |
1 |
5 |
|
|
Schizotypal |
2 |
2 |
4 |
|
|
Histrionic |
1 |
2 |
1 |
|
|
|
|
|
|
|
|
Any personality disorder |
78 |
64 |
50 |
|
|
|
|
|
|
|
|
Base (sample size) |
181 |
210 |
105 |
|
|
|
|
|
|
|
ONS says that the prevalence of hazardous drinking, in the year prior to coming to prison, is higher in men than in women. This applied to over half the men they interviewed regarding this: 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.
Prisoners who have problems with alcohol are often also addicted to drugs. Over 25 per cent of male prisoners and around 20 per cent of female prisoners who are hazardous drinkers are also dependent on one or more illegal drugs.
In 2002/03 around 6,400 prisoners took part in alcohol detoxification programmes. Another 7,000 prisoners joined detoxification programmes for combined alcohol and drug addiction.
The Prison Service published an alcohol strategy for prisoners in 2004. Key aims of the strategy are to balance treatment and support with measures that can reduce supply. Although, it is clear that alcohol misuse is a big problem for prisoners, the government has not been able to provide treatment for those who want it. One report on arrestees showed that of the 27 per cent who wanted treatment, only 9 per cent had been offered treatment.
ONS suggests that 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, is 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.
According to the ONS, the rates of all types of mental disorder - especially drug and alcohol dependency - are higher for prisoners than for the general population.
Remand prisoners are 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 has been reported by 41 per cent of females on remand and 26 per cent of males on remand, but only 23 per cent of females sentenced and 18 per cent of males sentenced.
Offenders who are sent to residential drug treatment centres are 45 per cent less likely to commit crimes after release compared to offenders who are sent to prison. Many offenders who are sent to prisons and who want treatment are not offered this. The greatest gap is for those addicted to crack (cocaine). One survey showed that 67 per cent of arrestees had wanted treatment for crack addiction, but only 9 per cent had been offered treatment. The survey also showed that 60 per cent of arrestees who took heroin five or more days a week had not been offered treatment in the past 12 months. HM Chief Inspector of Prisons has said that they get 60 per cent less funding than they had hoped for new integrated drug treatments.
The Home Office suggests that for every £1 spent on drug treatment saves society £9.50.
During 2007/08, the courts in England sent a total of 1,400 people to hospital for treatment under the Mental Health Act (Part III). Some were sent by the courts at the time of sentencing, while others were transferred from prison to hospital. During 2007/08 the courts in Wales sent 103 people to hospital.
In England, a total of 7,500 people were sent to secure hospitals (Place of Safety Orders) during 2007/08 - most of these were to an NHS hospital. That means the figures have trebled since 1997/98 when the number of Place of Safety Orders was 2,483. In Wales, a total of 367 people were put on Place of Safety detention in 2007/08. The figures have increased since 2003/04 when 262 people in Wales were sent to secure hospitals.
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 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 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.
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'.
The Confidential Enquiry into Homicides and Suicides by Mentally Ill People 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.'
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.)
[1] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[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., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[4] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[5] Prison Reform Trust, 2008, The Cruellest Wait
[6] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[7] HM Chief Inspector of Prisons for England and Wales, 2009, Annual report 2007-08
[8] HM Chief Inspector of Prisons for England and Wales, 2009, Annual report 2007-08
[9] The Howard League for Penal Reform, 2009, downloaded from www.howardleague.org , June 2009
[10] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[11] Ministry of Justice, 2009, Deaths in prison custody 2008
[12] Royal College of Psychiatrists, 2009, Multi-agency working needed to tackle 'worryingly high' prison deaths
[13] 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.
[14] HM Inspectorate of prisons, 2007, The mental health of prisoners, A thematic review of the care and support of prisoners with mental health needs
[15] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[16] HM Inspectorate of prisons, 2007, The mental health of prisoners, A thematic review of the care and support of prisoners with mental health needs
[17] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[18] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[19] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London.
[20] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[21] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[22] Prison Reform Trust, 2008, Bromley Briefings, Prison Factfile
[23] Prison Reform Trust, 2008, Bromley Briefings, Prison Factfile
[24] Prison Reform Trust, 2008, Bromley Briefings, Prison Factfile
[25] HM Prison Service, 2004, Addressing Alcohol Misuse: A Prison Service Alcohol Strategy for Prisoners
[26] Home Office, 2006, Home Office Statistical Bulletin, The Arrestee Survey Annual Report: Oct 2003-Sept 2004
[27] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[28] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[29] Singleton, N., Meltzer, H. and Gatward, R. 1998, Psychiatric morbidity among prisoners in England and Wales , The Stationery Office, London
[30] Prison Reform Trust, 2008, Bromley Briefings, Prison Factfile
[31] Prison Reform Trust, 2008, Bromley Briefings, Prison Factfile
[32] NHS Evidence, National Library for Public Health, 2009, 2009 Annual Update - Drugs - Drugs misuse treatment in Offender population
[33] Health and Social Care Information Centre, 2008, In-patients formally detained in hospitals under the Mental Health Act 1983 and other legislation, England 1997-98 to 2007-08
[34] Statistical Directorate, 2008, Admission of patients to mental health facilities in Wales, 2007/08 (including patients detained under the Mental Health Act 1983) National Assembly for Wales, SDR 167/2008. Available from http://new.wales.gov.uk/statsdocs/health/sdr167-2008.pdf
[35] Health and Social Care Information Centre, 2008, In-patients formally detained in hospitals under the Mental Health Act 1983 and other legislation, England 1997-98 to 2007-08
[36] Statistical Directorate, 2008, Admission of patients to mental health facilities in Wales, 2007/08 (including patients detained under the Mental Health Act 1983) National Assembly for Wales, SDR 167/2008. Available from http://new.wales.gov.uk/statsdocs/health/sdr167-2008.pdf
[37] Reed, J. 1997, 'Risk Assessment and Clinical Risk Management: The Lessons from Recent Enquiries', British Journal of Psychiatry, 170, supplement 32, pages 4-7.
[38] Taylor, P. and Gunn, J., Institute of Psyhiatry Research, quoted in The Guardian, Wednesday January 6 1999.
[39] Taylor, P. and Gunn, J. 1999.
[40] Parliamentary Written Answers, 14 October 1996.
[41] Royal College of Psychiatrists, 1996, Confidential Enquiry into Homicides and Suicides by Mentally Ill People, London.
[42] 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
This factsheet was updated by Inger Hatloy, Information Officer, Mind, July 2009.