ABSTRACT
What issues does the detention of mentally disordered offenders in prison raise? The fi rst point to stress, as noted above, is that the detention of offenders in prison, whether they be mentally disordered or not, is partly an end in itself, in that the deprivation of liberty is imposed as punishment (and not for punishment, or arguably even necessarily for rehabilitation). Second, the numbers of mentally disordered offenders in prison is, on any measure, substantial. Singleton et al (1998) found seven per cent of sentenced men (and a higher percentage for remand prisoners) with probable functional psychotic disorders. This would mean with a prison population of 84,354 on 2 October 2009 (Ministry of Justice, 2009a) there would be some 5,900 offenders with the most serious of mental illnesses in prison, an arguably wholly inappropriate environment even though they are convicted as culpable offenders. Notably, the numbers of restricted patients in high security hospitals stood at 643 in 2007 with a further 3,263 restricted patients detained in other hospitals (Ministry of Justice, 2009b) so the notion that these prisoner offender-patients might seamlessly be transferred into the hospital system is a logistical nonsense. Moreover, the Singleton et al (1998) survey of psychiatric morbidity found, using a much broader defi nition of mental disorder than just probable functional psychotic disorder, that only one in ten of the prison population were likely not to be suffering from one of four diagnosable disorders (broadly, psychosis, neurosis, personality disorder, drug dependence and alcohol abuse); and 64 per cent of the male sentenced population would have some type of personality disorder (Summary Report:11). Of course, having no national agreed defi nition as to what constitutes a ‘mentally disordered offender’ makes it impossible to settle on consistent estimates as to the number of such offenders in any given place within the criminal justice system (Criminal Justice Joint Inspection, 2009); all that can be said with confi dence is that the levels of mental health need within penal populations is much higher than in the community. This fi nding is not peculiar to England and Wales. Fazel and Danesh (2002) conducted a systematic review of psychiatric surveys of prison populations in 12 countries. Their fi ndings were similar to those of Singleton et al, with 3-7
per cent of men with psychotic illnesses, 12 per cent with major depression and 42 per cent with a personality disorder. As they observe ‘Prisoners were several times more likely to have psychosis and major depression, and about ten times more likely to have antisocial personality disorder, than the general population’ (2002:545). And Steadman et al (2009) in the United States found 31 per cent of women and 14 per cent of men being booked into local jails with current symptoms of serious mental illness. The incidence of mental disorder in prison is signifi cant and probably universal; the problems that trail in its wake are rife. Indeed, it would be fair to say that prison populations are riddled with mental disorder.
