ABSTRACT
The prison population is more than 60,000. In 1991 Gunn et al carried out a study of 5% of the male prison population and found that 1% were diagnosed schizophrenic, and 10% personality disordered (74% of whom required psychiatric treatment) (Gunn et al, 1991). Although the growth of forensic psychiatry as a specialism has been dramatic, from two consultants in 1962 to 70 consultants in 1992 (Home Office, 1992, para 2.8), the capacity of the health service to absorb mentally disordered offenders is limited. On 31 March 2000 there were 12,900 patients detained in hospital, of whom 1,305 were detained in high security hospitals, 10,200 in other NHS hospitals, and 1,400 in private mental nursing homes. The number of court admissions increased from 1,500 in 1988-89 to 2,110 by 1994-5, but then fell back to 1,900 in 1998-99 and more steeply to 1,600 in 1999-2000 (DoH, 2000, para 3.9). Whilst the penal system has the capacity to absorb large numbers of offenders, the ability of the health service to do so is limited by three main constraints: the lack of facilities, the reluctance of the psychiatric profession to become involved in treating those whom they do not believe are likely to respond to treatment, and competing demands for health and social services budgets.
