Anthony Maden

Treatment needs of prisoners with psychiatric disorders.

OBJECTIVE--To describe the prevalence of psychiatric disorder and the treatment needs of sentenced prisoners in England and Wales. DESIGN--Population survey based on a 5% sample of men serving prison sentences. SETTING--Sixteen prisons for adult males and nine institutions for male young offenders representative of all prisons in prison type, security levels, and length of sentences. SUBJECTS--406 young offenders and 1478 adult men, 404 and 1365 of whom agreed to be interviewed. MAIN OUTCOME MEASURES--History of psychiatric disorder, clinical diagnosis of psychiatrist, and required treatment. RESULTS--652 (37%) men had psychiatric disorders diagnosed, of whom 15 (0.8%) had organic disorders, 34 (2%) psychosis, 105 (6%) neurosis, 177 (10%) personality disorder, and 407 (23%) substance misuse. 52 (3%) were judged to require transfer to hospital for psychiatric treatment, 96 (5%) required treatment in a therapeutic community setting, and a further 176 (10%) required further psychiatric assessment or treatment within prison. CONCLUSIONS--By extrapolation the sentenced prison population includes over 700 men with psychosis, and around 1100 who would warrant transfer to hospital for psychiatric treatment. Provision of secure treatment facilities, particularly long term medium secure units, needs to be improved. Services for people with personality, sexual, and substance misuse disorders should be developed in both prisons and the health service.

Impact of a dedicated service for male mentally disordered remand prisoners in north west London: retrospective study

Government policy has encouraged speedy transfer of mentally ill prisoners to NHS care,1 2 but arrangements have often proved slow and ineffective.3 4 The Bentham Unit was set up in February 1994 to provide rapid assessment and (where appropriate) transfer for male mentally disordered remand prisoners in the former North West Thames Regional Health Authority. The unit provides regular outreach assessment sessions at Wormwood Scrubs and other prisons and is based in a 14 bed locked ward to which patients may be admitted before court disposal and determination of final placement. We retrospectively identified all prisoners referred for NHS psychiatric assessment who had been remanded to prisons within the area covered by North West Thames Regional Health Authority (Wormwood Scrubs, Brixton, Pentonville, Wandsworth, and Feltham) between 1 April and 31 August 1994 and determined those who were assessed and admitted …

Doctors should work towards elimination of all firearms and knives

Editor—With the publication of the Cullen report into the shooting of several children at a school in Scotland1 and the cross party support in parliament to increase the controls on handguns, the moment is ripe for the medical profession …