Luke Birmingham

Prospective cohort study of mental health during imprisonment

BACKGROUND Mental illness is common among prisoners, but little evidence exists regarding changes in symptoms in custody over time. AIMS To investigate the prevalence and predictors of psychiatric symptoms among prisoners during early custody. METHOD In a prospective cohort study, 3079 prisoners were screened for mental illness within 3 days of reception. To establish baseline diagnoses and symptoms, 980 prisoners were interviewed; all remaining in custody were followed up 1 month and 2 months later. RESULTS Symptom prevalence was highest during the first week of custody. Prevalence showed a linear decline among men and convicted prisoners, but not women or remand prisoners. It decreased among prisoners with depression, but not among prisoners with other mental illnesses. CONCLUSIONS Overall, imprisonment did not exacerbate psychiatric symptoms, although differences in group responses were observed. Continued discussion regarding non-custodial alternatives for vulnerable groups and increased support for all during early custody are recommended.

The psychiatric implications of visible tattoos in an adult male prison population

Abstract Tattoos of all kinds have been found to be associated with marginal groups, antisocial behaviours and mental health problems. Little is known, however, about the subgroup with prominent tattoos on areas of the body, such as the face, which are clearly visible to others. This paper investigates associations between visible tattoos and mental disorder, substance misuse and criminality in a large group of adult male prisoners. Childhood adversity, drug and alcohol misuse, self-harm, violent behaviour and previous imprisonment were all found to be significantly associated with the presence of visible tattoos in this population. Whilst prior contact with psychiatric services was also significantly more common, no relationship existed between visible tattoos and lifetime DSM-IV mental disorder per se. Personality disorder was not found to be more prevalent in the visibly tattooed group, but a statistically significant relationship was demonstrated between visible tattoos and schizophrenia or related ps...

The psychiatric aspects of imprisonment revisited

Thirty years ago, in their seminal consideration of the psychiatric treatment received by prisoners, Gunn and colleagues called for a comprehensive system of care and treatment in custodial environments (Gunn, Robertson, Dell, & Way, 1978). The first stage was for the National Health Service (NHS) to take responsibility for prison healthcare from the Home Office. The first foundations were laid in 2000 when the Prison Service and the NHS formed a formal partnership, and in 2006 primary care trusts (PCTs) finally became responsible for commissioning all prison health-care including mental health. Mental health in-reach teams, described as the prison equivalent of community mental health teams (Department of Health & HM Prison Service, 2001), were intended to be the main vehicle for improved mental health service delivery for prisoners.