Locking up the mentally disordered
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Editorial Locking up the mentally disordered This issue touches upon two entirely different aspects of the ways in which we, as a society, restrain those who suffer from mental disorder and whose behaviour poses problems. First, there are two papers from Christchurch, New Zealand, reporting a study of the psychiatric epidemiology of Christchurch prisons. New Zealand has a high incarceration rate (some 120 people per 100 000 being locked away), and levels of psychopathology within the prison population are comparable to British levels (Gunn et al., 1991, Brooke et al., 1996). In the United States Torrey (1995) has concluded that ‘quietly but steadily jails and prisons are replacing mental hospitals as the primary purveyors of public psychiatric services for individuals with serious mental illnesses’. Brinded et al. do not quite arrive at that conclusion, but they do note that prevalence rates for drug and alcohol abuse and dependence are grossly elevat- ed within the prison population they studied, and wonder if this is not a reflection of diverting substance abuse problems away from health care into the criminal justice system. Prison populations are rising sharply in the United States, in the United Kingdom and in New Zealand. It is probable that similar trends are occurring in other countries. Important questions are raised by these trends. Are social attitudes towards mentally disordered offenders changing? Are prisons good places in which to provide psychiatric services? Is the current system cost effective? In Britain we have calculated the number of prisoners who should, on peer-reviewed clinical criteria, be removed rapidly from prison and treated in a psychiatric hospital (Gunn and Maden, 1998). In England and Wales, which have a prison population of over 61 000, we estimated that between 800 and 1400 sentenced prisoners, and approximately 700 remanded prisoners required urgent transfer into hospital. By and large these transfers were not forthcoming. Second, the landmark legal issue in Britain, known as the Bournewood case, has yet to be finally decided. It is lucidly reported in this issue by one of the lawyers involved in the House of Lords appeal. It raises universal Criminal Behaviour and Mental Health, 9, 129–130 1999 © Whurr Publishers Ltd 129
Transcript of Locking up the mentally disordered
EditorialLocking up the mentally disordered
This issue touches upon two entirely different aspects of the ways in whichwe, as a society, restrain those who suffer from mental disorder and whosebehaviour poses problems. First, there are two papers from Christchurch, NewZealand, reporting a study of the psychiatric epidemiology of Christchurchprisons. New Zealand has a high incarceration rate (some 120 people per100 000 being locked away), and levels of psychopathology within the prisonpopulation are comparable to British levels (Gunn et al., 1991, Brooke et al.,1996).
In the United States Torrey (1995) has concluded that ‘quietly but steadilyjails and prisons are replacing mental hospitals as the primary purveyors ofpublic psychiatric services for individuals with serious mental illnesses’.Brinded et al. do not quite arrive at that conclusion, but they do note thatprevalence rates for drug and alcohol abuse and dependence are grossly elevat-ed within the prison population they studied, and wonder if this is not areflection of diverting substance abuse problems away from health care intothe criminal justice system.
Prison populations are rising sharply in the United States, in the UnitedKingdom and in New Zealand. It is probable that similar trends are occurringin other countries. Important questions are raised by these trends. Are socialattitudes towards mentally disordered offenders changing? Are prisons goodplaces in which to provide psychiatric services? Is the current system costeffective? In Britain we have calculated the number of prisoners who should,on peer-reviewed clinical criteria, be removed rapidly from prison and treatedin a psychiatric hospital (Gunn and Maden, 1998). In England and Wales,which have a prison population of over 61 000, we estimated that between800 and 1400 sentenced prisoners, and approximately 700 remanded prisonersrequired urgent transfer into hospital. By and large these transfers were notforthcoming.
Second, the landmark legal issue in Britain, known as the Bournewoodcase, has yet to be finally decided. It is lucidly reported in this issue by one ofthe lawyers involved in the House of Lords appeal. It raises universal
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questions. Can we continue to use paternalistic and informal systems torestrain mentally disordered people in a world that is increasingly legalisticand bureaucratic?
At first sight there seems to be no connection between an increasing crim-inalization and punitiveness towards the mentally disordered and the increas-ing legalism in the mental health field, but could they both be reflections ofmore fundamental unstated social changes? Is there a loss of confidence inhealth care professionals? If so, why? Is the loss of confidence wider than that?Have ‘civil rights’ and ‘justice’, both legal concepts with a hard edge, replacedcompassion, mercy and other difficult to define liberal but non-legal concepts?Again, if so, why?
The discussion is a difficult one. We would like to hear from readers in awide variety of countries as to whether the issues identified here are truly uni-versal, and we would welcome opinion about the way in which current trendscan be justified. We would like to publish these opinions.
John Gunn
References
Brooke D, Taylor C, Gunn J, Maden A (1996) A point prevalence of mental disorder in uncon-victed male prisoners in England & Wales. British Medical Journal 13: 1524–7.
Gunn J, Maden A (1998) Bed requirements in high security hospitals. Health Trends 30: 86–8.Gunn J, Maden A, Swinton M (1991) Treatment need of prisoners with psychiatric disorders.
British Medical Journal 303: 338–41.Torrey EF (1995) Jails and prison in America’s new mental hospitals. American Journal of Public
Health 85: 1611–13.
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