Skip to main content

Identification and management of prisoners with severe psychiatric illness by specialist mental health services

  • J. Senior (a1), L. Birmingham (a2), M. A. Harty (a3), L. Hassan (a1), A. J. Hayes (a1), K. Kendall (a2), C. King (a1), J. Lathlean (a2), C. Lowthian (a1), A. Mills (a4), R. Webb (a1), G. Thornicroft (a3) and J. Shaw (a1)...

The prevalence of mental disorders among prisoners is considerably higher than in the general population. This is an important public health issue as the vast majority of prisoners stay in custody for less than 9 months and, when not in prison, offenders' lifestyles are frequently chaotic, characterized by social exclusion, instability and unemployment. Multi-disciplinary mental health inreach services were introduced to target care towards prisoners with severe mental illness (SMI) in a similar way to that provided by Community Mental Health Teams outside prison. The aim was to establish the proportion of prisoners with SMI who were assessed and managed by prison mental health inreach services.


A two-phase prevalence survey in six prisons in England measured SMI upon reception into custody. Case-note review established the proportion of those with SMI subsequently assessed and treated by inreach services.


Of 3492 prisoners screened, 23% had SMI. Inreach teams assessed only 25% of these unwell prisoners, and accepted just 13% onto their caseloads.


Inreach teams identified and managed only a small proportion of prisoners with SMI. Prison-based services need to improve screening procedures and develop effective care pathways to ensure access to appropriate services. Improved identification of mental illness is needed in both the community and the Criminal Justice System to better engage with socially transient individuals who have chaotic lifestyles and complex needs.

Corresponding author
*Address for correspondence: Dr J. Senior, Offender Health Research Network, Centre for Mental Health and Risk, 2.317, Jean McFarlane Building, The University of Manchester, Manchester M13 9PL, UK. (Email:
Hide All
Anthony JC, Folstein M, Romanoski AJ, Von Korff MR, Nestadt GR, Chahal A (1985). Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Archives of General Psychiatry 42, 667676.
Armitage C, Fitzgerald C, Cheong P (2003). Prison in-reach mental health nursing. Nursing Standards 17, 4042.
Birmingham L (2003). The mental health of prisoners. Advanced Psychiatric Treatment 9, 191201.
Birmingham L, Mason D, Grubin D (1996). Prevalence of mental disorder in remand prisoners: consecutive case study. British Medical Journal 313, 15211524.
BMA (2001). Prison Medicine: A Crisis Waiting to Break. British Medical Association: London.
Bradley K (2009). The Bradley Report. Lord Bradley's Review of People with Mental Health Problems or Learning Disabilities in the Criminal Justice System. Department of Health: London.
Brooke D, Taylor C, Gunn J, Maden A (1996). Point prevalence of mental disorder in unconvicted male prisoners in England and Wales. British Medical Journal 313, 15241527.
Brooker C, Gojkovic D (2009). The second national survey of mental health in-reach services in prisons. Journal of Forensic Psychiatry and Psychology 20(Suppl. 1), 1128.
DH (1990). The Care Programme Approach for People with a Mental Illness, Referred to Specialist Psychiatric Services, Health and Social Services Circular HC (90)23/LASSL (90)11. Department of Health: London.
DH (2001). Changing the Outlook. A Strategy for Developing and Modernising Mental Health Services in Prisons. Department of Health and HM Prison Service: London.
Dunn G, Pickles A, Tansella M, Vazquez-Barquero JL (1999). Two-phase epidemiological surveys in psychiatric research. British Journal of Psychiatry 174, 95100.
Endicott J, Spitzer RL (1978). A diagnostic interview: the schedule for affective disorders and schizophrenia. Archives of General Psychiatry 35, 837844.
Fazel S, Danesh J (2002). Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys. Lancet 359, 545550.
Grubin D, Carson D, Parsons S (2002). Report on New Prison Reception Health Screening Arrangements: The Results of a Pilot Study in 10 Prisons. University of Newcastle: Newcastle.
Gunn J, Maden A, Swinton M (1991). Treatment needs of prisoners with psychiatric disorders. British Medical Journal 303, 338341.
Health Advisory Committee for the Prison Service (1997). The Provision of Mental Health Care in Prisons. Home Office: London.
HM Inspectorate of Prisons for England and Wales (1996). Patient or Prisoner? A New Strategy for Health Care in Prisons. Home Office: London.
Lee S (2003). Care co-ordinators and the CPA. Mental Health Nursing 23, 810.
Lukoff D, Nuechterlein KH, Ventura J (1986). Appendix A: Manual for Expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin 12, 594603.
Meiklejohn C, Hodges K, Capon D (2004). In-reach work with prisoners. Mental Health Nursing 24, 810.
Ministry of Justice (2007). Population in Custody Monthly Tables, April 2007. Ministry of Justice: London.
Parsons S, Walker L, Grubin D (2001). Prevalence of mental disorder in female remand prisoners. Journal of Forensic Psychiatry 12, 194202.
Rogers WH (1993). Regression standard errors in clustered samples. Stata Technical Bulletin 13, 1923.
Romanoski AJ, Folstein MF, Nestadt G, Chahal R, Merchant A, Brown CH, Gruenberg EM, McHugh PR (1992). The epidemiology of psychiatrist-ascertained depression and DSM-III depressive disorders: results from the eastern Baltimore mental health survey appraisal. Psychological Medicine 22, 629655.
Selzer ML, Vinokur A, Van Rooijen L (1975). A self-administered Short Michigan Alcoholism Screening Test. Journal of Studies on Alcohol 36 (Suppl. 1), 117126.
Shaw J, Tomenson B, Creed F (2003). A screening questionnaire for the detection of serious mental illness in the criminal justice system. Journal of Forensic Psychiatry and Psychology 14 (Suppl. 1), 138150.
Singleton N, Meltzer H, Gatward R, Coid J, Deasy D (1998). Survey of Psychiatric Morbidity Among Prisoners in England and Wales. Office for National Statistics: London.
Skinner HA (1982). The Drug Abuse Screening Test. Addictive Behaviours 7 (Suppl. 4), 363371.
StataCorp (2008). Stata Statistical Software: Release 10.0. Stata Corporation: College Station, TX.
Steel J, Thornicroft G, Birmingham L, Brooker C, Mills A, Harty M, Shaw J (2007). Prison mental health inreach services. British Journal of Psychiatry 190, 373374.
Telfer J (2000). Balancing care and control: introducing the Care Programme Approach in a prison setting. Mental Health Care 41, 9396.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 19
Total number of PDF views: 152 *
Loading metrics...

Abstract views

Total abstract views: 672 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.