The British Journal of Psychiatry
Prisoners with mental disorders in Europe
Harald Dressing, Christine Kief, Hans-Joachim Salize

The prevalence of psychiatric disorders in prisoners is substantially higher than in the general population.1 Additionally, there is scientific evidence that the number of prison inmates with mental disorders is rising. As a consequence, the World Psychiatric Association has repeatedly voiced concern about the increasing number of mentally ill individuals who are being placed in correctional facilities.2

In European Union (EU) member states, forensic legal provision governing the diversion of offenders with mental disorders is diversely included in penal codes, general and mental health legislation, and it is difficult to establish whether member states place emphasis more on medical or punitive parameters in judicial deliberations.3 From a human rights perspective, depriving such prisoners of any state-of-the-art treatment cannot be accepted.4 However, there is a serious shortage of information and data in the field. Therefore, the European Commission funded the research project EUPRIS, which aimed to collect structured information on concepts, models and routine practices in prison mental healthcare in 24 EU member states and other European countries.5 The results of the study are alarming and should give rise to public policy and research activities. Even the most rudimentary health-reporting standards for mental healthcare in prison are lacking almost everywhere in Europe. Almost none of the included countries provided regular national statistics on the frequency of mental disorders of prisoners or on the availability or frequency of psychiatric treatments. A major reason for the lack of data on the prevalence of mental disorders in prisons is the deficient implementation of standardised psychiatric screening and assessment procedures at prison entry and during imprisonment. In many countries, the appointment of inadequately trained staff to perform such screenings increases considerably the risk that mental disorders or psychiatric needs of the inmates will remain undetected. Furthermore, the pathways to care in case of an acute psychotic episode differ significantly, since referral to prison hospitals, medical prison wards, forensic hospitals or general psychiatric hospital are used in various combinations depending on different national legal regulations, the availability of services and other regional circumstances. Therefore, the equivalence of care for prisoners with mental disorders has been questioned by the cooperating national experts. As a basic prerequisite for any action taken, more awareness of the deficiencies and problems must be raised by responsible authorities and decision makers. The implementation of some basic indicators used in general psychiatric research seems to be overdue.