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5 Crim. Behav. & Mental Health 3 (1995)

handle is hein.journals/cbmh5 and id is 1 raw text is: Criminal Behaviour and Mental Health, 5, 3-8, 1995 0 Whurr Publishers Ltd. Editorial: Management for dangerous mentally disordered prisoners in England and Wales Providing satisfactory health care for prisoners in any country is a difficult problem. The management of mentally disordered prisoners, whether they be remanded in custody awaiting trial or serving a sentence, is complicated and composed of many competing practical and dynamic factors. Changes in the system do not occur easily (Bluglass, 1988) and complex ethical issues abound (Royal College of Psychiatrists, 1992). Despite concerted efforts in England and Wales to divert the mentally dis- ordered away from custody, research studies continue to suggest that there are large numbers of mentally abnormal prisoners. For example, a recent study (Gunn et al., 1991) based on a 5% sample of the England and Wales sen- tenced prison population suggests that between 750 and 1400 prisoners might require hospital inpatient (rather than prison) care and up to one-third of these are thought likely to need treatment in conditions of maximum hospital security owing to their potential dangerousness. Indeed, the study suggests that up to 38% of the sample could be given a psychiatric diagnosis. The results of a current major study of psychiatric disorder in the remand prison population for the same countries being carried out by the Department of Forensic Psychiatry at the Institute of Psychiatry, London, are awaited but past studies have suggested that approximately 9% of prisoners on remand may suf- fer from psychosis (Taylor & Gunn, 1984) with numerous prisoners having other psychiatric difficulties. Studies in other parts of the world such as the United States have also suggested that significant numbers of mentally disor- dered prisoners can be detected (Jemelka et al., 1989). In the United Kingdom it is generally accepted that seriously mentally dis- ordered prisoners must be removed from the custodial setting and treated in hospital. Indeed, this is reflected in the mental health legislation that per- tains. The prison environment is inappropriate for the mentally disordered who, within the institution, can present problems out of all proportion to their numbers and take away scarce resources from other individuals. Significant prison disturbances and suicides may not by any means always be a result of mental illness (Liebling, 1992), but they certainly are unacceptable and can result in adverse and sometimes scandalous publicity (e.g. Dyer, 3

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