Psychiatric needs in local jails: emergency issues

Prevalence of mental disorder and related treatments in a local jail: a 20-month consecutive case study

Aims – To define the prevalence of mental disorder within an Italian local jail and to describe main psychiatric treatments provided. Methods – Cross-sectional study of consecutive male prisoners referred, over a twenty-month period, for a clinical psychiatric assessment, among population (N=990) of Casa circondariale “Torre del Gallo”, Pavia (I); clinical DSM-IV diagnostic assessment and retrospective analysis of provided psychiatric treatments (i.e. psychiatric visits and pharmacological prescriptions). Results – 191 men (19.3%) had one or more current mental disorders (excluding substance misuse), including 13 (1.3%) psychosis; 53 (5.4%) mood disorder; 24 (2.4%) anxiety disorder; 26 (2.6%) adjustment disorder; 40 (4.1%) personality disorder; 32 (3.2%) personality disorder plus mood disorder; 3 (0.3%) mental retardation. Substance- (N=89, 47%) and HIV-related (N=19, 10%) disorders comorbidity is recognised. Psychiatric visits are mainly provided to psychosis and personality disorder plus mood disorder subgroups. Off-label antipsychotics prescriptions are frequent. Conclusions – The prevalence of mental disorder in this population is higher than US and EU averages, and for particular diagnostic subgroups it could be underestimated. Psychiatric management in prison should be reorganized according to national and European health guidelines.

Persons with severe mental illness in jails and prisons: a review

One of the greatest problems of deinstitutionalization has been the very large number of persons with severe mental illness who have entered the criminal justice system instead of the mental health system.

Outcome for psychiatric emergency patients seen by an outreach police--mental health team

Outreach emergency teams comprising police officers and mental health professionals can help to avoid criminalization of the mentally ill.

Deinstitutionalization at the beginning of the new millennium

This overview of deinstitutionalization explores its accomplishments and disappointments.

Interactions between mental health and law enforcement systems: problems and prospects for cooperation

This article examines the challenges posed by system specialization, as illustrated by the difficulties of coordinating the roles of the mental health and law enforcement agencies working with people with severe mental illness. Dealing with the needs of clients in one system when they are most appropriately served by the other may make both law enforcement and mental health systems appear ineffective and inefficient. This could increase the incidence of disorderly or violent behavior, which forments the myth that the seriously mentally ill are inherently dangerous. Despite the evident need to manage these issues, conventional methods of coordinating services have failed. This article concludes by developing a contracting model that creates more appropriate incentives for the two systems and bridges the gap between them.