2775 – The issues involved in the management of foreign mentally disordered offenders in the UK at the point of entry

Abstract

This literature review examines the issues facing foreign mentally disordered offenders (FNMDOs) in accessing psychiatric care in the UK. Studies/reports relevant to FNMDOs in Healthcare, Probation services, Inspectorate of prisons, Crime reduction charities, Department of Health were examined. Keywords searched on MEDLINE and Psychinfo: ‘foreign, mental,*offender,*criminal.*’ According to 2009 statistics, 14% of UK prisons consisted of foreigners of which 80% suffered mental health problems. FNMDOs face a number of issues like negative stereotyping, racism, poor family contact, language/cultural barriers, which hinder accessing psychiatric help. Indefinite detention of foreign prisoners, post-amendment of the UK Borders Act 2007, has been found to result in increased depression and suicidal ideation. Self-inflicted deaths increased since 2006. Research on migration-morbidity hypothesis and refugees/asylum-seekers demonstrates higher psychiatric morbidity. A 2005 meta-analysis reported worse outcomes for institutionalized refugees. Detention centres often have poor healthcare provision, though prevalence of PTSD, depression, anxiety, somatoform disorders is high. FNMDOs face limitations in availability of legal aid and immigration advice across the prison system. Lack of a clear care pathway compounded by poor inter-agency communication and understanding of immigration procedures adversely affects treatment and continuity of psychiatric care. FNMDOs are a vulnerable group with complex needs which may go unidentified. Improving care and outcomes for FNMDOs requires adequate prison staff training, ready interpreter access, facilitation of family visits/cultural contact. Effective multi-agency collaboration in early identification, intervention, clarity in care pathway and immigration advice would result in reduced psychiatric morbidity in this vulnerable group of offenders.