Imprisonment and diagnostic delay among male offenders with schizophrenia

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Psychotic symptoms are common among prisoners, a diagnosis of schizophrenia probably more likely than in the general population; however, less is known about the extent to which prisoners may show a different course of illness. The aims of the study were to characterise schizophrenic male offenders and to compare their age at diagnosis with that of people with schizophrenia in general mental health services in Finland. The study population comprised all the male offenders in Finland who left the national psychiatric prison hospital between 1 January 2003 and 31 December 2006 with an International Classification of Diseases, Tenth Edition, diagnosis of schizophrenia. The comparison group was drawn from 9992 Finnish people screened at random for psychotic illnesses. There was no overall difference in age of diagnosis between prisoners and their community peers, but three-quarters of the offenders had received their diagnosis of schizophrenia in the prison hospital rather than in the community, and for them, the median age at diagnosis (30) was significantly older than that (27) in the community comparison group. Our findings show that men with schizophrenia who have to serve prison sentences are not a homogenous group, but that for a majority, complex presentations are likely to delay diagnosis and appropriate treatment. If replicated, the findings raise concerns that psychiatry is failing such men who can only access treatment for a severe illness through the penal system.