Is the Number of Mentally Disordered Offenders Appearing in Front of the Courts and in Prison Linked with the Rate of Civil Detentions and the Closure of Psychiatric Beds? Data from 1984-2016 in England

Abstract

Background, The current Mental Health Act (MHA 1983) in England and Wales allows for two broad types of detentions in hospital: civil detentions under Part II; and forensic detentions under Part III. Concern has recently been expressed about the rising rate of detention. A strong association between the closure of mental illness beds and the rise in civil detentions has previously been reported. We will test whether there has been an association between the reduction of beds and the rate of forensic detentions, as well as the size of the prison population. We will explore any association between the rate of civil detentions and the rate of forensic detentions. Methods, Secondary analysis of routinely collected data with a time lagged analysis of time series of yearly rates of detention. Yearly rates of the prison population were also calculated. Forensic detentions were separated into prison transfers, court treatment orders, and court assessment orders. Findings, From 1984 until 2016 the rate of civil detention nearly tripled from 38.8 to 112.6 per 100,000 ( 191%) and the rate of prison transfers increased eightfold from 0.2 to 1.6 per 100,000 ( 710%). In contrast the rate of court treatment orders reduced by 39% from 2.3 to 1.4 per 100,000. There was an association between the reduction of psychiatric beds and the increase in prison transfers, and between the increase in civil detentions and the reduction in court orders. Interpretation, The closure of psychiatric beds, which has occurred at the same time as a substantial increase in the prison population, has been associated with a subsequent increase in the need for patients to be transferred from prison to hospital for treatment. The increase in civil detentions which has occurred over the thirty years of the study has been associated with a reduction in the rate of courts detaining people who have committed serious crimes to hospital. Funding Statement: none Declaration of Interests: no conflict of interests identified for any author Ethics Approval Statement: not applicable as this was a secondary analysis of routinely collected data.