Abstract
BackgroundBoth the frequency of court-ordered treatments (COT) for offenders and prevalence of mental disorders among regular prison inmates steadily increased in most western countries. Whether there are major sociodemographic and clinical differences between these two populations is still matter of debate.MethodsWe compared the sociodemographic and clinical characteristics in a representative sample of 139 regular prison inmates versus 61 offenders with COT admitted during a 5-year period in an acute psychiatric care unit located in the central prison of the Geneva county. Fisher exact, unpaired Student’s t and Mann–Whitney U tests were used to compare demographic and clinical variables between COT patients and regular inmates. In addition, univariate and multivariable ordered logistic regression models were built to identify the sociodemographic and clinical determinants of COT.ResultsCOT patients were significantly older, less frequently married, with better education attainment, predominantly French-speaking, of the Christian religious group and with regular religious practice. History of psychiatric outpatient care was significantly more frequent in this group. Unlike the significantly higher occurrence of adjustment disorders in regular prisoners, psychosis was the main diagnosis in COT patients. When all diagnostic categories were taken into account in multivariable models, the presence of personality and psychotic disorders were the stronger predictors of COT status.ConclusionsOur data reveal that offenders with COT represent a clinically distinct group with an overrepresentation of personality and psychotic disorders. Moreover, they show that, at least in the Swiss penitentiary system, COT patients are less exposed to acculturation issues compared to regular inmates.
Highlights
High levels of psychiatric morbidity are well documented in prisons and are frequently associated with violence, victimization and self-harm [1]
History of psychiatric outpatient care was significantly more frequent in offenders with court-ordered treatments (COT) compared to regular prison inmates (Chi2 = 17.93, Fisher exact = 0.0001)
Regular inmates had lower rates of annual admissions in Unité hospitalière de psychiatrie pénitentiaire (UHPP) compared to COT patients (Mann–Whitney U test, z = − 5.54, p = 0.0001)
Summary
High levels of psychiatric morbidity are well documented in prisons and are frequently associated with violence, victimization and self-harm [1]. In Germany, COT encompasses inpatient care in high and medium-security hospitals in the federal states that provide a therapeutic environment suited for the specific needs of forensic psychiatric patients in long-term settings [3] The investment in such inpatient settings for COT (as opposed to the usual outpatient care of regular inmates) is found in Switzerland. Curabilis includes a unique psychiatric ward for acute treatment of both regular inmates and COT patients for the same catchment area (UHPP; Unité hospitalière de psychiatrie pénitentiaire) Both the frequency of court-ordered treatments (COT) for offenders and prevalence of mental disorders among regular prison inmates steadily increased in most western countries. Whether there are major sociodemographic and clinical differences between these two populations is still matter of debate
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