Abstract
PurposePrisoners experience extremely high rates of psychiatric disturbance. However, ex-prisoners have never previously been identified in representative population surveys to establish how far this excess persists after release. Our purpose was to provide the first community-based estimate of ex-prisoners’ mental health in England using the data from the 2014 Adult Psychiatric Morbidity Survey (APMS).MethodsAPMS 2014 provides cross-sectional data from a random sample (N = 7546) of England’s household population aged 16 or above. Standardised instruments categorised psychiatric disorders and social circumstances. Participants who had been in prison were compared with the rest of the sample.ResultsOne participant in seventy had been in prison (1.4%; 95% CI 1.1–1.7; n = 103). Ex-prisoners suffered an excess of current psychiatric problems, including common mental disorders (CMDs), psychosis, post-traumatic disorder, substance dependence, and suicide attempts. They were more likely to screen positive for attention-deficit/hyperactivity disorder and autistic traits, to have low verbal IQ, and to lack qualifications. They disclosed higher rates of childhood adversity, including physical and sexual abuse and local authority care. The odds (1.88; 95% CI 1.02–3.47) of CMDs were nearly doubled in ex-prisoners, even after adjusting for trauma and current socioeconomic adversity.ConclusionsPrison experience is a marker of enduring psychiatric vulnerability, identifying an important target population for intervention and support. Moreover, the psychiatric attributes of ex-prisoners provide the context for recidivism. Without effective liaison between the criminal justice system and mental health services, the vulnerability of ex-prisoners to relapse and to reoffending will continue, with consequent personal and societal costs.
Highlights
Psychiatric disorder in prisonersHigh levels of mental disorder and suicide in prisoners worldwide have long been acknowledged [1,2,3,4,5,6,7,8]
Prisoners experienced an excess of every type of psychiatric morbidity, including common mental disorders (CMD), psychosis, personality disorder, and drug and alcohol problems
We examined the extent to which the link between incarceration history and common mental disorders can be explained in terms of exposure to adverse contexts and experiences
Summary
Psychiatric disorder in prisonersHigh levels of mental disorder and suicide in prisoners worldwide have long been acknowledged [1,2,3,4,5,6,7,8]. The WHO Regional Office for Europe initiated a Health in Prisons Programme to address the health needs of people in prisons, with the intention of establishing valid and comparable data This led to the recent report on the physical and mental health of the 1.5 million people in prison on any given day in the WHO European Region, underlining their coexisting poor mental and physical health, and setting it in the context of “entrenched and intergenerational social disadvantage” [9]. Social Psychiatry and Psychiatric Epidemiology (2021) 56:2083–2093 of Psychiatric Morbidity in Prisons [10] sampled prisoners from every prison in England and Wales It applied the methods of the first British national survey of psychiatric morbidity [11], thereby allowing direct comparison with the general population. Others have noted high levels of PTSD [15]
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