Ex-prisoners with mental health problems 'more likely to reoffend'
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Version 0 of 1. Ex-prisoners with common mental health problems, such as bipolar disorder, and who misuse drugs and alcohol are more likely to commit violent offences after their release than other former prisoners, according to research. The study from Oxford University treads on highly sensitive ground, raising concerns among some experts that it may lead to assumptions mentally ill people are more prone to violence than others. But the authors say that is the wrong interpretation. They call for better diagnosis and treatment of mental illness for offenders in prison and after release, with the aim of bringing down the reoffending rate. “One in seven prisoners has a psychotic illness or major depression and around one in five enters prison with clinically significant substance abuse disorders,” said Seena Fazel, lead author of the study and professor of forensic psychiatry at the University of Oxford. “As these disorders are common and mostly treatable, better screening and mental health services before and after release are essential to prevent future violence and improve both public health and safety,” he said. The study, published in the Lancet Psychiatry journal, suggests that diagnosed psychiatric disorders are responsible for 20% of violent offences committed by male ex-prisoners and 40% of those committed by female former inmates. Using the records of nearly 48,000 ex-prisoners in Sweden, the researchers were able to link common psychiatric disorders with convictions for violent offences such as assault, robbery, arson and sexual offences over a 10-year period from 1 January 2000. Fazel said the study broke new ground by comparing the mental health and reoffending record of siblings who had been jailed, which he said was a powerful way to ensure they were calculating the impact only of mental health, unaffected by people’s backgrounds. They found that 42% of male prisoners were diagnosed with at least one psychiatric disorder before release and 25% were convicted of violent crimes in the 3.2 years of average follow-up in the released individuals. Around 60% of female prisoners had a psychiatric disorder and 11% were convicted of violent crimes following release. “A lot of people have been very cautious in this area not to place too much emphasis on mental health problems linked with reoffending risk,” said Fazel. But small studies have shown that other adverse outcomes, including deaths and suicides, go up if ex-offenders are not treated. The study supported putting resources into prison health, he said. Not only do prisoners have a right to health, “but beyond that there are other consequences because we have to improve public safety as well,” he said. In a linked commentary in the journal, Louis Appleby, national director for health and criminal justice and professor of psychiatry at the University of Manchester, and colleagues said nobody could disagree with the authors that better mental health care for prisoners and ex-offenders was needed. But in their view the study did not sufficiently take account of the other factors in ex-prisoners’ lives that lead to reoffending. Treatment of mental illness might only be effective “if the poor housing, substance misuse or absence of a job that are so common in released prisoners are also addressed,” they said. “Governments and some justice agencies might be tempted by the simple message that the answers to issues in the criminal justice system lie with mental health services. Meanwhile, the claim that mental illness is a direct cause of violence will make uncomfortable reading in mental health. “The implication of this study lies between the two: treatment of psychiatric disorders in prisons and on release is crucial, but will not be enough to bring about a major reduction in violent crime. Comprehensive packages of treatment and social support are needed that hold a therapeutic mirror to the complexity and adversity of offenders’ lives,” they write. Frances Crook, chief executive of the Howard League for Penal Reform, said a prisoner may get a few sessions of help but then the good was undone when they went back to their cell and were offered illegal drugs, or became suicidal. “You can treat people, but in the end a prison environment is so toxic and at the moment is so awful that having a few sessions of treatment is a sticking plaster on a major wound,” she said. “A prison is not an environment to treat people. You don’t send people to prison for treatment or education. You should offer them treatment they need, but people who are ill should not be in prison.” |