Offenders with mental disorders in prison and the courts: links to rates of civil detentions and the number of psychiatric beds in England – longitudinal data from 1984 to 2016

Background The Mental Health Act in England and Wales allows for two types of detention in hospital: civil and forensic detentions. An association between the closure of mental illness beds and a rise in civil detentions has been reported. Aims To examine changes in the rate of court orders and transfer from prison to hospital for treatment, and explore associations with civil involuntary detentions, psychiatric bed numbers and the prison population. Method Secondary analysis of routinely collected data with lagged time series analysis. We focused on two main types of forensic detentions in National Health Service (NHS) hospitals and private units: prison transfers and court treatment orders in England from 1984 to 2016. NHS bed numbers only were available. Results There was an association between the number of psychiatric beds and the number of prison transfers. This was strongest at a time lag of 2 years with the change in psychiatric beds occurring first. There was an association between the rate of civil detentions and the rate of court orders. This was strongest at a time lag of 3 years. Linear regression indicated that 135 fewer psychiatric beds were associated with one additional transfer from prison to hospital; and as the rate of civil detentions increased by 72, the rate of court treatment orders fell by one. Conclusions The closure of psychiatric beds was associated with an increase in transfers from prison to hospital for treatment. The increase in civil detentions was associated with a reduction in the rate of courts detaining to hospital individuals who had offended. Declaration of interest None.

Download Full-text

The Penrose hypothesis in the second half of the 20th century: investigating the relationship between psychiatric bed numbers and the prison population in England between 1960 and 2018–2019

The British Journal of Psychiatry ◽

10.1192/bjp.2021.138 ◽

2021 ◽

pp. 1-7

Author(s):

Georgina Wild ◽

Ross Alder ◽

Scott Weich ◽

Iain McKinnon ◽

Patrick Keown

Keyword(s):

Mental Illness ◽

Intellectual Disability ◽

Prison Population ◽

Significant Negative Correlation ◽

Time Lags ◽

Female Prisoners ◽

Annual Reduction ◽

Prison Populations ◽

Psychiatric Beds ◽

Bed Numbers

Background NHS Psychiatric beds comprise mental illness and intellectual disability beds. Penrose hypothesised that the number of psychiatric in-patients was inversely related to prison population size. Aims To ascertain whether the Penrose hypothesis held true in England between 1960 and 2018–2019. Method A time-series analysis explored the association between total prison population and NHS psychiatric beds; this was also tested for the male and female prison populations, using non-psychiatric beds as a comparator. Associations were explored with time lags of up to 20 years. Linear regression was conducted to estimate the size of the effect of bed closures. Results NHS psychiatric beds decreased 93% and the prison population increased 208%. A strong (r =−0.96) and highly significant negative correlation between these changes was found. Annual reduction in psychiatric bed numbers was associated with an increase in prison population, strongest at a lag of 10 years. The closure of mental illness and intellectual disability beds was associated with increases in female prisoners 10 years later. The only significant explanatory variable for the increase in male prison population was intellectual disability bed reduction. Conclusions The Penrose hypothesis held true between 1960 and 2018–2019 in England: psychiatric bed closures were associated with increases in prison population up to 10 years later. For every 100 psychiatric beds closed, there were 36 more prisoners 10 years later: 3 more female prisoners and 33 more male prisoners. Our results suggest that the dramatic increase in the female prison population may relate to the closure of NHS beds.

Download Full-text

1539Australia’s worsening mental health – what’s next?

International Journal of Epidemiology ◽

10.1093/ije/dyab168.151 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Shrinkhala Dawadi ◽

Frances Shawyer ◽

Helena Teede ◽

Graham Meadows ◽

Joanne Enticott

Keyword(s):

Mental Health ◽

Mental Illness ◽

Secondary Analysis ◽

Symptom Burden ◽

Population Level ◽

Policy And Strategy ◽

Level Data ◽

Related Symptom ◽

Australian Census ◽

Population Mental Health

Abstract Background The population prevalence of mental illness over time, and by sociodemographic subgroups, are important benchmark data. Examining reliable population level data can highlight groups with greater mental-illness related symptom burden and inform policy and strategy. Methods Secondary analysis of Australian National Health Surveys (n = 78,204) from 2001-02 to 2017-18. Trends in the prevalence of very high scores on the Kessler-10 (K10), a measure of psychological distress capturing symptoms of affective and anxiety disorders, were examined by time, age, gender, and socioeconomic status. Data were standardised to the 2001 Australian census population on the strata of sex and age. Results In 2017-18, the rate of probable mental illness was estimated at 5.1%, a 1.5% increase (representing an additional 367,000 Australians) since 2007. In 2017-18, the subgroups with the highest rates were women aged 18-24 (8.01%, 95% CI = 5.9%-10.2%), and the poorest fifth of Australians (8.02%, 95% CI = 7.0%-9.0%). Women aged 55-64 demonstrated the greatest increase in rates (2001: 3.5%, 95% CI = 2.5%-4.6%; 2017: 7.2%, 95% CI = 5.9%-8.5%; z = 4.10, p ≤ 0.001). Conclusions Despite efforts to improve population mental health, rates of probable mental illness in Australia have increased since 2007. Findings will be discussed in conjunction to extant social and health policies, and potential gaps in the delivery of gold-standard mental health care. Key messages The rate of probable mental illness in Australia seem to be increasing, especially in women aged 55-64, and those from low-SES backgrounds.

Download Full-text

Over-occupancy in London's acute psychiatric units – fact or fiction?

Psychiatric Bulletin ◽

10.1192/pb.23.10.590 ◽

1999 ◽

Vol 23 (10) ◽

pp. 590-594 ◽

Cited By ~ 8

Author(s):

Bernard Audini ◽

Richard Duffett ◽

Paul Lelliott ◽

Alison Pearce ◽

Catherine Ayres

Keyword(s):

Mental Health ◽

Catchment Population ◽

Service Demand ◽

Psychiatric Units ◽

Hospital Stays ◽

Prolonged Hospital ◽

Changes Over Time ◽

Psychiatric Beds ◽

Bed Numbers ◽

Current Provision

Aims and methodInner London psychiatric services face particular pressures. One measure of this is over-occupancy of acute psychiatric beds. Seven census-based surveys were conducted between June 1994 and January 1999 to quantify and monitor problems of inner London acute psychiatric bed provision. The censuses involved 14 inner London mental health services with a combined catchment population of approximately three million. Measures included levels (and changes over time) of occupancy, detention under the Mental Health Act, prolonged hospital stays and ward violence.Results‘Minimum’ occupancy levels for the combined services were above 100% at all census points. Occupancy level fell from 122% to 112% between the first and seventh census. This was associated with an increase in bed numbers of 2.5 per 100000. Levels of detention were consistently at around 50% and violent incidents were high at all census points.ConclusionsCurrent provision of acute beds remains insufficient to meet service demand. To meet the 85% ward occupancy level recommended by the Royal College of Psychiatrists a further 14 beds or community alternatives per 100000 population would be required.

Download Full-text

Time trends in mental health indicators during the initial 16 months of the COVID-19 pandemic in Denmark

BMC Psychiatry ◽

10.1186/s12888-021-03655-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Michelle T. Pedersen ◽

Thea O. Andersen ◽

Amy Clotworthy ◽

Andreas K. Jensen ◽

Katrine Strandberg-Larsen ◽

...

Keyword(s):

Mental Health ◽

Time Series ◽

Mental Illness ◽

Chronic Illness ◽

Time Trends ◽

Time Series Data ◽

Health Indicators ◽

Series Data ◽

Cross Sectional ◽

Mental Health Questionnaire

Abstract Background The COVID-19 pandemic and its associated national lockdowns have been linked to deteriorations in mental health worldwide. A number of studies analysed changes in mental health indicators during the pandemic; however, these studies generally had a small number of timepoints, and focused on the initial months of the pandemic. Furthermore, most studies followed-up the same individuals, resulting in significant loss to follow-up and biased estimates of mental health and its change. Here we report on time trends in key mental health indicators amongst Danish adults over the course of the pandemic (March 2020 - July 2021) focusing on subgroups defined by gender, age, and self-reported previously diagnosed chronic and/or mental illness. Methods We used time-series data collected by Epinion (N=8,261) with 43 timepoints between 20 March 2020 and 22 July 2021. Using a repeated cross-sectional study design, independent sets of individuals were asked to respond to the Copenhagen Corona-Related Mental Health questionnaire at each timepoint, and data was weighted to population proportions. The six mental health indicators examined were loneliness, anxiety, social isolation, quality of life, COVID-19-related worries, and the mental health scale. Gender, age, and the presence of previously diagnosed mental and/or chronic illness were used to stratify the population into subgroups for comparisons. Results Poorer mental health were observed during the strictest phases of the lockdowns, whereas better outcomes occurred during reopening phases. Women, young individuals (<34 yrs), and those with a mental- and/or chronic illness demonstrated poorer mean time-series than others. Those with a pre-existing mental illness further had a less reactive mental health time-series. The greatest differences between women/men and younger/older age groups were observed during the second lockdown. Conclusions People with mental illness have reported disadvantageous but stable levels of mental health indicators during the pandemic thus far, and they seem to be less affected by the factors that result in fluctuating time-series in other subgroups.

Download Full-text

What does self rated mental health represent

Journal of Public Health Research ◽

10.4081/jphr.2014.287 ◽

2014 ◽

Vol 3 (3) ◽

Cited By ~ 22

Author(s):

Daphna Levinson ◽

Giora Kaplan

Keyword(s):

Mental Health ◽

Mental Illness ◽

Physical Health ◽

Multiple Logistic Regression Analysis ◽

Secondary Analysis ◽

The Self ◽

Computer Assisted ◽

Physical And Mental Health ◽

Physical Conditions ◽

Design And Methods

Background. Unlike the widely used self rated health, the self rated mental health was found unsuitable as a proxy for mental illness. This paper analyses the relationships between the self ratings of physical health, mental health and overall health, and their association of with the objective indicators for physical and mental health. Design and methods. The study is a secondary analysis of data from a nationwide representative sample of the non-institutionalized adult residents of Israel in 2003 that was collected via computer-assisted personal interview methods [n=4859]. Results. The self rated physical health and the self rated mental health were strongly related to each other yet the self rated mental health was not related to chronic physical conditions and the self rated physical health was not related to mental disorders. In a multiple logistic regression analysis, those with positive self rated mental health had 93 times the odds of reporting positive overall health whereas those with positive self rated physical health had 40 times the odds of reporting positive overall health. Conclusions. The self rating of mental health presents a qualitatively different dimension from mental illness. The self rated mental health is two times more important than the self rated physical health in predicting the self rated overall health

Download Full-text

Psychiatric beds attached to a community mental health centre

Psychiatric Bulletin ◽

10.1192/pb.21.4.202 ◽

1997 ◽

Vol 21 (4) ◽

pp. 202-204 ◽

Cited By ~ 2

Author(s):

Jed Boardman ◽

Richard Hodgson ◽

Martyn Lewis

Keyword(s):

Mental Health ◽

Mental Illness ◽

Community Mental Health ◽

Severe Mental Illness ◽

Community Care ◽

Health Centre ◽

Community Mental Health Centre ◽

Psychiatric Institutions ◽

Mental Health Centre ◽

Psychiatric Beds

The loss of psychiatric beds associated with the closure of large psychiatric institutions creates problems for the community care of those with severe mental Illness. This paper describes the use and possible advantages of a non-acute in-patient unit attached to a Community Menial Hearth Centre in North Staffordshire which has prioritised Individuals with severe mental Illness.

Download Full-text

Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators

Psychological Medicine ◽

10.1017/s003329172000269x ◽

2020 ◽

pp. 1-10

Author(s):

Mathias Siebenförcher ◽

Francesco D. Fritz ◽

Matías Irarrázaval ◽

Andrés Benavides Salcedo ◽

Corinne Dedik ◽

...

Keyword(s):

Latin America ◽

Panel Data ◽

Latin American ◽

Fixed Effects ◽

Inverse Relationship ◽

Prison Population ◽

Prison Populations ◽

Psychiatric Beds ◽

Latin American Countries ◽

Bed Numbers

Abstract Background In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America. Methods We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela. Results The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006). Conclusions Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

Download Full-text

Amphetamine availability predicts amphetamine-related mental health admissions: A time series analysis

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418763538 ◽

2018 ◽

Vol 52 (11) ◽

pp. 1050-1056 ◽

Cited By ~ 1

Author(s):

Grant Sara ◽

Clifford Baxter ◽

Patricia Menendez ◽

Julia Lappin

Keyword(s):

Mental Health ◽

Time Series ◽

Time Series Analysis ◽

Hospital Admissions ◽

Time Lag ◽

Treatment Strategies ◽

Indirect Measure ◽

Series Analysis ◽

Amphetamine Use ◽

Service Data

Objective: Amphetamine use and availability have increased in Australia and there are concerns that this has led to more frequent hospital admissions with amphetamine-related psychosis. This study examines whether amphetamine-related admissions to mental health units are more common at times of greater amphetamine availability. Methods: We conducted an ecological study using aggregate crime and health service data for NSW, Australia, from January 2000 to March 2015. Amphetamine-related criminal incidents (arrests or cautions for possession or use) were used as an indirect measure of amphetamine availability. Semiparametric time series analysis was used to compare monthly arrest rates to monthly hospitalisation rates for (1) amphetamine abuse or dependence, (2) amphetamine-related psychosis and (3) any psychosis. Results: Amphetamine-related admissions to NSW mental health units have increased four- to fivefold since 2009 and comprised approximately 10% of all admissions to these units in early 2015. There was a significant association between arrests and amphetamine-related admissions. After adjustment for seasonal variation, this effect demonstrated a time lag of 1–2 months. There was no relationship between amphetamine arrests and overall admissions for psychosis. Conclusion: Greater amphetamine availability significantly predicts admissions for amphetamine use disorders and amphetamine-related psychosis. Better treatment strategies are needed to break the nexus between drug availability and drug-related harm.

Download Full-text

The mental health of older prisoners

International Psychogeriatrics ◽

10.1017/s1041610210000359 ◽

2010 ◽

Vol 22 (5) ◽

pp. 693-701 ◽

Cited By ~ 23

Author(s):

Alexander Kakoullis ◽

Nick Le Mesurier ◽

Paul Kingston

Keyword(s):

Mental Health ◽

Mental Illness ◽

Environmental Factors ◽

Prison Population ◽

Contributing Factors ◽

Complex Interactions ◽

Older Prisoners ◽

Older Offenders ◽

Before And After ◽

Older Inmates

ABSTRACTBackground: Older prisoners are a minority within the prison population but their numbers are increasing at a greater rate than any other age group. The mental health of younger prisoners has been well researched but this is not the case for older inmates. The aim of this paper is to provide a review of the existing literature on the mental health of older prisoners.Methods: Relevant papers were identified through database searches and an examination of cited references in the selected papers. The literature was divided into different sections in order to examine the contributing factors and rates of mental illness in older prisoners.Results: The first section looks at demographic factors relevant to older prisoners. Subsequent sections examine psychosocial factors, environmental factors and physical health factors that may have a detrimental effect on mental health. The final sections look at the prevalence of mental illness in older offenders before and after sentencing.Conclusions: Mental illness in older prisoners is a result of complex interactions between numerous individual and environmental factors. It currently remains poorly researched and service provision for older prisoners with mental illness is poorly developed. Further research is needed, with a particular focus on the different groups of older prisoners and the most beneficial service models, because the number of older prisoners, including those with mental illness, is likely to increase in the future.

Download Full-text

A Tribute to the Late William J. Curran

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500004058 ◽

1996 ◽

Vol 24 (3) ◽

pp. 274-275

Author(s):

O. Lawrence ◽

J.D. Gostin

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Illness ◽

United Nations ◽

Mental Health Care ◽

Harvard University ◽

Legal Medicine ◽

General Assembly ◽

International Institute ◽

University Professor

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.

Download Full-text