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Start chapter 8, Part I: Mental disordersPrevalence of mental disorders in prison populationPrevalence of mental disorders in prison populationMental disorders and offending are both common phenomena, and they frequently overlap. Surveys carried out on different prison populations have found that the prevalence rate for psychotic disorders* in prisons varies between 2 and 15 percent and is 20 times higher than in the general population[1]. Substance abuse (drugs and alcohol) is one of the most common mental disorders in prisons. Up to 73 per cent of prisoners might have this disorder, and about one third have injected drugs intravenously. Neurotic symptoms and disorders are frequent (between 6 and 76 per cent), either alone or co-morbid with other disorders. Personality disorders, especially antisocial personality disorder, are also very common in prisons and their prevalence may rise to 75 per cent[2]. The high prevalence of antisocial personality disorder poses a huge problem for prison authorities in the management and provision of regimes. Co-occurrence of disorders is common. Approximately 25% of prisoners have more than one mental disorder.The high level of psychiatric morbidity in the prison population means that doctors providing health care within prison come into frequent contact with mental health problems, often of a considerable severity. In most respects care of the mentally ill in prisons is no different from such care in other areas of the mental health services. However, it does differ in some respects[3]. It occurs in an environment in which compulsion and coercion play a great role, and voluntary treatment is rare. The modern concept of mental health care focuses on therapy and rehabilitation rather than control and containment. This is not easy to achieve in prisons, where dual loyalties and responsibilities are dominant. There is no doubt, however, that doctors should consider the care of mentally disordered offenders as their primary function. The goals to reduce symptoms and improve function are not in conflict with prevention of recidivism (social function). Prevention and rehabilitation of mental disorders should not be neglected in prison settings.* Psychotic disorders can be of various origin, clinical signs and outcome (acute, chronic, transient, recurrent, etc.). They can be recognized by impaired reality testing, which manifests by delusions and/or hallucinations (see later in the text).[1] Chiswick, D. (2000). Association between psychiatric disorder and offending. In New Oxford Textbook of Psychiatry (eds. M.G. Gelder, J.J. López-Ibor Jr, and N.C.Andreasen, N.C.) pp. 2037-2056. Oxford University Press. Oxford, New York.
[2] Singleton, N., Meltzer, H., Gatward, R., Coid, J., Deasy, D. (1998). Psychiatric morbidity among prisoners in England and Wales. Office for National Statistics, Government Statistical Service, London.
[3] Banks, S.M., Stone, J.L., Pandiani, J.A., Cox, J.F. Morschauser, P.C. (2000). Utilization of local jails and general hospitals by state psychiatric centre patients. The Journal of Behavioral Health Services & Research 27, 454-459.
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