The legitimacy of psychiatry in prisons

Imprisonment may be such a stress that on occasions it can produce mental breakdown. Anybody who has worked in prisons, whether for criminals or for other detainees such as prisoners of war, will have seen examples of so-called prison psychosis, a paranoid delusional or hallucinatory state importing lots of prison paraphernalia into its content that tends to occur in personality disorders and remits when freedom is regained. Equally it is common to see severe, highly understandable depressions at the beginning of a long sentence, or at a point where an individual begins to comprehend the enormity of the events which led him to prison – perhaps a killing. The increased suicide rate in prisons, especially during the first few months of imprisonment, is probably related, in part, to depressions of this kind.

Some would say that not only do prisons generate psychiatric problems but they also collect them inappropriately and act as unofficial mental hospitals for individuals who should be in health care. A mental health census within the English prison system has estimated that approximately one third of sentenced men could be regarded as psychiatric cases (Gunn et al. 1978). This is not to suggest that all these men required inpatient care. The majority were suffering from personality disorders, chronic neuroses, alcoholism, and drug dependency. Nevertheless 20% had previously been patients in the National Health Service (NHS) and many showed severe anxiety and depression; perhaps 1% were psychotic.