Introduction

In the last two or three years popular attention has again been focused by the media on the fate of people discharged into the community from longstay mental hospitals. Vivid images have been provided of the ‘bag people’ who were bused out of hospitals and were dropped off on successive street corners in New York City. Closer to home, people in contact with the courts can all provide anecdotal accounts of mentally ill people being imprisoned because no hospital place could be found for them. At the same time, official figures show an increase in the prison population together with a dramatic decrease in the population figures for mental hospitals. These two trends have been linked and some people have gone on to assume that we are witnessing a direct transfer of institutional populations.

The argument about the impact of community care seems to have been based more on speculation than hard data. An additional factor is the tendency to treat the policies which make up community care as if they were homogeneous and have been implemented synchronously across the health authorities of England and Wales. Detailed analysis of recent changes in institutional populations quickly reveals how little we really know about the people and processes involved.

The intention in this paper is to look in more detail at the changes in populations observed in prisons and mental hospitals - what has been called the ‘transcarceration’ hypothesis - and to look at the available evidence which has led to the argument that more mentally ill people are coming into contact with the criminal justice system. Brief references will be made to the American literature and data but as will be seen this tends to be of value only at a conceptual level.

The argument that changes in prison and mental hospital populations are linked is not new. Lionel Penrose put the idea forward in the 1930s but it has been given a new lease of life with the advent of de-institutionalization and community care. These two terms are often used interchangeably but, for our purposes, they are probably better treated as distinct terms especially as care in the community may be in short supply for those discharged from long-stay institutions.