My favourite scene in the film Wayne's World has the aspiring rock stars brought face to face with the real thing, in the shape of Alice Cooper, clad in leather and mascara. Overawed, their wits desert them and they can only babble: “We're not worthy, we're not worthy, we're not worthy!”, as they prostrate themselves at his feet. I had to be restrained from a similar action at my first meeting with the Office for National Statistics (ONS) team, after reading their magnum opus. I had coauthored previous national studies of sentenced and remanded prisoners, but these were amateur efforts, a forensic psychiatrist playing at surveys. Here is the real thing - nearly 400 pages of epidemiology as it should be done.
The authors came fresh from largescale studies of mental disorders in private households, in institutions catering for people with mental health problems and among the homeless. This book describes the extension of similar methods to the prison population, to complete the picture of psychiatric morbidity throughout England and Wales. Taken together, these projects rival the Epidemiologic Catchment Area surveys in the USA. Indeed, they surpass the American work by including prisoners, and both the authors and the Department of Health deserve praise for recognising that prisoners are part of our population (anyone who doubts this claim should bear in mind that most of the subjects of this research would have been released before the book was published).
The book is based on over 3000 interviews, and its comprehensive nature means that it will become an essential reference for anyone interested in prisons or the epidemiology of mental disorders. The diagnoses covered include psychosis, neurosis, substance misuse, intellectual functioning and personality disorder. Extensive analyses link each of these with socio-demographic variables, offending and service use.
The style is matter of fact, with the emphasis on clear presentation of a wealth of data. I would have liked to see more comment and analysis - at some points, any comment at all would have been welcome. For example, it is revealed that 21% of female remand prisoners have a probable psychotic disorder. This is a stunning figure, as it is four times the rate found in a previous English survey, and considerably higher than American figures. If correct, it would mean that we lead the world in imprisoning female psychiatric patients. Yet, this bombshell is delivered in the downbeat manner characteristic of ONS reports, with no more fanfare than would accompany the figures for how many citizens have access to a colour television or indoor plumbing.
This is a minor criticism of an excellent work. The authors can claim to have done exactly what they set out to do, and to have done it well. They have created a reference that will be indispensable to those working in this area, and it is reasonable to leave most of the discussion and argument to others.
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