Psychiatry in Prisons and Corrections

Abstract

Over 11 million people are imprisoned worldwide at any given time. Despite methodological challenges, high levels of psychiatric morbidity in people in prison have been documented in many countries, including low- and middle-income countries. Research has consistently shown high levels of major depression, psychosis, posttraumatic stress disorder, substance use disorders and, to a lesser extent, developmental disorders among individuals in prison. Existing evidence also reported high prevalence rates for the co-occurrence of several mental health and substance use problems. Suicide and self-harm are more common in people in prison than community-based persons of similar age and gender. Women, juveniles, and people in prison aged 55 years and older present with higher rates of many disorders than other persons in prison settings. The prison environment is stressful and people suffering from psychiatric disorders may have difficulties coping with the many stressors of the prison regime (violence, victimization, solitary confinement, etc.). Equivalence of healthcare inside and outside prison, independence from the justice system, respect for confidentiality, and informed consent are core ethical principles of practicing psychiatry in prison settings. Evidence-based best practice should be the goal for the psychiatric treatment (including screening and assessment, medication, and psychotherapy) of incarcerated people. Importantly, the transition from prison to the community is associated with poor outcomes and psychiatry in prison settings is therefore not sufficient without follow-up care after release. Research gaps about the mental health problems of people in prison are outlined.