Services fail to treat prisoners with schizophrenia -- increasing risk of violent reoffending

November 20, 2013

New research from Queen Mary University of London shows released prisoners with schizophrenia are three times more likely to be violent than other prisoners, but only if they receive no treatment or follow-up support from mental health services.

Maintaining psychiatric treatment both during imprisonment and after release can substantially reduce the risk of violent reoffending. Better screening and treatment of prisoners is therefore essential to prevent violence.

The research, funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) and published in the American Journal of Psychiatry, investigated whether treated or untreated psychotic disorders were linked with increased risk of violent re-offending among prisoners.

The Prisoner Cohort Study* was conducted amongst 967 adult male and female offenders serving sentences of 2 years for more for sexual or violent offences.

Researchers compared the occurrence of violence among prisoners with schizophrenia, delusional disorder, or drug-induced psychosis, who 1) did not receive treatment whilst in prison or upon release 2) received treatment only during prison 3) received treatment during prison and after release. The same research was also carried out among prisoners with no psychosis as a baseline.

Prisoners with schizophrenia who remained untreated during and after imprisonment were more likely to be violent following release than other prisoners. Results revealed the cause of this violent behaviour was linked to delusional beliefs in individuals that someone or something is out to harm them - a symptom itself caused by lack of treatment.

Interestingly, there was no increase in risk of violence for untreated prisoners with delusional disorder. Drug-induced psychosis was linked with a nearly twofold risk of violence following release, but this became non-significant following adjustments for drug and/or alcohol dependence**.

Professor Jeremy Coid, Professor of Forensic Psychiatry, Queen Mary University of London (Barts and The London School of Medicine and Dentistry), comments:

"Associations between major mental illness and violent behaviour are controversial, and many misconceptions remain in our society about what it means to have a psychotic disorder. Most people with schizophrenia are not violent and pose no danger to others. However, among those who have shown severe violent tendencies and been imprisoned as a result, the risk of future violence is greatly increased if they are not treated.

"Current risk assessment tools do not take treatment into account and we are therefore missing out on this vital part of the puzzle. We need to improve our screening methods and ensure the treatment of prisoners with psychosis, both in prison and following release, if the aim is to manage their risk of violence."

Despite the high prevalence of mental disorders among prisoners, treatment is often less available in prison than in the outside world. A recent study found that mental health teams successfully identified only 25% of prisoners with severe mental illnesses and only 13% were accepted onto their caseloads***. Furthermore, it is estimated in the UK, less than 25% of prisoners who screen positive for psychosis will subsequently receive an appointment with a mental health professional after release****.

Professor Coid concludes:

"This is an important public health problem and at the moment we're failing high-risk people with psychotic disorders and the public by not screening and treating people with severe mental disorders well enough, nor accurately evaluating risk when they're released from prison."
-end-
For media information contact:

Charli Scouller
PR Manager (School of Medicine and Dentistry)
Queen Mary University of London
c.scouller@qmul.ac.uk
Tel: 020 7228 7943

Notes to the editor

The full research can be accessed via the American Journal of Psychiatryhttp://ajp.psychiatryonline.org/Article.aspx?ArticleID=1773703

* The Prisoner Cohort Study (October 2002 to May 2006) was funded by the Ministry of Justice (formerly the Home Office). It was a large-scale study of a cohort of serious sexual and violent offenders who were about to be released from prison.

** These effects may therefore be the result of substance-related comorbidity. Findings did not differ according to treatment, which suggests that subsequent violence had little or no relationship with psychotic symptoms and instead may reflect re-engagement in the drug economy and criminal networks.

*** Senior J, Birmingham L, Harty MA, Hassan L, Hayes AJ, Kendall K, King C, Lathlean J, Lowthian C, Mills A, Webb R, Thornicroft G, Shaw J: Identification and management of prisoners with severe psychiatric illness by specialist mental health services. Psychol Med 2012; 43:1511-1520

**** Melzer D, Tom BDM, Brugha T, Fryers T, Grounds A, Johnson T, Meltzer H, Singleton N: Prisoners with psychosis in England and Wales: a one-year national follow-up study. Howard J Crim Justice 2002; 41:01-13

Queen Mary University of London

Queen Mary University of London is one of the UK's leading research-focused higher education institutions with 17,000 undergraduate and postgraduate students.

A member of the Russell Group, QM is amongst the largest of the colleges of the University of London. QM's 4,000 staff deliver world-class degrees and research across 21 academic departments and institutes, within three Faculties: Science and Engineering; Humanities and Social Sciences; and the School of Medicine and Dentistry.

Queen Mary is ranked 11th in the UK according to the Guardian analysis of the 2008 Research Assessment Exercise, and has been described as 'the biggest star among the research-intensive institutions' by the Times Higher Education. In 2012, a Queen Mary study was awarded Research Project of the Year at the Times Higher Education Awards. The university has been nominated again in 2013.

In 2014, Queen Mary was positioned 35th among 130 UK universities in the Complete University Guide and 36th according to the Guardian University Guide. The 2013-4 QS World Rankings placed us 115th of 700 universities worldwide and 19th in the UK, while the 2013 Shanghai Jiao Tong Academic Rankings of World Universities placed us in the top 30 in the UK and in the top 201-300 bracket worldwide.

QM has a strong international reputation, with around 20 per cent of students coming from over 150 countries. The university has an annual turnover of £350m, research income worth £100m, and generates employment and output worth £700m to the UK economy each year.

QM is unique amongst London's universities in being able to offer a completely integrated residential campus, with a 2,000-bed award-winning Student Village on its Mile End campus.

National Institute for Health Research

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

Queen Mary University of London

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