Inverse care for mentally ill prisoners: unmet needs in forensic mental health services

Previous studies have demonstrated increasing levels of psychiatric morbidity among the UK prison population. Few studies of this population have been conducted using systematic needs assessment instruments. We tested the hypotheses that mentally disordered offenders (MDOs) who go into prison from the community differ significantly from general adult patients in having (1) more needs and (2) more unmet needs. We compared 73 consecutive male patients who had psychotic illness and were transferred from prison with 84 male patients who had psychotic illness and were in the community. Patients were interviewed using the Camberwell Assessment of Need schedule (CAN). Inmate medical records were examined and prison healthcare staff were interviewed. The results showed that the prison group had significantly more total needs on average and significantly more unmet needs than their general adult patient counterparts. The greater unmet needs were in the following domains: psychotic symptoms, psychological distress, welfare benefits, money, daytime activities, company and food. The results suggest an inverse care law so that MDOs in the community have high rates of need and low levels of treatment and care.