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

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.

Schizophrenia Myths

#1
MYTH: Jail is an appropriate place for people with schizophrenia.
FACT: Jails and prisons are frequently used to warehouse the mentally ill and get them off the streets. Thementally ill most often end up in prison because of vagrancy offenses, substance abuse, or minor property crimes.They frequently fail to show up for court appearances, leading to further charges and jail time. Jails and prisonstypically have very inadequate psychiatric services. Mentally ill prisoners receive little or no treatment. If they arehoused with the general prison population, their abnormal behavior leads to beatings and abuse by other prisoners.If they are segregated for their protection, they lose all social contact and the isolation often worsens theirsymptoms.