Mental health care in prison: How to manage our care

In the prison system there are high percentages of mentally disordered offenders, often with co-morbid psychiatric disorders. In addition, the setting and ward atmosphere in prisons are not designed to care for psychiatric patients and places a burden on vulnerable inmates. Management of care of the different subgroups in the prison population is therefore necessary on four different levels, from basic health care to forensic psychiatric treatment. A fifth level is forensic care, which is directed towards re-integration into the community rather than treatment at the symptom-level of disease. Continuity of care, evidence-based care and coercion within mental health care are discussed with regard to their forensic ethical meaning towards both patients and the community. Drawing on the Dutch situation a case is made for the promotion of voluntary treatment for those prisoners with mental health problems to aid their rehabilitation and to lessen the risk to the public at large.

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