Treating psychiatric patients during illness and after illness is very important in maintaining health and preventing relapse. The Queen Mary University of London has released new meta-data concerning the prognosis of released prisoners who have been diagnosed with schizophrenia. Compared to other prisoners, those who deal with schizophrenia are three times as likely to be repeat offenders of violent crimes if they do not receive follow-up treatment and support after their release.
Many prisoners enter the penal system with no official diagnosis of schizophrenia. The lack of proper screening and psychological evaluation prior to imprisonment means that many schizophrenics enter prison and receive no treatment or medication during their stay. Treatment and maintenance medication are essential factors in reducing the incidence of violence during and after a prison sentence. This also means that these patients would be much less likely to become repeat offenders and re-enter the prison system only to repeat this harmful cycle.
The Prison Cohort Study
The Prisoner Cohort Study was funded by the National Institute for Health Research’s Programme Grants for Applied Research. The study’s focus of investigation surrounded the treatment or non-treatment of psychotic disorders in regards to the risk of becoming a violent re-offender. 967 adult prisoners of both genders made up the experimental group, using only those who were serving a sentence of at least 2 years for sexual or violent assault.
The groups were separated into those suffering from schizophrenia, drug-induced psychosis, or delusional disorder. The were further sub-divided among the following three groups:
- Those who received no treatment during their imprisonment or after release
- Those who were treated only while in prison
- Those who were treated for their illness while imprisoned and after release
The control group were prisoners in the same sentence range and offense, but without the added feature of psychosis.
The Results of the Prison Cohort Study
Groups 1 and 2 were more likely, up to triple as likely, to repeat their violent behaviors following their release from prison as group 3. These were the groups that received less treatment than the ideal amount. The cause of this repeat behavior after release was largely due to delusions, specifically the kind that made an individual feel victimized or targeted by someone who aims to harm them. Paranoia played a large role here, which could have been minimized or even eliminated through consistent treatment.
Here is where things become interesting. Untreated prisoners suffering from delusional disorder had no increase in their overall risk of violence after being released. However, equally strange, those dealing with psychosis induced by drug use were twice as likely to recommit violent acts, however, when cross-referenced with data for prisoners with substance abuse issues without a dual diagnosis of psychosis, the difference was no longer significant and thus not attributable to psychosis treatment.
So How Do We Interpret This Study?
We must tread carefully because the many myths surrounding schizophrenia and violence already detract from the reputation of this culture. Let us be careful to not further these misconceptions and misunderstandings. It can safely be said that schizophrenics in general are not violent, but that some can exhibit this behavior during fear and paranoia states as a self-defense mechanism. Those people, violent schizophrenics (versus substance abusers and people with delusional disorder) are three times more likely to recommit a violent act after being released from prison if they are not treated during their time in prison and after their release. Disregarding everything else, we can confidently extract that conclusion from the data.
What Changes Should Be Made?
Risk assessment tools need to be refined to take present and projected future treatment into account. Screening methods for the prison population during intake must be improved so that each prisoner receives the proper treatment. Prison should not be a storehouse for criminals, but a safe-house and treatment center.
We know that the prevalence of mental disfunction among prison inmates is very high compared to the non-imprisoned population. We also know there is data that estimates that only a quarter of all inmates who screen positive for a form of psychotic disorder will receive any treatment for it. Our prison system is failing in this regard and without their proper efforts, the mental health community cannot step in and help. Changes must be made within the prison system’s intake and screening processes to make sure effort is being taken to help mental health sufferers.