The transfer of women offenders with mental disorder from prison to hospital

Abstract

Women offenders constitute a small minority of prisoners in England and Wales, but also the sub-group of prisoners with the fastest growth curve. High rates of mental disorder have been established amongst such women but the extent to which their treatment needs are met is less clear. The aim was to identify and describe women who gain placement in the health service under the Mental Health Act (MHA) 1983 and to compare those under the MHA classifications of ‘psychopathic disorder’ (PD) and ‘mental illness’ (MI). From all new receptions to Holloway Prison – London's prison for pre-trial and sentenced women – between 1st January 1995 and 31st December 1995, those gaining an MHA 1983 disposal were identified. A full record search was done for each woman in this sub-group. Among 3,309 new receptions, only 62 women were transferred from prison to inpatient health services. Full data were available for 26 women under the MHA 1983 category of PD and 34 under MI. The women in the PD group were significantly more likely to have had a history of self-harm and of sexual abuse as a child than women in the MI group, but the PD women remained significantly longer in prison awaiting a hospital bed. It is doubtful whether these women had an adequate response from the health service. Despite manifest need, even among those accepted for in-patient treatment, those with personality disorder appeared disadvantaged compared to those with mental illness. This was a group particularly prone to self-harm, at a time when completed suicide in prison continues to rise. Further research on the specific difficulties in effecting transfer may assist, but it seems likely that there may be a training issue to ensure that health service personnel understand the risk to these women if their needs are not met.

Keywords:

• Women offenders
• mental disorder
• forensic provision

ACKNOWLEDGEMENTS

We are grateful to the Governor and staff at HMP Holloway for facilitating data collection and to Martin Butwell, Research Department, Broadmoor Hospital for statistical advice.