The Imprisonment of Mentally Disordered Offenders

Extract

I am glad to have this opportunity to talk about an unfortunate consequence of developments in the Health Service over recent years. My theme will be what is now happening to mentally disordered people who have committed criminal offences. At present, many of them are going to prison. The prison system—already severely overcrowded—contains some hundreds of mentally disordered offenders who in the opinion of prison medical officers need and are capable of gaining benefit from care, management and treatment in psychiatric hospitals. When using the term ‘mental disorder’ I shall, of course, be referring to those states of mind which have been classified and defined in Section 4 of the Mental Health Act 1959: members of the College who work in the National Health Service will be relieved to know that I do not share the view of the citizens of Samuel Butler's Erewhon that crime itself is an illness, whose sufferers should all be placed in the hands of the omniscient psychopathologists. Indeed, when one has the practical responsibility for the provision of health care for prisoners, it is quite irrelevant whether or not they committed their offences as a result of a mental disorder or whether their mental disorder developed before or after the offence or trial. The only thing that matters is their present condition. If a prisoner is suffering from mental disorder of a nature or degree that warrants his detention in hospital for treatment, then the prison medical officer will want to bring about his admission to hospital under the appropriate section of the 1959 Act. This is wholly in accordance with the philosophy of the Act, which does not limit hospital admission to cases in which the criminal offence was causally related to a mental disorder. In this talk I shall want to consider why in so many cases hospital places cannot be found.