White Paul, Chant David, Whiteford Harvey
Mental Health Policy and Economics Group (QCMHR) The Park--Centre for Mental Health, Queensland, Australia.
Aust N Z J Psychiatry. 2006 Mar;40(3):260-5. doi: 10.1080/j.1440-1614.2006.01783.x.
People remanded into custody by the courts have a substantially higher rate of severe mental disorder than other prisoners and the general population. Knowledge of their prevalence, needs and characteristics and an analysis of pathways to care may be necessary to provide mental health care effectively and efficiently. Previous prison studies focusing on psychotic offenders have suffered from the use of instruments not validated in a forensic setting and lack of a relevant comparison group.
The Diagnostic Interview for Psychosis (DP) is a composite semi-structured standardized interview schedule. It combines social and demographic descriptors with measures of functioning adapted from the World Health Organisation Disability Assessment Schedule (DAS). The remand centre surveyed had 466 cells and is the main remand and reception centre for males for the southern region of the state of Queensland, Australia. Of the 621 men screened, 65 answered yes to at least one question in the DP and were interviewed.
Six hundred and twenty-one remandees were screened and of these 61 were interviewed as screened positive for psychotic disorder. Thirty-five per cent had been homeless for an average of 32 weeks during the previous year. Most had had little contact with families or close friends. Eighty-one per cent were receiving no treatment at the time of offence. Seventy-eight per cent were unemployed and in receipt of a pension. Eighty per cent were dependent on alcohol, cannabis or amphetamines. Statistical issues of power are detailed in the text.
The simplistic 'prison, hospital or community treatment' debate is misleading. Instead, the development of flexible preventative, management and accommodation services for people with severe mental disorder who have committed offences is a priority.
被法庭还押候审的人患严重精神障碍的比例远高于其他囚犯和普通人群。了解他们的患病率、需求和特征，并分析护理途径，对于有效且高效地提供精神卫生保健可能是必要的。以往针对精神病罪犯的监狱研究存在一些问题，如使用未经法医环境验证的工具，且缺乏相关对照组。
精神病诊断访谈（DP）是一种综合的半结构化标准化访谈程序。它将社会和人口统计学描述与从世界卫生组织残疾评估量表（DAS）改编而来的功能测量相结合。所调查的还押中心有466个牢房，是澳大利亚昆士兰州南部地区男性主要的还押和接待中心。在621名接受筛查的男性中，65人对DP中的至少一个问题回答为“是”并接受了访谈。
对621名还押候审人员进行了筛查，其中61人因被筛查出精神病障碍呈阳性而接受访谈。35%的人在前一年平均有32周无家可归。大多数人与家人或亲密朋友很少联系。81%的人在犯罪时未接受任何治疗。78%的人失业且领取养老金。80%的人依赖酒精、大麻或安非他明。文中详细阐述了统计学效力问题。
简单化的“监狱、医院或社区治疗”争论具有误导性。相反，为有犯罪行为的严重精神障碍患者开发灵活的预防、管理和住宿服务是当务之急。
