Lamb H R, Weinberger L E
Department of Psychiatry, University of Southern California School of Medicine, Los Angeles 90033, USA.
Psychiatr Serv. 1998 Apr;49(4):483-92. doi: 10.1176/ps.49.4.483.
The presence of severely mentally ill persons in jails and prisons is an urgent problem. This review examines this problem and makes recommendations for preventing and alleviating it.
MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and Books were searched from 1970, and all pertinent references were obtained.
Clinical studies suggest that 6 to 15 percent of persons in city and county jails and 10 to 15 percent of persons in state prisons have severe mental illness. Offenders with severe mental illness generally have acute and chronic mental illness and poor functioning. A large proportion are homeless. It appears that a greater proportion of mentally ill persons are arrested compared with the general population. Factors cited as causes of mentally ill persons' being placed in the criminal justice system are deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support for persons with mental illness, mentally ill offenders' difficulty gaining access to community treatment, and the attitudes of police officers and society. Recommendations include mental health consultation to police in the field; formal training of police officers; careful screening of incoming jail detainees; diversion to the mental health system of mentally ill persons who have committed minor offenses; assertive case management and various social control interventions, such as outpatient commitment, court-ordered treatment, psychiatric conservatorship, and 24-hour structured care; involvement of and support for families; and provision of appropriate mental health treatment.
监狱中存在严重精神疾病患者是一个亟待解决的问题。本综述对这一问题进行了研究，并提出了预防和缓解该问题的建议。
检索了1970年以来的医学期刊数据库（MEDLINE）、心理学文摘数据库以及法律期刊与书籍索引，获取了所有相关参考文献。
临床研究表明，市县监狱中有6%至15%的人以及州立监狱中有10%至15%的人患有严重精神疾病。患有严重精神疾病的罪犯通常患有急性和慢性精神疾病，且功能较差。很大一部分人无家可归。与普通人群相比，似乎有更大比例的精神疾病患者被逮捕。被认为是精神疾病患者进入刑事司法系统的原因包括去机构化、民事收容标准更加严格、对精神疾病患者缺乏足够的社区支持、患有精神疾病的罪犯难以获得社区治疗，以及警察和社会的态度。建议包括为实地警察提供心理健康咨询；对警察进行正规培训；对入狱被拘留者进行仔细筛查；将犯轻微罪行的精神疾病患者转至心理健康系统；积极的个案管理以及各种社会控制干预措施，如门诊治疗、法庭命令治疗、精神病监护以及24小时结构化护理；让家庭参与并提供支持；以及提供适当的心理健康治疗。
