Interacting mechanisms between general psychiatry, forensic psychiatry and the prison systems and their influence on admission rates

Alongside great advantages, the shift from hospital based to community mental health care has also caused problems, e.g. a high frequency of involuntary re-admissions to psychiatric hospitals. To analyse whether or not the process of deinstitutionalisation in general psychiatry might have gone too far, studies are needed that cover general psychiatry, forensic psychiatry, and penitentiaries and analyse the interdependencies among these sectors.

We combined epidemiological and service utilization data from three recent European studies that explored legal frameworks and practices of involuntary treatment in general mental health care, the care of mentally disordered offenders in forensic care and the care of mentally ill inmates in the European prison systems.

Time series from several European Union Member States suggest that intrastate civil detention rates remained more or less stable during the 1990s, although on varying levels across countries. Admissions to forensic psychiatric facilities have increased during the same period. Data on the mental state (or on rates of psychiatric morbidity) in European prison populations are hardly available – aside from the prison suicide rate. Cross-sectional data from selected countries suggest that changes to the legal framework in one sector may considerably affect admission rates in others.

Better national data-bases and more international studies are needed to analyse the linkage between sectors and to identify inappropriate detention or patient shifting, as pathways to these sectors are strongly affected by legislation and the overall frameworks of national health care and criminal justice systems.